Promote urinary continence

The promotion of urinary continence is the task of medicine (urology, among others) and the nursing care of people at risk of incontinence . This promotes the self-esteem of the person and their participation in social life. In the context of care, one speaks of a self-determined everyday activity (ATL elimination).

Often, however, it is a question of secondary prevention before the further worsening of the incontinence ( urine ) clinical picture or further dependence on caregivers.

Elimination pathology, consequences

The adult human can consciously control the urine excretion in a quantitative range between 50 and 500 ml over a longer period of time (min./hour). This is intended to secure the use of a toilet (in evolutionary terms, it was about avoiding traces of predators). Does this skill learned in childhood (toilet training) go through illness or the like? lost, the adult affects their social interaction considerably, because others lose respect or the self-esteem suffers massively for fear of it.

Urinary incontinence is used when there is repeated involuntary relaxation of the sphincter muscles at the neck of the bladder and thus unwanted emptying of the bladder . This can have various causes, for example advanced age with accompanying muscle weakness, neurologically due to conduction disorders or a lack of information processing in the brain. For the meaning, compare the term age syndrome . The anatomy of the kidneys and bladder functions .

The consequences of incontinence are complex. Not all of them have to occur at the same time. It can be:

Odor formation (subjective and in the perception of others: unpleasant) triggers a feeling of shame or, in the case of other aversions, another consequence of social isolation and loneliness.
Skin rash (e.g. intertrigo , anal eczema )
For people unable to walk: promote a pressure ulcer
Another consequence: increased effort in washing and cleaning the clothing (also costs).

Therapy of incontinence, secondary prevention

After a number of forms of incontinence have occurred, medical therapy is possible (see also web links under guidelines). For the future, it may then be necessary to prevent the condition from worsening again. This is then called secondary prevention . Depending on the underlying disease, this is the same as prevention for middle or very old people at risk of incontinence. Further fluid intake, regular times for visiting the toilet, pelvic floor exercises, successive bladder filling training, handling of aids.

Nursing prevention and avoidance of complications

In 2006, the Network for Quality Development in Nursing developed and presented a so-called National Expert Standard on Urinary Continence Promotion in the area of professional nursing.The first update appeared in March 2014. Expert standards are based on extensive literature analyzes, the expert knowledge of many nurses involved and the inventory of the circumstances in health services research.

The basic ideas of nursing prevention are:

systematic recording of all risk factors (parallel to medical diagnostics)
Description of the degree of dependency of a supply (continence profile)
Advice on care options (parallel to medical therapy advice)
Agreement on the supply measures
Timely implementation of care or support for self-sufficiency
Success control for further adaptation of the measures (nursing terminology: evaluation)

The quality of care can be observed on the basis of briefly described structure, process and result characteristics.

To 1. Record all risk factors

The systematic recording of all risk factors should take place in parallel with the medical diagnosis. In particular, the skills of the person concerned are described and the support effect of their respective environment is recorded. This allows individual planning in help planning.

To 2. continence profile

With the description of the degree of dependency on care (be it by people or with certain aids) it can be differentiated whether the person can still (partially) take care of himself or is completely dependent on outside help. A distinction must be made between the level of continence and the compensated and non-compensated incontinence. (Compensated means that the consequences are mastered, but the basic disease persists.)

For the interlocking of the supply chain, it is important that everyone involved understands who is doing what.

The need for supplies can also fluctuate massively in 24 hours and must be adjusted accordingly in terms of personnel and the use of aids. If toilet training is carried out consistently, success is often achieved very quickly. But even without complete success it must be checked whether this supply does not represent the minor interference with the personal rights of the sick person.

To 3. Advice on supply options

Advice on supply options should ideally take place in parallel with medical therapy advice. In many cases, the involvement of relatives and their conviction is at least as important for success as counseling the person concerned.

The following aids can be used: disposable templates worn close to the body, disposable medical pads, reusable templates worn on the body. Incidentally, reusable documents should, if possible, not be referred to as “diapers” or “pampers” to the elderly or the patient. These words signal a regression into baby-like, which should be avoided for ethical reasons, out of respect for the adult and in order to maintain their self-esteem. “Deposit” or the word “bandage”, which was previously used for provision in the rule, are a neutral solution. This can be done regardless of the correct product name in the documentation or in the ordering system.

See forms of care and long-term care insurance under see also .

In addition, the promotion of exercise and skin care are also important nursing topics in promoting continence.

To 4. Agreement on the supply measures

It is sometimes difficult for family caregivers to respect personal decisions. The situation is similar in the institutionalized framework of a nursing home. The nursing process is a recognized form of work planning - but it must also be based on respect for individual decisions. With the care planning measures, changes in the organization of the daily routine or the renunciation of habits almost inevitably result. They should never be experienced as irrevocable, but ultimately only serve as an aid to self-help.

In nursing homes , the increase in the number of people with dementia among the clientele, especially in the area of external control and care, has opened up a problem for all caregivers that has not yet been satisfactorily resolved.

To 5. Care or support for self-sufficiency

The timely implementation of care or support for self-sufficiency does not require a high level of personnel, but does require a constant effort throughout the day. Organizing this is often difficult for very old people and should therefore be supported. This also includes all questions relating to the financing of external personnel.

To 6. Success control for further adjustment of the measures

In professional nursing, success monitoring is a must for further adaptation of the measures (nursing terminology: evaluation ). Since continence promotion is very often a task in which a wide variety of people are involved, it is important to explain the importance of the step to them and to motivate them to participate.

Structuring the 6 sub-steps

The national expert standard basically contains the standard statement: "The people being cared for are as continent as this is possible with the correct professional nursing support." The national expert standard also provides rules / statements on the 6 points presented. These points are explained in terms of their structural requirements, the rules for handling (process) and the result. So 6 × 3 sentences have to be fulfilled until the standard statement is secured. This threefold subdivision follows the currently accepted consideration of care quality .

The statements on structure, process and result characteristics of the quality of care always begin with the phrase “The nurse can / should / ...”. This should make it easy to check the expectations and, in the event of deficits, it should be clear which goal is still to be pursued when implementing the national expert standard.

literature

Source, expert standard:

German network for quality development in care (2006): Promotion of urinary continence in care , ISBN 3-00-017143-6 , 101 pages.
Marthin Moers, Doris Schiemann, (2004): Expert Standards in Nursing - Procedure of the German Network for Quality Development in Nursing (DNQP) and benefits for practice , in: Pflege & Gesellschaft 9 (3)

Literature on incontinence:

Ingo Füsgen, W. Barth (1987 and subsequent J): Incontinence manual . Diagnostics, therapy, economy. Springer, Berlin et al. (Standard medical information)

Ingo Füsgen, A. Welz-Barth (2004): Therapy options for bladder dysfunction in old age . In: Der Urologe A Volume 43, number 5 pages: 547–551. Springer, Berlin / Heidelberg. doi : 10.1007 / s00120-004-0572-z

Cornelia Stolze : The agonizing urge. In: DIE ZEIT, December 1, 2005 No. 49.

S2 guideline : Urinary incontinence of the DGG, AWMF register number 084/001, status 05/2008

Web links

Individual evidence

↑ Expert standard promoting urinary continence at www.dnqp.de (link checked February 27, 2019)

[1] Expert standard promoting urinary continence at www.dnqp.de (link checked February 27, 2019)