Jakou péči poskytujeme pacientům s inkontinencí v rezidenčních zařízeních a v domácí péči?
I. Názory a postoje zdravotnických profesionálů

Czech version

Authors: E. Topinková ^1,2; D. Jurásková ^3,4; Z. Kučera ⁵; N. Müllerová ⁶
Authors‘ workplace: Geriatrická klinika 1. LF a VFN, Praha ¹; Subkatedra geriatrie Institutu postgraduálního vzdělávání ve zdravotnictví, Praha ²; Všeobecná fakultní nemocnice, Praha ³; Česká asociace sester ⁴; IncoForum, Česká společnost podpory zdraví, Praha ⁵; Odbor vzdělávání a vědy MZ ČR ⁶
Published in: Čes Ger Rev 2009; 7(1): 14-21

Overview

Background.
Urinary and fecal incontinence are considered as symptoms worsening significantly patient’s quality of life and accounting for high costs particularly for nursing care for incontinent in long‑term care facilities. Repeated complaints of substandard quality of care and nursing practices provided to incontinent persons in these settings have been reported. In institutions, prevalence of incontinence reaches 50– 70% of residents and, about a half of home care clients suffer from incontinence, too. In the article we present results of the project “Incontinence in the context of nursing care”. Methods. Survey in 34 nursing middle management specialists was performed in 9 nursing homes, 5 social care facilities, 10 homes for seniors and 10 home care agencies focusing on the current system and quality of nursing care. Results. Specific nursing standards for incontinent patients are non‑existent in 80% of social care and senior’s facilities, 50% of home care agencies and 22% of nursing homes. 41% of respondents belief that because of incontinence higher amount of nursing time is provided, in 52.2% usual nursing care is satisfactory. Continence training programs for incontinent persons (44%) and protective absorbing garments (21%) are considered as the most appropriate nursing interventions. However, no agreement exists for the frequency of the continence training. 32% of respondents falsely believe that a training once a day and less is sufficient. Expert estimates for the optimal numbers of incontinence aids vary depending on incontinence severity. As the main barriers financial limits for incontinence garments (56%), lack of personnel (53%) and high number of incontinent persons in facility (32%) are reported. Conclusions. Significant variability in nursing practices and quality of care was found among individual providers and types of setting. Understanding of barriers differs according to different types of providers. The causes of this situation are multiple, both objective (lack of personnel, financial limits for incontinence aids) and subjective (lack of specific standards, insufficient knowledge, and low motivation). Educational activities on incontinence should be promoted together with a national guideline for nursing care in patients with urinary incontinence.

Keywords:
incontinence – diagnostic, medical and nursing interventions – quality of care – elderly people

Sources

1. Zmrhal J, Topinková E. Inkontinence moči u žen vyššího věku, diagnostika a léčebné možnosti. Postgrad Med 2004; 6 (3): 47– 56.

2. Klevetová D. Důsledky inkontinence na psychosociální prožívání. Sociální péče 2008; 9 (2): 34– 36.

3. Monz B, Pons ME, Hampel C et al. Patient– reported impact of urinary incontinence – results from treatment seeking women in 14 European countries. Maturitas 2005; 52 (Suppl 2): S24– S34.

4. Martinický D. Nejčastější problém – inkontinence a hrozba dekubitů. Sestra 2007; 17 (4): Temat. Sešit (197 – Urologie).

5. Bojar M, Kučera Z, Svěráková M. Inkontinence moči – psychosociální a ekonomické souvislosti. Urol listy 2004; 2 (1): 40– 44.

6. Chmel R. Močová inkontinence snižuje kvalitu života. Med Tribune 2007; 3 (27): C2– C3.

7. Jančová B. Inkontinence, problém nejen zdravotní, ale i společenský. Med Pro Praxi 2008, 5 (2): 87– 88.

8. Hirdes JP, Fries BE, Morris JN et al. Home Care Quality Indicators (HCQIs) based on the MDS- HC. Gerontologist 2004; 44 (5): 665– 679.

9. Department of Health. Good practice in continence services. [http:/ / www.dh.gov.uk/ en/ Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/ DH_4005851].

10. Močová inkontinence v ČR. Eklektik Porter Novelli. Stem/ Mark, Praha 2003.

11. Svěráková M, Kučera Z, Hanuš T. Aktivity IncoFora – České společnosti podpory zdraví. Urologické listy 2008; 6 (1): 91– 95.

12. Hunskaar S, Lose G, Sykes D et al. The prevalence of urinary incontinence in women in four European countries. BJU Int 2004; 93 (3): 324– 330.

13. Klausner AP, Vapnek JM. Urinary incontinence in the geriatric population. Mt Sinai J Med 2003; 70 (1): 54– 61.

14. Hanuš T. Epidemiologie inkontinence moči. Urol listy 2004; 2 (1): 14– 18.

15. Topinková E, Neuwirth J. Výskyt močové inkontinence v české populaci nad 60 let a stav soběstačnosti u inkontinentních osob. Lék Obz 1998; 47: 96– 98.

16. Sgadari A, Topinková E, Bjornson J et al. Urinary incontinence in nursing home residents: A cross- national comparison. Age Ageing 1997; 26 (Suppl 2): 49– 54.

17. Sorbye LW, Finne- Soveri H, Ljunggren G et al. Urinary incontinence and use of pads – clinical features and need for help in home care at 11 sites in Europe. Scand J Caring Sci 2008; 22: 1– 12.

18. Topinková E, Neuwirth J, Staňková M et al. Inkontinence moči a stolice v geriatrických zařízeních v České republice. Čas Lék čes 1997; 136: 573– 577.

19. Topinková E. Prevalence inkontinence moči a její determinanty u pacientů v dlouhodobé geriatrické péči v mezinárodním srovnání. Geriatria 1996; 1 (3– 4): 35– 42.

20. Landi F, Cesari M, Russo A at al. Potentially reversible risk factors and urinary incontinence in frail older people living in community. Age Ageing 2003; 32 (2): 194– 199.

21. Maggi S, Minicuci N, Langlois J et al. Prevalence rate of urinary incontinence in community- dwelling elderly individuals: the Veneto study. J Gerontol A Biol Sci Med Sci 2001; 56 (1): M14– M18.

22. Du Moulin MF, Hamers JP, Ambergen AW et al. Prevalence of urinary incontinence among community- dwelling adults receiving home care. Res Nurs Health 2008; 31 (6): 604– 612.

23. Žajdlíková J. Inkontinence – každodenní problém v domácí péči. Sestra 2008; 18 (1): 46– 47.

24. Finne– Soveri H, Sorbye LW, Jonsson PV et al. Increased work- load associated with faecal incontinence among home care patients in 11 European countries. Eur J Public Health 2008; 18 (3): 323– 328.

25. Sorbye LW, Finne- Soveri H, Ljunggren G et al. Indwelling catheter use in home care: elderly, aged 65+, in 11 different countries in Europe. Age Ageing 2005; 34 (4): 377– 381.

26. Čermák A, Pacík D. Inkontinence moči. Praha: Triton 2006.

27. McDowell BJ, Engberg S, Sereika S et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc 1999; 47 (3): 309– 318.

28. Zmrhal J, Zmrhalová B, Záhumenský J. Inkontinence u žen nejen ve vyšším věku Postgrad med 2008; 10 (7): 753– 759.

29. Zachoval R, Borovička V, Záleský M et al. Diagnostika a léčba inkontinence moči. Medicína po promoci 2008; 9 (Suppl. 1): 28– 35.

30. Thüroff J, Abrams P, Andersson KE et al. Guidelines EAU pro léčbu močové inkontinence. Urologické listy 2008; 6 (1): 97– 99.

31. Klevetová D Nedirektivní komunikace u osoby s inkontinencí moče. Sociální péče 2003; 4 (1): 8– 12.

32. Topinková E, Jurásková D, Kučera Z et al. Jakou péči poskytujeme pacientům s inkontinencí v rezidenčních zařízeních a v domácí péči? II. Diagnostika a léčba inkontinentních pacientů. Čes ger rev 2009 v tisku.

33. Horčička L. Cvičení svalů pánevního dna – možnosti konzervativní léčby inkontinence moči. Sestra 2008; 18 (1): 40– 41.

34. Holáňová R, Krhut J, Muroňová I. Efekt fyzioterapie v léčbě močové inkontinence. Sestra 2008; 18 (1): 41– 42.

35. Newman DK. Incontinence products and devices for the elderly. Urol Nurs 2004; 24 (4): 316– 333.

36. Horčička L. Jaké pomůcky poskytuje dnešní medicína v řešení močové inkontinence. Urol listy 2004; 2 (1): 36– 39.

37. Tarbox RS, Williams WL, Friman PC. Extended diaper wearing: effects on continence in and out of the diapier. J Appl Behav Anal 2004; 37 (1): 97– 100.

38. Du Moulin MF, Hamers JP, Paulus A et al. The role of the nurse in community continence care: a systematic review. Int J Nurs Stud. 2005; 42 (4): 479– 492.

39. Du Moulin MF, Hamers JP, Paulus A et al. Effects of introducing a specialized nurse in the care of community-dwelling women suffering from urinary incontinence: a randomized controlled trial. J Wound Ostomy Continence Nurs 2007; 34 (6): 631– 640.

40. Cheater FM, Baker R, Reddish S et al. Cluster randomized controlled trial of the effectiveness of audit and feedback and educational outreach on improving nursing practice and patient outcomes. Med Care 2006; 44 (6): 542– 551.

41. Albers- Heitner P, Berghmans B, Joore M et al. The effects of involving a nurse practitioner in primary care for adult patients with urinary incontinence: the PromoCon study (Promoting Continence). BMC Health Serv Res 2008; 8: 84.