‘We tend to get pad happy’: a qualitative study of health practitioners’ perspectives on the quality of continence care for older people in hospital

BMJ Open Quality

article

John Percival¹  Katharine Abbott²  Theresa Allain³  Rachel Bradley⁴  Fiona Cramp¹  Jenny L Donovan⁵  Candy McCabe¹  Kyra Neubauer²  Sabi Redwood⁶  Nikki Cotterill¹ 

[1] Nursing and Midwifery , University of the West of England Faculty of Health and Applied Sciences;North Bristol NHS Trust;Department of Medicine for Older Persons , University Hospitals Bristol and Weston NHS Foundation Trust;Department of Geriatric & Orthogeriatric Medicine , University Hospitals Bristol and Weston NHS Foundation Trust;Medical School , University of Bristol;National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West;Population Health Sciences , University of Bristol Medical School

关键词: communication;    continuing education;    continuing professional development;    healthcare quality improvement;    infection control;    patient-centred care;   

DOI  :  10.1136/bmjoq-2021-001380

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Bladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement.Objective To identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus.Methods We conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.Results Interviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.Conclusions Findings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.

【 授权许可】

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