Biomedical subjects
Publications and source records attributed to D K Newman.
The problem of urinary incontinence in the homebound elderly patient is frequently encountered and is frustrating to the community health nurse. Through a thorough nursing assessment and evaluation, the nurse can successfully employ many simple, effective nursing interventions. Nurses can make a tremendous impact on aiding the homebound incontinent patient by implementing various behavioral interventions.
The inability to control urination is a condition that causes a loss of dignity in persons of all ages. It is a distressing condition that affects a large number of young women and becomes a most distressing problem for the older adult. This article deals with the general treatment approaches for the urinary incontinent patient, including drug therapy, surgical intervention and mechanical devices. Special emphasis is placed on nursing measures, including behavioral intervention approaches for this disturbing problem. Many non-invasive treatments can benefit patients searching for relief from urinary incontinence.
Millions of Americans suffer needlessly from the embarrassment and discomfort of urinary incontinence. Understanding the problem is the first step in helping these patients regain control.
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Approximately 20% of women ages 25-64 years experience urinary incontinence. The symptoms increase during perimenopause, when 31% of women report that they experience incontinent episodes at least once per month. Bladder training and pelvic muscle exercise are the recommended initial treatment and can be taught effectively in the ambulatory care setting. Bladder training enables women to accommodate greater volumes of urine and extend between-voiding intervals. Pelvic muscle exercise increases muscle strength and reduces unwanted urine leakage. Accumulated research results provide evidence-based guidelines for nursing practice. The Association of Women's Health, Obstetric, and Neonatal Nurses has identified continence for women as the focus of its third research utilization project. This article presents the rationale, evidence base, and educational strategies compiled by the Research Utilization 3 Nurse Scientist Team. Nurses can enable women to incorporate these noninvasive techniques into self-care.
OBJECTIVE: To develop an evidence-based protocol for initial evaluation and treatment of urinary incontinence and to design procedures that would facilitate the protocol's implementation into clinical practice. DESIGN: Descriptive report of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Continence for Women Project. SETTING: Twenty-one public, private, and other women's health sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided demographic statistics. METHODS: The protocol was developed, sites were selected, site coordinator training was provided, data collection was facilitated by project-specific teleforms, and the overall process was evaluated by the science team. MAIN OUTCOME MEASURES: Site representation, patient representation, site coordinator feedback on the training program, and site coordinator experience during project implementation. RESULTS: The process yielded a representative mix of site and patient diversity appropriate for testing of the protocol. Site coordinators felt well-prepared to implement the protocol and experienced increased professional satisfaction because of therapeutic benefits achieved for patients and positive collaboration with physicians. CONCLUSIONS: The Continence for Women Project demonstrated the potential for developing and testing evidence-based protocols for clinical practice when the resources of an organization such as AWHONN and the research community are combined.
OBJECTIVE: To test the effectiveness of an evidence-based protocol for urinary incontinence in increasing identification of women with the condition and improving their outcomes. DESIGN: Prospective formative evaluation study. SETTING: Twenty-one public, private, and other women's health care sites. PARTICIPANTS: Women in ambulatory care settings (N = 1,474) provided descriptive statistics. Clinical outcomes were tested in 132 cases for whom pre- and posttreatment data were available. INTERVENTIONS: Standardized screening and baseline follow-up forms were used to minimize time burden on clinicians; bladder and pelvic floor muscle training materials were provided to clinicians for distribution. MAIN OUTCOME MEASURES: Self-reported frequency, volume, and quality of life related to incontinence and cost of self-management were used to assess protocol effectiveness. RESULTS: Frequency of incontinence episodes, estimated volume lost per episode, and the cost of self-management decreased. Quality of life improved, as reflected in decreased bother attributed to incontinence and in the number of women avoiding activities such as shopping, exercising, or travel because of incontinence. CONCLUSIONS: This simple program of pelvic floor muscle and bladder training, as it has been systematically implemented in a variety of ambulatory women's health care settings, has benefited women's continence status. The results of this project strongly support widespread application.
Urinary incontinence (UI) is a prevalent medical problem in the USA. Approximately 12 million Americans are incontinent of urine. Hu et al (1994) estimate that the costs of managing the problem are $10 billion annually. In persons aged 65 years and older the incidence of UI is 30% or more it is estimated that more than 60% of people with UI never mention their problem to a doctor of nurse. This is a sad fact considering that UI is a highly treatable, if not curable, problem. In the USA, advanced practice nurses, nurse practitioners and clinical nurse specialists who have advanced educational and master's degrees and clinical practice requirements are making a significant impact on the management of UI. This article outlines the role of advanced practice nurses in the diagnosis and behavioural management of UI.
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Behavioral interventions are recommended by Agency for Health Care Policy and Research Clinical Guideline as the first line of treatment for most types of urinary incontinence. This article defines and briefly describes the six behavioral treatment techniques and discusses the research base for the efficacy of each type of intervention. Caveats and needed research are also presented.
Urinary incontinence (UI) effects people of all ages, but is especially prevalent in the elderly population. Also significant is a lack of knowledge about UI. A health promotion project was developed and implemented in six ethnically diverse, predominantly minority, inner city senior centers, a program designed to address an elder population, as they are very likely to be experiencing UI and lacking knowledge concerning healthy bladder habits. The project consisted of three phases: orientation/training of key staff members/peer educators at the six senior centers; educating elder consumers through four one-hour weekly sessions involving visual aids and completion of bladder records and quizzes, and follow-up sessions with senior staff/peer educators to reinforce previous training. One result was that training of peer educators needed further refinement to allow for a more significant role throughout the program. The program was very well received by the participants and roughly 80 percent felt they had more control over their bladder by the end of the last session. This project will continue into 1997 and in addition to information on UI, the project will include prostate health for men and gynecological health for women, as this need became evident throughout the program.
The Agency for Health Care Policy and Research (AHCPR) released their first updated guideline in March, 1996. Three documents were released: the Clinical Practice Guideline, Urinary Incontinence in Adults: Acute and Chronic Management; the Quick Reference Guide, Managing Acute and Chronic Urinary Incontinence; and the Patient Guide, Understanding Incontinence. The new areas are outlined and addressed. Unlike the 1992 version, the update emphasizes the problem of urinary incontinence (UI) in a specific population, those with chronic "intractable" incontinence. It provides an algorithm in the Quick Reference Guide for selecting appropriate behavioral, pharmacologic, and surgical treatments and supportive devices for use in managing UI. The concept of "prevention" of UI and the promotion of healthy bladder habits is introduced. The updated guideline developed recommendations for each assessment and treatment method. Specific interventions that can impact individuals with chronic "intractable" incontinence are discussed including toileting assistance programs, physical and environmental alterations, fluid and dietary management, management of nighttime voiding, and other measures and supportive care. Skin care and social and organizational environmental factors are also discussed. In August, 1996 the AHCPR released two additional, original documents, the Caregiver Guide, Helping People with Incontinence, and Alert for Directors of Nursing, which are briefly discussed.
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Stress urinary incontinence is a problem for one in four women seen in the primary care setting. The incontinence usually is not identified as women do not view it as a problem, do not seek treatment, and turn to self-care practices. Technology in product development is evolving that can assist women in managing their incontinence. This article reviews new innovations in treatment that can be recommended by primary care providers.
Pessaries provide nonsurgical management of pelvic organ prolapse in women who are not viable candidates for or who do not choose to undergo surgical intervention. It is necessary to take into consideration that when pessary use is indicated, it is crucial that the clinician assess the physical and mental capabilities of the individual. A client with compromised eyesight or motor abilities may not be able to manage the insertion and subsequent care of the device.
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