Non-invasive method overcomes incontinence: Program retrains residents to recognize the urge to void. (Caregiving).

FEW ASPECTS OF THE AGING PROCESS CAUSE US MORE DIScomfort--physically and emotionally--than incontinency. Nationally, approximately 48 percent of all nursing home residents experience urinary incontinence and the number can be as high as 70 percent, depending upon a facility's case mix. Considering it is the second most common reason for nursing home admission behind dementia, it's little wonder that managing incontinence ranks high among caregivers' concerns. Recently, Shepherd of the Valley Lutheran Retirement Services, headquartered in Youngstown, Ohio, looked to technology for help with continence care.

Restorative nurse Patty Brincko, LPN, who manages bladder-control problems among the facility's residents, instituted a program that uses a portable bladder scanner to assess bladder volume accurately. After a Scan of the resident's bladder, a caregiver can determine if catheterization or toileting is necessary. "We've seen a dramatic reduction in infections, disposable products, and staff time spent toileting residents unnecessarily," said Peg Kratofil, RN, staff developer.

When Mrs. C was admitted, she had been using a Foley catheter to void for 10 months. The 63-year-old woman has multiple sclerosis and, at admission, suffered from pressure sores and contractures. Although her incontinence was secondary to the other medical challenges she was facing, it was still a source of concern for her.

Prior to the use of the bladder scanner, nursing staff would use a straight catheter to measure bladder volume. This is an uncomfortable, invasive procedure that often encourages urinary tract infections in residents. "When you consider that urinary-tract infections are the number-one type of nosocomial infection in a nursing home, that's important," said Kratofil. Incontinence problems can be aggravated by three main factors: urinary tract or bladder infections, previous use of a Foley catheter, and certain medications, especially diuretics.

"Some residents feel a sense of urgency to void every 10 minutes and others can't tell when their bladder is completely full," said Brincko.

"Often, it's simply a case of the right message not getting to the brain," added Kratofil. The bladder scanner is an invaluable aide in guiding residents through their bladder therapy program. "It shows them exactly how much is in their bladder, and they have to believe it even if it contradicts what they think they're feeling," Kratofil said.

Brincko monitors the resident's fluid intake and then scans his or her bladder to accurately assess its volume for three days. The scanning process takes only about a minute to complete. After applying ultrasound gel, Brincko positions the scanner head over the bladder. An aiming icon helps her to locate the resident's bladder. A timed and dated printout of the results helps to establish the bladder-function pattern.

After three days of monitoring, Brincko is able to make her recommendations. "I can develop a continence-care schedule specifically suited for the resident," she said. Brincko then begins the weaning process to ensure that the resident begins to rely on his or her own sensation rather than the reading from the bladder scanner. "I do it gradually so that they don't become too dependent on what the scanner tells them instead of learning to trust their own instincts," she said. This process helped Mrs. C learn to recognize the sensation associated with the need to void.

Mrs. C's pressure sores have healed and physical therapy has helped reduce her contractures. No less important to her than these dramatic improvements in her condition is one that is far less visible--the peace of mind she's gained through Brincko's program. "I just needed to know I was okay," she said. "And now I do." Mrs. C will be going home soon, leaving behind the Foley catheter and taking with her a newfound sense of independence.

JoAnne K. McCliment is director of community relations at Shepherd of the Valley Lutheran Retirement Services Inc., Youngstown, Ohio. She can be reached by phone at 330-270-9700 ext. 216 or by e-mail at [e-mail]