189 research outputs found
Small study finds that hydrophilic catheters decrease use of antibiotics to treat UTI in people with spinal cord injury who use self-intermittent catheterisation compared with non-coated catheters
No full textEffects of absorbent incontinence pads on pressure management mattresses
No full textAim. The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses.Background. Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads.Methods. An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition.Results. There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads.Conclusions. Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care
“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care
No full textBackground Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians’ decisions need to be better understood. Objective To explore why clinicians decide to place IUCs in acute medical care. Methods We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. Results Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. Conclusions These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.</p
Continence and skin health: new methods and new thinking
No full textUrinary and faecal incontinence are associated with dermatitis (Brown, 1994) and pressure ulcers (Spector and Fortinsky, 1998) but the mechanisms are poorly understood. Current nursing practices related to continence care, skin cleansing and protection have a weak foundation in research (Ersser et al, 2005) and much practice is based on beliefs, particularly regarding the use of products such as barrier creams. This symposium bring stogether recent work comprising the development of new methodologies and measurement techniques to study continence and skin care - the most basic of nursing care activities. Continence and skin health – how does water damage skin? Dr. M. Fader Drawing on evidence from baby diaper, pressure ulcer and cosmetic research, this paper will examine the theoretical background to hydration skin damage and will discuss the reliability and validity of current methods of measuring skin health in both laboratory and clinical settings. These will include including measurement of skin pH, erythema, trans-epidermal water loss (TEWL), capacitance and subjective rating
Experiences and impact of living with incontinence associated stigma: A protocol for a systematic review and narrative synthesis of qualitative studies
No full textINTRODUCTION: Incontinence is global health and social issue, with urinary incontinence alone affecting over 400 million people. Incontinence can lead to physical harms such as skin damage, but it also commonly causes social and psychological harms, including those associated with stigma. For many people, treatment to cure incontinence does not work or is not suitable and they live with the long-term consequences of incontinence. At the moment, no stigma reduction interventions (increasingly used with other conditions such as mental health problems and HIV) have been developed for people living with incontinence. As a starting point for developing such an intervention, this review will address the questions 1) What are the incontinence (urinary or faecal) associated experiences of stigma of people living with incontinence? 2) What is the impact of incontinence associated stigma on their lives? METHODS: The reviewers will search Embase, Medline, PsychINFO and the Cumulative Index to Nursing and Allied Health Literature using controlled vocabulary and relevant search terms. Articles assessed to meet inclusion criteria will be included. Once duplicates have been removed, titles and abstracts will be screened and full texts of selected research articles will be reviewed. An adapted Joanna Briggs Institute Data Extraction Form will be used to collect the data and quality will be assessed using the Joanna Briggs Institute checklist for qualitative research appraisal tool. A framework approach (using the Revised Framework for Understanding Non-communicable Disease Related Stigma) will be used to organise, integrate, interpret and summarise findings from included articles. The review will be reported in accordance with the Enhancing Transparency in reporting the synthesis of qualitative research statement. Prospero registration number CRD42021259065. DISCUSSION: The systematic review described in this protocol will provide the first in-depth, comprehensive understanding of people’s experiences of the stigma associated with incontinence and the impact that it has on their lives. It will identify broader influences of contextual variables such as age, sex, cause and type of incontinence, socio-economic culture and geographical location. The review aims to provide insights to support the development of incontinence associated stigma reduction interventions
The management of night-time incontinence: An investigation into the effects of different pad changing routines on skin and sleep
No full textAbsorbent pads are the main method of managing urinary incontinence in residential settings for elderly people. Improvements in technology have resulted in highly absorbent products which may be worn all night, but the effects of prolonged pad wearing on aged skin are unknown. Wet skin is known to be more susceptible to dermatitis, friction and abrasion. Nighttime pad changing (and resident turning) have been found to be associated with sleep fragmentation. However it has not been demonstrated that changes in nighttime continence management result in less sleep fragmentation. The following question was posed: What is the effect of different pad changing regimes on the skin health and sleep of elderly women living in residential settings. In addition, earlier findings were explored, which indicated that a substantial proportion of residents, who were turned by staff, also turned themselves METHODS: A cross-over design was used. Following a two week baseline period subjects from residential settings were randomly allocated to one of two pad changing regimes: a frequent pad changing regime (whereby residents were changed at 22.00, 02.00 and 06.00) or a less frequent pad changing regime (with residents changed at 22.00 and 06.00 only). Each regime lasted four weeks and was followed by the alternative regime. Skin measurements were taken twice during each regime from selected skin sites using the following tools (i) the Diastron erythema meter (ii) visual grading scale (iii) the Servomed evaporimeter (to measure trans-epidermal water loss) (iv) a pH meter. The primary outcome variable was measurement of erythema using the Diastron erythema meter. Sleep measurements were made twice during each regime using the Stowood Scientific Instruments Visi-lab which comprises an infra-red camera and video with movement and audio detection. RESULTS: Eighty one subjects from 18 nursing/residential homes for elderly people completed the skin component of the study and twenty-two subjects from 5 homes completed the sleep component. Statistical analysis for erythema meter, trans-epidermal water loss, pH and sleep fragmentation data (mean number of movements per hour) was carried out by fitting general linear models and visual grading data were analysed using the Mainland-Gart method. Video data (of self- turning) were analysed descriptively using a coding sheet. No significant differences were found in the severity of erythema, or skin pH, between regimes. However, measurements of trans-epidermal water loss were significantly higher in the less frequent pad changing regime indicating that skin was 'wetter' (P = 0.01; difference of means 12.14, 95% confidence interval 2.89 - 21.39). Five subjects developed grade 2 pressure ulcers (abrasions) during the less frequent pad changing regime, but none in the frequent pad changing regime; this result was not significant (P = 0.1; 95% confidence interval 0 - 1.09). No significant differences were found in the sleep measurements (mean number of movements per hour) between regimes. During both pad changing regimes staff seldom turned residents. Subjects who turned themselves were more likely to be turned by staff at the time of pad change, but overall redundant turning was not evident. CONCLUSIONS: No evidence was found that a less frequent pad changing regime has an effect on skin erythema, pH or on sleep fragmentation. However, there is evidence that the skin is wetter, which may make it more vulnerable to friction and abrasion. The non-significant finding of greater incidence of grade 2 pressure ulcers is a cause for concern and merits further investigation. MAIN RECOMMENDATIONS FOR PRACTICE: Residents may use one standard good quality night pad (without changing) throughout the night. Residents who have had (or develop) grade 2 pressure ulcers (including 'wet skin abrasions') should have their pads changed during the night to reduce skin wetness
A multicentre exploratory study of the impact of urinary incontinence in the 6 weeks after catheter removal following radical prostatectomy
No full textA common complication of radical prostatectomy surgery is the sudden onset of urinary incontinence (UI), with most men experiencing at least transient post‐surgery UI [1]. Carrier et al.’s [1] recent meta‐synthesis of qualitative studies on men’s perceptions of the impact of physical symptoms post radical prostatectomy on their quality of life found that UI is a “significant problem for which men feel ill‐prepared” (p.13). In the post‐operative weeks, men must cope with the practicalities of effectively containing urine, whilst also dealing with the psychological burden of sudden onset incontinence which can cause a “second shock following the initial shock of the diagnosis” [2]
Intermittent catheterisation for long-term bladder management.
No full textDespite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategie
Novel insights into the Proteus mirabilis crystalline biofilm using real-time imaging
No full textThe long-term use of indwelling catheters results in a high risk from urinary tract infections (UTI) and blockage. Blockages often occur from crystalline deposits, formed as the pH rises due to the action of urease-producing bacteria; the most commonly found species being Proteus mirabilis. These crystalline biofilms have been found to develop on all catheter materials with P. mirabilis attaching to all surfaces and forming encrustations. Previous studies have mainly relied on electron microscopy to describe this process but there remains a lack of understanding into the stages of biofilm formation. Using an advanced light microscopy technique, episcopic differential interference contrast (EDIC) microscopy combined with epifluorescence (EF), we describe a non-destructive, non-contact, real-time imaging method used to track all stages of biofilm development from initial single cell attachment to complex crystalline biofilm formation. Using a simple six-well plate system, attachment of P. mirabilis (in artificial urine) to sections of silicone and hydrogel latex catheters was tracked over time (up to 24 days). Using EDIC and EF we show how initial attachment occurred in less than 1 h following exposure to P. mirabilis. This was rapidly followed by an accumulation of an additional material (indicated to be carbohydrate based using lectin staining) and the presence of highly elongated, motile cells. After 24 h exposure, a layer developed above this conditioning film and within 4 days the entire surface (of both catheter materials) was covered with diffuse crystalline deposits with defined crystals embedded. Using three-dimensional image reconstruction software, cells of P. mirabilis were seen covering the crystal surfaces. EDIC microscopy could resolve these four components of the complex crystalline biofilm and the close relationship between P. mirabilis and the crystals. This real-time imaging technique permits study of this complex biofilm development with no risk of artefacts due to sample manipulation. A full understanding of the stages and components involved in crystalline encrustation formation will aid in the development of new protocols to manage and ultimately prevent catheter blockage
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