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Biomedical subjects

M H Palmer

Publications and source records attributed to M H Palmer.

At least 19 recordsLinked to original sources
PubMed2001

Professional information about urinary incontinence on the World Wide Web: is it timely? Is it accurate?

OBJECTIVE: Access to timely and accurate information about urinary continence and incontinence is important to the assessment and treatment of adults with urinary incontinence. The aims of this study were to identify current Web sites containing information about urinary continence that are easily accessible to health care providers and to determine the timeliness and accuracy of the information included on these Web sites. METHODS: The World Wide Web was searched for sites devoted to health care provider information about urinary continence and incontinence. Two external content reviewers evaluated content in terms of timeliness and accuracy. A table outlining each sites credibility, content, and function was constructed. RESULTS: Two hundred sixty-five sites were located, but only 15 met the inclusion criteria. Readability levels ranged from 6.2 to 14.5 years. All sites provided links, and 53% had internal search engines. Most information located was accurate; however, some sites contained dated information. Forty percent of the sites were not dated, and thus determining the currency of the information was impossible. CONCLUSIONS: The World Wide Web is a valuable tool containing state-of-the-art knowledge about urinary continence that WOC nurses can use to educate themselves and others. However, using critical skills to evaluate the information posted on these and any other sites is essential.

Authorship↗
PubMed2001

Using epidemiology in patient education for post-prostatectomy urinary incontinence.

This article reviews and discusses the prevalence and incidence of and risk factors for urinary incontinence after prostate cancer surgery. The reported prevalence rates of urinary incontinence in men vary among studies due to different definitions and methodologies; however, it is agreed that urinary incontinence is a common condition, especially immediately after surgery. Although few risk factors have been identified, damage to the sphincter or its nerves is an accepted underlying pathology. Urinary incontinence can be devastating to men and sensitivity to emotional and educational needs is critical.

Epidemiology↗
PubMed2000

Postprostatectomy incontinence: the magnitude of the problem.

Prostate cancer is being detected earlier in its development as a result of heightened public awareness and better screening and assessment techniques. Localized prostate cancer is often surgically treated, leaving many men incontinent of urine on either a short-term or long-term basis. This article explores the epidemiology of prostate cancer and the prevalence and incidence of urinary incontinence in men after they have undergone radical prostatectomy. Implications for WOC nursing research and practice are addressed.

Humans↗
PubMed2000

Path analysis of efficacy expectations and exercise behaviour in older adults.

The benefits of regular exercise for older adults are well documented and include improvements in physical, functional, as well as psychological, health. The purpose of this descriptive study was to test a theoretically and empirically based model describing the factors that influence exercise behaviour of older adults in the United States of America. The hypothesized model suggested that age, gender, and mental and physical health have an effect on self-efficacy and outcome expectations, and that all these variables influence exercise behaviour. Exercise behaviour was hypothesized to have a reciprocal relationship with self-efficacy expectations and mental and physical health. The convenience sample was 187 older adults living in a continuing care retirement community (CCRC) in Baltimore, Maryland. A one-time health interview was conducted which included a measure of self-efficacy and outcome expectations related to exercise, a measure of health status (SF-12), and gathering of information from participants about their actual exercise behaviour. Of the 187, 71 (38%) reported participating in 20 minutes of continuous aerobic exercise at least three times per week over the previous 3 months. Six hypothesized paths were significant. The model fitted the data and accounted for 32% of the variance in exercise behaviour. Interventions that focus on strengthening self-efficacy and outcome expectations can improve exercise behaviour in older adults.

Aged↗
PubMed2000

Urinary incontinence. Impact on working women.

Until recently, the impact of urinary incontinence (UI) on working women, a population generally characterized as healthy, has not been the focus of research. Women employed full time at a large university center participated in a cross sectional survey about UI. Of the 1,113 women surveyed, age 18 and older, 21% (n = 232) reported UI at least monthly. Incontinent women were significantly older and had a higher body mass index than continent women. Using disposable products, limiting fluids, avoiding caffeinated beverages, using voiding schedules, and keeping extra clothes or underwear were strategies used to manage UI at work. Responses to an open ended question related to the impact of UI on working life included: interference with sleep and resulting fatigue at work, embarrassment, alteration of concentration, and emotional distress. Implications for nurses are discussed in relation to assessment, education, and management of UI in the occupational setting.

Adaptation, Psychological↗
PubMed1999

Staff compliance with and ratings of effectiveness of a prompted voiding program in a long-term care facility.

BACKGROUND: Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding. METHODS: This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes. RESULTS: Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709). CONCLUSIONS: Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.

Adult↗
PubMed1999

Urinary incontinence in working women: an exploratory study.

Women who work for a large academic center were surveyed about urinary incontinence. The response rate was 57%. Of the 1113 usable questionnaires, 232 (21%) indicated that urinary incontinence occurred at least monthly. The average age of incontinent women was 45 years (SD = 10 years). Incontinent women were significantly older and had a higher body mass index than continent women. There were also ethnic differences between incontinent and continent groups, although ethnicity was not a predictor of incontinence. Only a third of the women thought incontinence was an important problem to resolve and 46% reported incontinence to their physician or nurse. Forty percent reported that they did not know if the incontinence could be improved, but 81% wanted to learn more about incontinence.

Adolescent↗
PubMed1999

Incontinence and PPS: a new era.

Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Assessing residents with incontinence is necessary to determine the pathophysiologic causes and associated factors that can interfere with self-toileting. Nurses can perform this assessment at the bedside. Guideline tools have been developed to assist nursing home staff through the evaluation of UI and intervention. Treatment techniques, specifically behavioral interventions and toileting assistance programs, can be readily incorporated into nursing practice. Most nursing home staffs can easily implement interventions such as bowel and nighttime voiding management and dietary modifications. Nursing home research has demonstrated the effectiveness of toileting assistance programs; however, very little of this research and documented techniques has been used by nursing home staff. Scheduled toileting and bladder training programs can be successfully implemented in nursing home residents. The key to the success of these programs is identifying residents who should be targeted for each specific program. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.

Aged↗
PubMed1998

In their own words: nursing assistants' perceptions of barriers to implementation of prompted voiding in long-term care.

Prompted voiding is an effective intervention for the improvement of continence in long-term care. This study investigated certified nursing assistants' (CNAs) perceptions of incontinence etiologies, as well as perceived barriers to prompted voiding implementation. A questionnaire was administered to CNAs in 23 long-term care facilities. Data analysis was conducted using descriptive statistics and correspondence analysis. CNAs perceived prompted voiding as helpful; however, inadequate staffing, workload, and turnover/absenteeism hindered implementation. CNA recommendations for long-term success included increased staff, staff support, improved communication, ongoing education, and alternative delivery models of care.

Aged↗
PubMed1997

Pelvic muscle rehabilitation: where do we go from here?

Pelvic muscle rehabilitation has been used in the treatment of stress and urge urinary incontinence for many years. This article reviews the anatomy of the female pelvic floor and its role in the maintenance of continence. The purpose and goals of pelvic muscle rehabilitation are reviewed, and implications for future applications and research are discussed.

Exercise Therapy↗
PubMed1997

Urinary continence changes after hip-fracture repair.

Hip fractures can adversely affect an older adult's functional well-being. Little is known about the changes in continence status after hip-fracture repair. To investigate postoperative complications, the authors reviewed a convenience sample of 100 medical records of adults ages 55 years and over who were admitted to two metropolitan Baltimore hospitals for surgical repair of a fractured hip. There were data regarding postoperative incontinence for 95 individuals. Prevalence of urinary incontinence significantly increased from the preoperative rate of 20% to 43% postoperatively. That is, 19 individuals were incontinent preoperatively, and 41 individuals were incontinent postoperatively. Two individuals who had been incontinent preoperatively became continent postoperatively. Men were more likely to become incontinent than women, as were cognitively impaired individuals compared to cognitively intact individuals.

Aged↗
PubMed1997

Urinary outcomes in older adults: research and clinical perspectives.

There is a need for continued collaboration between clinicians and researchers to further improve urinary continence outcomes. This article presents the perspectives of four nurses who conduct continence research or who have independent continence services practices. Each discusses continence outcomes used in long-term care facilities or the community as a researcher or clinician and suggests implications for future nursing development.

Aged↗
PubMed1996

Mobility in older patients with hip fractures: examining prefracture status, complications, and outcomes at discharge from the acute-care hospital.

The purpose of this study was to examine the relationships among prefracture status, development of complications, mobility outcomes at discharge, and disposition at discharge. We singled out a case series of consecutive noninstitutionalized elderly persons hospitalized for hip fracture (ICD 820.0-820.9) at two Baltimore hospitals during 1992-1993. Data were abstracted from the medical records for the following variables: sociodemographic information, prefracture status, selected medical conditions, injury and surgical treatment, complications, functional mobility and assistance needed at discharge, and disposition. Factors associated with four complications were identified from multiple logistic regression analyses. (a) Prefracture needs for assistance with activities of daily living (ADL), and age > or = 80, were associated with the development of pressure ulcers. (b) Male gender and prefracture urinary incontinence (UI) were associated with pneumonia. (c) Prefracture UI and weight-bearing status were associated with UI after removal of an indwelling catheter. (d) Age > or = 80 was associated with urinary retention. The amount of assistance needed for mobility tasks at discharge was associated with prefracture need for assistance with ADLs, gender, weight-bearing status, and hospitals with shorter lengths of stay and fewer physical therapy sessions. Patients who were older and had shorter lengths of stay and less physical therapy were more likely to go to another health facility than directly home. Prefracture status (ADL, prefracture UI) was significantly associated with the development of complications. Prefracture needs for assistance with ADL and complications were associated with mobility outcomes at discharge. These prefracture factors have an effect on outcomes and need to be addressed in the development of critical pathways for case treatment. Specific protocols for subgroups of patients may need to be designed and evaluated.

Activities of Daily Living↗
PubMed1996

A new framework for urinary continence outcomes in long-term care.

Careful assessment and individual care planning are especially important when approaching the problems of incontinence in long-term care patients. Identification of appropriate interventions and desired outcomes is assuming greater prominence. This article provides an overview of some of the issues that affect incontinence with long-term patients and presents a refined concept of several classifications of incontinence that direct approaches to care. The classifications are based on whether a patient is dependent or independent on a caregiver to achieve continence. Assumptions, goals, and evidence for effectiveness of these interventions are discussed for the four classifications. Further implications for nursing are also addressed.

Activities of Daily Living↗