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Forstyrrelser i de nedre urinveier hos gamle på sykehejm: urininkontinens, residualurin, urinveisinfeksjon, samt inkontinenspleie
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2012 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Abstract [no]

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = <0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie.

Abstract [en]

The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = <0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) < 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet , 2012. , 77 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 124
Keyword [en]
absorbent pads, content analysis, focus groups interviews, incontinence care, home residents, post voiding residual urine, statistics, urinary incontinence, urinary tract infection
Keyword [no]
Absorberende bleier, fokusgruppeintervju, innholdsanalyse, inkontinenspleie, residualurin, statistikk, sykehjemsbeboere, urininkontinens, urinveisinfektsjon
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-16337ISBN: 978-91-87103-11-7 (print)OAI: oai:DiVA.org:miun-16337DiVA: diva2:530149
Supervisors
Available from: 2012-06-01 Created: 2012-06-01 Last updated: 2012-08-01Bibliographically approved
List of papers
1. Urinary incontinence in Norwegian nursing home residents
Open this publication in new window or tab >>Urinary incontinence in Norwegian nursing home residents
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2012 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 2, no 2, 116-122 p.Article in journal (Refereed) Published
Abstract [en]

Urinary incontinence is a multi-factorial condition that has a high impact on older persons living in nursing homes. While urinary incontinence is common, only a small percentage of nursing home residents have an official diagnosis. Factors influencing urinary incontinence in this population are poorly understood. The aim of this study was to evaluate the prevalence of urinary incontinence in Norwegian nursing home residents and to study the factors associated with urinary incontinence in this population. Residents from six different nursing homes were included in this study. Data on sex, age, medication, comorbid illnesses, urinary incontinence and the use of absorbent pads was collected. Barthel`s Index of Activities of Daily Living (ADL) was used to estimate residents’ functional levels. Post-voiding residual urine was measured by means of a portable ultrasound. A questionnaire was completed by the nursing staff for each of the residents. In total, 173 residents participated in the study. One hundred and twenty-two residents (69%) were incontinent for urine and 144 used absorbent pads (83%). Fourteen percent of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine. The prevalence of urinary incontinence in Norwegian nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are significantly associated with urinary incontinence.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-16332 (URN)10.4236/ojn.2012.22018 (DOI)
Available from: 2012-06-01 Created: 2012-06-01 Last updated: 2014-08-11Bibliographically approved
2. Residual urine as a risk factor for lower urinary tract infections: A 1-year follow-up study in nursing homes
Open this publication in new window or tab >>Residual urine as a risk factor for lower urinary tract infections: A 1-year follow-up study in nursing homes
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2008 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 5, 871-874 p.Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-16333 (URN)10.1111/j.1532-5415.2008.01646.x (DOI)18331294 (PubMedID)
Available from: 2012-06-01 Created: 2012-06-01 Last updated: 2012-07-26Bibliographically approved
3. Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents
Open this publication in new window or tab >>Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents
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2010 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 39, no 5, 549-554 p.Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-16334 (URN)10.1093/ageing/afq082 (DOI)20631404 (PubMedID)
Available from: 2012-06-01 Created: 2012-06-01 Last updated: 2012-07-26Bibliographically approved
4. Perceptions and barriers that influence the ability to provide appropiate incontinence care in nursing home residents: Statements from nursing staff
Open this publication in new window or tab >>Perceptions and barriers that influence the ability to provide appropiate incontinence care in nursing home residents: Statements from nursing staff
2013 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 6, 437-444 p.Article in journal (Refereed) Published
Abstract [en]

among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than uri- nary incontinence in younger people. Previous re- search has shown that incontinence care in nursing home residents often is inadequate and little systema- tized. The aim of this study was to identify percep- tions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group meth- odology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verba- tim and analyzed according to qualitative content analysis. Three topics and eight categories were iden- tified. The first topic, Perceptions and barriers associ- ated with residents, consisted of one category: "phy- sical and cognitive problems". The second topic, Per- ceptions and barriers associated with nursing staff, consisted of three categories: "lack of knowledge", "attitudes and beliefs" and "lack of accessibility". The third topic, Perceptions and barriers associated with organizational culture, consisted of four cate- gories: "rigid routines", "lack of resource", "lack of documentation" and "lack of leadership". The find- ings from this study show that there are many barri- ers that might influence the possibilities of nursing staff to provide appropriate incontinence care to re- sidents in nursing homes. However, it can neverthe- less seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-16336 (URN)10.4236/ojn.2013.36059 (DOI)
Available from: 2012-06-01 Created: 2012-06-01 Last updated: 2013-12-20Bibliographically approved

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