Evaluation of an electronic monitoring device for urinary incontinence in elderly patients in an acute care setting

Abstract

Aim: The primary aim of this study was to determine whether the use of habit training with an electronic monitoring device is better than standard habit training in the assessment and management of urinary incontinence in elderly patients in acute care hospitals. The second aim was to describe nurses' perceptions of continence management in acute care settings.

Design: A randomized controlled trial was conducted for an 18-month period.

Sample and setting: The sample consisted of 41 elderly incontinent patients who resided on the acute care rehabilitation wards of 2 western Australian hospitals.

Instruments: A continence assessment form was used to document self-reported or carer-reported frequency and severity of incontinence. A continence monitoring chart was used to record voiding patterns and continence outcomes. A semi-structured interview guide was developed to elicit nurses' perceptions of continence management.

Results: Findings revealed no significant improvements in the self-reported or carer-reported frequency of incontinence from baseline to follow-up of in-patients and at 1 month after discharge, although there was a trend toward improvement in both the experimental and the control groups at the posttest time points. A significant reduction in self-reported or carer-reported severity of incontinence was demonstrated in the experimental group at 1 month follow-up (P = 5.025).Nurses' perceptions of continence management of elderly patients in acute care settings ranged from positive to extremely negative. Even those with positive perceptions were challenged by problems with device malfunction, perceptions of lack of time, lack of support from other staff, and lack of knowledge about how best to meet the continence management needs of this complex group of patients.

Conclusion: The potential value of an electronic monitoring device for reducing incontinence could not be adequately assessed because of the small sample size and problems with the device and with implementing the study protocol. Although it was possible to determine a pattern in voiding times using the electronic device, compliance with the toileting regimen was difficult to achieve.Researchers and clinicians planning future studies with this device should be aware of the practical limitations associated with habit-training regimens for elderly patients in the acute care setting.