Incontinence products: technology expands options.
Since the early 1980s, Procter & Gamble has been instrumental in increasing awareness of such products among care givers with information in the nursing literature, followed by inservices for nursing home staffs. In addition, most manufacturers continue to respond to consumer feedback about reliability, comfort, ease, and special needs by creating and marketing greatly improved versions of familiar products.
Successful product selection is multi-faceted. As always, a thorough history and assessment help to clarify the nature, etiology, and pattern of incontinence. An individualized management strategy can then be tailored to the severity and unique characteristics of the resident's problem. This requires the staff to familiarize themselves with the array of products available, assess the needs and desires of the resident, and make "trial runs" of several products to determine which best meets those needs.
Absorbent products include disposable briefs and a variety of shields, pant-pad systems, and underpads. The HIP Resource Guide (available from Help For Incontinent People, Spartanburg, SC) provides valuable listings of incontinence products marketed by major manufacturers. They fall into the following categories:
Disposable Briefs: These are undergoing continuous improvements, both in construction and basic materials and, when used appropriately, are highly effective, particularly for residents who are bedfast or doubly incontinent (i.e. incontinent of urine and stool). Some washable products are not designed to effectively contain stool, making disposables the products of-choice for such residents.
Shields and Absorbent Pads: Disposable shields, or absorbent pads, are similar in appearance to sanitary napkins, often with an adhesive strip that attaches to underwear. Most of the early shields were made with a fluff wood pulp filler that served as a core absorber. Today, many of the newer products have a polymer component: some are all-polymer (super absorbers) and some are combinations of polymer and pulp absorbers.
Interestingly, in a small comparative study of six shield products, 20 women with mild incontinence were equally satisfied with both the pulp and polymer shields with respect to reliability. The most notable findings were those related to comfort, with a significant preference expressed for the shields designed in an hour glass, rather than a rectangular, shape.|1~
In the nursing home setting, the choice of absorbent pad should be based upon an assessment of each resident's type, degree, frequency (predictable pattern or constant dribbling) and volume of leakage. Many pad manufacturers offer choices of size and shape specifically designed for light or heavy leakage. Some large pads, for example, provide effective overnight protection.
It is not yet clear whether the protection provided by the polymer absorbers is superior to that of the well-constructed pulp-fill pads. The shape and size of the pad also play a role in urine absorption. But regardless of the type of pad used, all pads--pulp and polymer--have a saturation point that must be determined for each resident.
The only way to do so is to take the time to check and document. If Mrs. Jones is wet 2 hours after the pad is applied, the next check should be made 15 minutes sooner, and so on. Eventually, a voiding pattern will be established that enables a match with the appropriate product and management strategy to meet her specific needs. It is, however, important to remember that a voiding pattern established during the day will likely differ at night. Thus, residents should be checked every two or three hours until a nighttime pattern is established.
Pant-Pad Systems: Designed as a unit, these can be worn as clothing by residents who are ambulatory and involved in social situations, such as activities and out-trips. Also, since the pant-pad system keeps the absorbent material securely in place, it is especially useful for residents who tend to wear loose fitting clothing that might otherwise fail to support a pad alone. Most of the systems are unisex in basic design, but a few manufacturers are beginning to design gender specific products, such as one pant system with a built-in fly for men.
Protective Padding: These pads are designed to keep beds or chairs dry while drawing moisture away from the patient. Use of a sound underpad, such as the Kylie, an Australian product, or the Dundee, an American product, can sometimes be used as an alternative to a shield or pant-pad system during the night, when the resident's skin is allowed to "breathe." They can also be used as permanent protection for beds or furniture, but of course must be checked regularly for cleanliness and dryness.
Washables: Today, manufacturers are addressing environmental concerns with a trend toward developing washable products that may prove as effective and convenient as the disposables. Many nursing homes keep both washable and disposable products in stock. However, as noted, disposable briefs are still preferable for residents incontinent of both urine and stool.
EXTERNAL COLLECTION DEVICES
External collection devices (generally known as external catheters) are most suitable for alert, ambulatory residents who want an occassional alternative to absorbent products. The devices are useful for outings and social activities, since they allay any concerns about pad leakage and odor, and can be worn for several hours. Because of the potential for irritation due to their prolonged, repeated contact with the skin, external catheters are recommended for occasional rather than daily use, and the skin should be monitored carefully with each changing.
The standard male collection device consists of a condom attached to the penis with velcro or some type of expandable tape. The condom is, in turn, connected to tubing that empties leaks into a bedside receptacle or leg bag when residents are ambulatory. Unlike the older "Texas catheters," the new generation of mens' collection devices have molded forms that resist twisting in the tube, as well as condoms designed to prevent urine from refluxing upwards.
Women have the National Aeronautics and Space Administration (NASA) to thank for their external collection devices. since the agency needed to find a similar collection device for the first female astronauts. The principle is essentially the same as that employed for men. In this case, however, the perineum and urethral orifice are measured and a circular diaphragm-like collection device is fitted around the urethra; this can be sized for optimum fit. The device is held in place with a pant system incorporating a slit through which the tubing empties into a bedside or leg bag.
OLD STAND-BYS WITH NEW FEATURES
While disposable. external catheters are widely available. some other, relatively mundane devices are sometimes overlooked, even though they, too, have been the subject of technological advance. The best example is the urinal, which is ideal for the alert resident able to feel the urge to void, but perhaps unable to get to the toilet without assistance. Still easy to use, inexpensive, durable, washable, and reusable, urinals are now available in a variety of "customized" forms for both men and women.
For men, one of the newest innovations is the spillproof urinal, made so by the design. Female urinals are available in a variety of configurations, with wider mouths to catch the urine and with mouthpieces specially shaped to fit against the urethra. For women with hip problems, urinals with narrow necks minimize the need to spread the legs. And some manufacturers now provide urinals with handles specially designed to facilitate a firm grasp with arthritic hands.
Another device, aptly called the "tinkle tube," is especially helpful for wheelchair-bound women. The narrow, elongated funnel-type device is attached to a long tube. Rather than requiring strenuous and often disturbing lifts onto and off of the toilet, the resident moves forward slightly in her wheelchair, and, through the tube, urinates into the toilet or bedpan, usually without the need for assistance. The tube is easily portable, and allows residents to maintain their independence and dignity without worrying about pads or external bags.
In general, containment products are now available to meet virtually any conceivable resident need. To maximize their effectiveness. however, they must be used knowledgeably and with careful attention to identifying those needs.
1. Clancy B. Bed protectors: No easy choice. Nursing Times 1989;85:70-75.
KEEPING THE TERMINOLOGY STRAIGHT
Just as all tissues are Kleenex and most bandages are Band-Aids, many incontinence products have become synonymous with specific brand names, while others are known by five or six names in addition to their "true" marketing names. The resulting communication is, at best, difficult. And because product terminology is not likely to be standardized in the near future, the following may help you to translate "incontinence product-speak."
Disposable brief = adult diaper
Washable brief = underpant
Shield = liner, insert, guard, pad
Protective padding = underpad, bed pad, chair pad, bedsheet, drawsheet
Pant-Pad System = often referred to by specific brand name
Carol Brink, RN, MPH, is Associate Professor of Clinical Nursing and Chief of Gerontological Nursing at the University of Rochester. She was co-founder of the first continence clinic in the United States, located at the University of Michigan. Her articles on incontinence and continence management have appeared in numerous publications, including the Journal of the American Geriatric Society, Nursing Research, Topics in Geriatric Rehabilitation, Clinics in Geriatric Medicine, Geriatric Nursing, Journal of Gerontological Nursing, Public Health Nursing, and The Danish Medical Bulletin.
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|Title Annotation:||Special Advertising Section|
|Date:||Mar 1, 1994|
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