Caring for continence in stroke care settings: a qualitative study of patients’ and staff perspectives on the implementation of a new continence care intervention

Citation

Brady MC, Jamieson K, Bugge C, Hagen S, McClurg D, Chalmers C & Langhorne P (2016) Caring for continence in stroke care settings: a qualitative study of patients’ and staff perspectives on the implementation of a new continence care intervention. Clinical Rehabilitation, 30 (5), pp. 481-494. https://doi.org/10.1177/0269215515589331

Abstract
Objectives: Investigate the perspectives of patients and nursing staff on the implementation of an augmented continence care intervention after stroke.  Design: Qualitative data were elicited during semi-structured interviews with patients (n = 15) and staff (14 nurses; nine nursing assistants) and analysed using thematic analysis.  Setting: Mixed acute and rehabilitation stroke ward.  Participants: Stroke patients and nursing staff that experienced an enhanced continence care intervention.  Results: Four themes emerged from patients’ interviews describing: (a) challenges communicating about continence (initiating conversations and information exchange); (b) mixed perceptions of continence care; (c) ambiguity of focus between mobility and continence issues; and (d) inconsistent involvement in continence care decision making. Patients’ perceptions reflected the severity of their urinary incontinence. Staff described changes in: (i) knowledge as a consequence of specialist training; (ii) continence interventions (including the development of nurse-led initiatives to reduce the incidence of unnecessary catheterisation among patients admitted to their ward); (iii) changes in attitude towards continence from containment approaches to continence rehabilitation; and (iv) the challenges of providing continence care within a stroke care context including limitations in access to continence care equipment or products, and institutional attitudes towards continence.  Conclusion: Patients (particularly those with severe urinary incontinence) described challenges communicating about and involvement in continence care decisions. In contrast, nurses described improved continence knowledge, attitudes and confidence alongside a shift from containment to rehabilitative approaches. Contextual components including care from point of hospital admission, equipment accessibility and interdisciplinary approaches were perceived as important factors to enhancing continence care.

Keywords
Incontinence; rehabilitation; nursing; bladder function; patient-centred care

Journal
Clinical Rehabilitation: Volume 30, Issue 5