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"We tend to get pad happy": a qualitative study of health practitioners' perspectives on continence care for older people in hospital.

By John Percival, Katharine Abbott, Theresa Allain, Rachel Bradley, Fiona Cramp, Jenny Donovan, Cany McCabe, Kyra Neubauer, Sabi Redwood, Nikki Cotterill

Posted 10 Dec 2020
medRxiv DOI: 10.1101/2020.12.05.20234690

Background Bladder and bowel control difficulties affect twenty and ten per cent of the UK population respectively, touch all age groups and are particularly prevalent in the older (65+) population. However, the quality of continence care is often poor, compromising patient health and wellbeing, 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 in hospital. 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 with incontinence. Resolute continence promotion, in hospitals and throughout the NHS, 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.

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