Student nurse understanding of the psychosocial impact of urinary incontinence.
Key Words: Nursing education, older adults, psychosocial impact, urinary incontinence.
The national objective of Healthy People 2020 is the goal of improving the health, function, and quality of life of older adults (U.S. Department of Health and Human Services [DHHS], 2012). Urinary incontinence (UI) has a significant negative effect on quality of life for many individuals because incontinence affects physical, emotional and social health, and wellbeing (Rogalski, 2005). The National Institutes of Health reports that the prevalence of UI is high, and recognition of this problem by health care providers is low (Landefeld et al., 2008). The associated costs of UI, including containment products, medications, and treatment interventions, are difficult to quantify because the burden of absorbent pads, laundry, and hygiene care expenses primarily fall to the patient (Davis, 2008; Herbruck, 2008). In 2000, the total estimated cost of UI was $16.3 billion; new data, although more limited in nature, from DHHS identified 2007 expenditures for Medicare beneficiaries 65 and older for treatment of UI at 479.8 million (Hu et ah, 2004; Litwin & Saigal, 2012). With an increasing aging population, the costs of UI will continue to burden this country's finite health care resources. Decreased patient reporting and clinician assessment contribute significantly to the problem because undiagnosed UI exacerbates the scope of the problem (Newman et al., 2009). Educational competencies for student nurses focusing on UI treatment and prevention may help alleviate some of the financial burden.
UI is estimated to affect 20 million women and 6 million men in the United States (Landefeld et ah, 2008). UI afflicts people of all ages; however, as individuals age, the chance of having UI significantly rises. The increased incidence of UI as women age has contributed to the incorrect notion that incontinence is a normal part of the aging process (Day, 2000; Rogalski, 2005). Women up to the age of 49 have UI prevalence rates of 19%, while women over 80 years of age have an incontinence prevalence rate of 29% (Anger, Saigal, & Litwin, 2006; Landefeld et ah, 2008; Smith et ah, 2010). Men over 65 years of age have a prevalence of 21%, signifying that one in four women and one in five men will be impacted by incontinence during their lifetime (Landefeld et ah, 2008). As Baby Boomers age, the societal health burden from incontinence and incontinence-associated concerns will significantly increase. It is projected that due to the rising age of the overall population, incontinence will be as prevalent as cardiovascular disease in the United States by 2025 (Newman et al., 2009).
The financial burden of UI on society is substantial; it is greater than the cost of breast cancer and is comparable to the cost of arthritis (Landefeld et al., 2008). By addressing incontinence and its associated problems, nurses can help promote bladder health for those impacted by UI and prevent UI-associated economic burdens. This economic burden of UI includes patient out-of-pocket cost, and government support of nursing home patient cost (Landefeld et al., 2008). Costs to patients with UI can vary, and can include absorbent pads, diapers, briefs, physical therapy, medications, and surgeries (Davis, 2008).
To reduce UI-associated demands on the American public, the Agency for Health Care and Policy Research (AHCPR) initial guidelines recommended that UI education should be included in graduate and undergraduate training programs for all health care providers; however, the current guidelines do not provide UI education recommendations for health care workers (Agency for Healthcare Research and Quality [AHRQ], 1996, 2009). Because UI interventions and treatment can save older adults from nursing home placement, Bradway and Cacchione (2010) recommend that nursing faculty incorporate incontinence education in both the classroom and clinical setting. Enhancing nursing education by addressing incontinence assessment and interventions is likely to be more cost-effective than nursing home placement and the price of containment pads (Coyne et al., 2014; Davis, 2008; Rigby, 2003). Nurses have an opportunity to enhance a patient's quality of life through encouragement of health promotion strategies related to UI and its resulting symptoms.
Review of the Literature
Nurses are in key positions to assist those affected by UI. Nurses can identify people with incontinence, establish appropriate interventions, and provide valuable education to empower patients (Kelly & Byrne, 2006). Nurses have a huge potential to help people troubled by incontinence in an array of settings, such as the community, acute care, and post-acute care. More over, educating people about UI and preventative techniques is well suited to nursing (Newman et al., 2009).
Ideally, continence care for all patients should be considered an important component of care. Nursing staff have identified environmental barriers, such as lack of time at work, and consider UI a low priority that prevents the facilitation of interventions (Peplar & Wragg, 2010). In some work environments, continence care is primarily task-based without regard to the individual's needs. For example, Wright, McCormack, Coffey, and McCarthy (2006) found patients were often not assessed for UI, and care was primarily focused on applying incontinence pads and briefs. This study identified that a strong work culture that encourages patient advocacy may be essential to promote continence-centered care for patients who are dealing with UI-associated concerns.
For individuals suffering from UI-associated problems, UI may have a substantial impact on their quality of life. Many clinicians do not understand how incontinence affects individuals' perceptions of themselves, relationships, and overall feelings related to quality of life (Landefeld et al., 2008; Rogalski, 2005; Thompson & Smith, 2002), Practicing nurses lack accurate information and treatment strategies to deal with UI, with care focusing on containment (Abrams et al., 2002; Albers-Heitner, Berghmans, Nieman, Lagro-Janssen, & Winkens, 2008; Newman et al., 2009). Multiple sources have identified nurses' lack of sufficient knowledge as a barrier to appropriate interventions for patients who suffer from an inability to control their bladder (Collette, Leclerc, & Tu, 2003; Dowling-Castronovo & Specht, 2009; Saxer, De Bie, Dasseb, & Halfens, 2008; Wilson, 2003). For nurses to apply evidence-based interventions, they must first have a working knowledge of incontinence causative etiologies, assessment techniques, and intervention methods.
A contributing factor to this practice gap is the lack of standardized educational approaches for nursing curriculums in undergraduate nursing programs (Newman et al., 2009). One study surveyed nurses regarding their educational preparation, with only 40% of respondents identifying that they received education related to UI. Incontinence is a condition reported by many older adults; however, a comprehensive literature review revealed just a few recent reports on curriculum related to the aging adult (Dorfman, Murty, Ingram, & Li, 2008; Ferrario, Freeman, Nellett, & Scheel, 2008; Gebhardt, Sims, & Bates, 2009). The American Association of Colleges of Nursing (AACN) (2006) guide for faculty does not provide any guidance related to UI management education. The rates of UI are likely to continue to climb as the population of people over 65 years of age increases to 20% by the year 2030 (AACN & John A. Hartford Foundation Institute for Geriatric Nursing, 2000; Landefeld et al., 2008). The potential increased rates of UI warrant the need for further nursing preparation regarding incontinence management. However, there is a dearth of literature regarding baccalaureate student nurse understanding of the psychosocial impact UI has on the affected adult.
As the American population ages, it is imperative to evaluate not only nurses' knowledge and practice, but also students' perceptions and beliefs regarding caring for patients with UI. Henderson and Kaskha (2000) studied the effect of nursing attitudes and the relationship to nursing practice when providing care for patients with UI. They identified attitude as the "perspective which influences nurses' thoughts, feelings, perceptions, and behaviors toward care of adults with UI" (Henderson & Kashka, 1996, p. 11). Moreover, they identified the variable belief as the "theoretically conceptualized conviction or expectation regarding UI in general" (Henderson & Kashka, 1996, p. 14). The attitude and beliefs of student nurses today may influence how they provide patient care tomorrow.
The purpose of this study is to explore the beliefs and attitudes student nurses have regarding the psychosocial effects UI has on afflicted adults. This study of students may provide a better understanding of the nursing practice gap that currently affects incontinent patients. The following research questions guided this study:
* What attitudes do baccalaureate student nurses have regarding caring for incontinent patients?
* What are student nurses beliefs regarding the psychosocial impact UI has on afflicted adult patients?
* What are the beliefs and attitudes of traditional-aged student nurses compared to those of older nontraditional students?
A descriptive correlational design was deemed appropriate for this study. The Northwest Nazarene University Institutional
Review Board approved the study. We obtained permission to contact students in two baccalaureate nursing programs from two universities in the Northwest. Two hundred students were contacted through emails sent through online learning portals. The student nurses were in their junior or senior year of study to ensure previous exposure to basic fundamental incontinence education, and participation in two adult and older adult clinical experiences, including anticipated experience with patients with chronic or transient UI. The convenience sample consisted of 52 participants who met the following criteria: self-reported senior or junior nursing level status, and were 18 years of age or older. All students met the inclusion criteria, and no students were excluded.
The attitude and belief sections of the Urinary Incontinence Scales (Henderson & Kashka, 1999) were distributed to participants via the student online learning portals. The Urinary Incontinence Scales have been recognized and cited in the literature related to nurses' understanding and practice of incontinence interventions (Karlowicz, 2009; Saxer et al., 2008). The tool was chosen for its scholarly validation through Henderson's doctoral dissertation work (Henderson & Kashka, 1996).
The Urinary Incontinence Scales is a 42-item Likert scale and includes four subscales: Belief, Attitude, Practice, and Knowledge. For this study, the subscales Belief and Attitude were used because students were not practicing nurses. Henderson gave the authors permission to use the Attitude and Belief subscales of the original Urinary Incontinence Scales. There are 19 questions in the Attitude subscale and 23 questions in the Belief subscale. The instrument uses a Likert-type scale to capture responses. The original validity and reliability values for the scales were determined with psychometric testing, with resulting values of [alpha] = 0.8002 for the Urinary Incontinence Belief Scale, and [alpha] = 0.8425 for the Urinary Incontinence Attitude Scale using Cronbach's coefficient and squared multiple correlation (Henderson & Kashka, 1999). The six-point responses are recorded as strongly agree to strongly disagree, and are summed and averaged to obtain a score for the subscales. Higher scores reflect a positive attitude toward the care of the patient with UI and the belief that UI has psychosocial ramifications. However, there is little similarity between this study sample and Henderson's original sample.
Demographic information allowed comparison between various student characteristics. Because general attitudes toward aging have been shown to be different in younger students as compared to older students (Heise, Johnson, Himes, & Wing, 2012), demographic information included age. Other demographic variables were gender, ethnicity, previous educational preparation, and marital status.
The survey results were converted into an Excel[R] spreadsheet for descriptive data analysis purposes. A further data analysis was done using the SPSS Inc. Version 17.0 program. Survey questions were classified as "attitude" or "belief" questions following Henderson's original Urinary Incontinence Scales item description (Henderson & Kashka, 1996). Students' survey responses were then grouped into traditional and non-traditional age group categories (O'Connor, 2006). Group statistics were obtained and analyzed using the mean, standard deviation, and standard error of the mean. A f-test for Equality of Means was also obtained to analyze the difference between the traditional and non-traditional students to evaluate for statistical significance. A moderate level of significance p-value of 0.05 was used to analyze the data.
The sample of 52 participants had a self-reported age range of 18 to 50 years. The majority (71%) of the group was currently seeking their first degree, and approximately half of the group (48.08%) had never been married. The sample was predominantly female (94%), with only three males participating (6%). The ethnicity of the group was primarily white, with 39 participants (75%) accounting for the majority of survey respondents. The remaining respondents identified their ethnicity as Hispanic or Latino (n = 6, 11.5%), Asian (n = 2, 3.8%), African American (n = 2, 3.8%), and Pacific Islander (n = 1, 1.9%). The percentage of traditional nursing students ages 18 to 25 accounted for 58% (n = 30) of the study sample, and the nontraditional nursing students' ages 26 to 50 accounted for 42.3% (n = 22) of the sample. The study sample age distribution is similar to the National League for Nursing (NLN) percentage of students in the BSN programs, as traditional age students' account for the largest majority of students represented (NLN, 2008).
The possible score range for the Attitude subscale is 19 to 114, and this sample had a mean cumulative total score of 90.67. As shown in Table 1, analysis of the sample results demonstrated students had a mean score of 4.77 regarding their overall attitude of caring for patients afflicted by UI. The questions the students scored most positively were nurses should be knowledgeable regarding caring for patients with UI; nurses should not hesitate to discuss UI with a patient; nurses should ask patients if they have incontinence; nurses should have a positive attitude when caring for patients with UI; a genitourinary history should be a part of the nursing assessment; and nursing education should prepare nurses how to care for patients with UI.
The possible score range for the belief subscale is 23 to 138, and this sample had a mean cumulative total belief score of 98.03, demonstrating an overall belief that UI has a moderate-level impact on the patient. Analysis of the entire group's overall beliefs related to caring for patients with UI demonstrated an average mean score of 4.26, with a higher score indicating a better understanding of the negative psychosocial effects UI has on the afflicted patient. The questions the students scored most positively were; UI is annoying to have, and having UI decreases self-esteem (see Table 1).
Traditional Versus Non-Traditional Students
Attitude. Analysis of traditional aged student nurses (18 to 25 years) compared to nontraditional (25 to 50 years) demonstrated a variance in attitude and belief scores (see Table 2). On the Attitude subscale, traditional students demonstrated a mean score of 4.65 regarding their overall attitude related to caring for patients afflicted by UI. The cumulative mean score for this group was 88.36. Both scores were lower than those of the entire sample. The non-traditional group of student nurses demonstrated a mean attitude score of 4.94 regarding their overall attitude related to the care of an incontinent patient. The cumulative mean score for the nontraditional students was 93.85, higher than both the traditional students and the entire combined group attitude score, demonstrating a more positive attitude than the traditional students. Belief. The Belief subscale scores for traditional and nontraditional students demonstrated a mean score range of 4.26 and 4.27, regarding overall belief about how patients are negatively affected by urinary incontinence. The entire sample demonstrated a moderate level of understanding of the psychosocial issues of patients affected by UI. Data show little difference in the Belief subscale in the total group, traditional, and non-traditional scores. This may indicate that while the attitudes are different, their beliefs as a group are similar, regardless of age grouping.
Differences. A f-test evaluation was run on all 42 questions used for this project, comparing nontraditional and traditional student scores. The f-test identified a significant difference between the traditional students and the non-traditional students for the attitude and belief questions shown in Figure 1.
A moderate level of significance a = 0.05 was utilized to evaluate for statistical significance. As Table 3 shows traditional students believed working with men who have UI is an unpleasant experience p = 0.005, the doctor rather than the nurse should discuss UI with the client p = 0.019, and having UI results in isolation p = 0.013.
People who are afflicted by UI can be found in all settings, including hospitals, community, and long-term care centers (Bradway & Cacchione, 2010). UI is often a primary factor for nursing home placement (Rogalski, 2005). UI impacts the affected patient negatively by causing feelings of shame, fear, increasing depression, straining sexual relationships, and impacting patients overall quality of life (Rogalski, 2005). Nurses are ideally situated to help patients affected by UI and to prevent its associated costs and consequences through the implementation of assessments and application of corresponding interventions (Australian Government Department of Health and Ageing, 2007; Newman et al., 2009; Sharaf, El Sebai, Ewieda, Shokry, & Salem, 2010; Spencer, 2009). The findings of this study suggest student nurses may not be aware of the negative impact incontinence has on the psychosocial aspects of the patient, and therefore, may not be as inclined to initiate interventions due to a diminished awareness of the problem.
The cumulative attitude findings of the sample group demonstrated a positive attitude when caring for patients who have urinary incontinence. Students identified strongly with the perspective that nurses should be knowledgeable, approachable, and caring when dealing with incontinent patients. This may directly relate to the image of the ideal professional nurse being knowledgeable, skillful, and caring. The attitudes of student nurses may reflect the ideal image of the nurse as it relates to the care of the patient with UI. Non-traditional students' scores indicated a better understanding of the negative consequences people with UI may experience when compared to their traditional peers.
The cumulative beliefs of the student nurses were more moderate or neutral compared to attitudes when caring for the incontinent patient. Students strongly identified with the beliefs that UI is an annoyance and having UI decreases self-esteem in women. However, they agreed that UI is manageable for those who have it, demonstrating a lack of understanding regarding the negative psychosocial effects of UI. This lack of understanding at the student level may account for the lack of incontinence interventions practicing nurses initiate; if nurses better understood the significant negative impact UI has on a patient, nurses might be quicker to intervene (Karlowicz & Palmer, 2006).
Findings indicated the students had more positive attitudes than beliefs regarding the care of the patient with UI. Students identified the need for nursing knowledge, assessment, and care for the patient with UI. However, findings also indicated students are only moderately aware of the negative effects UI has on the afflicted patient demonstrated by the moderate cumulative belief score.
Although only a section of the original instrument was used, findings of this study are consistent with the findings of Henderson's work regarding the beliefs and attitudes of nurses. She identified that nurses working in Texas had a more positive attitude toward the care of the patient with UI in comparison to their beliefs. She also identified that the nurses had a shared belief regarding UI as being undesirable (Henderson & Kashka, 1996). This supports the validity of the current study's findings because they appear to demonstrate consistency with Henderson's findings using the full instrument.
The similarity between the two findings from both studies suggests that a need still exists for change. Nurses and student nurses lack an understanding of the psychosocial effects UI has on the adult patient. The differences between traditional nursing student scores and those of their non-traditional peers show an increased awareness of the nursing role for incontinent patients by the older-aged students. The limited sample of non-traditional students may have a more positive attitude regarding the care of the incontinent patient due to the potential for life experiences outside the nursing program shaping their perceptions. The non-traditional students demonstrated a better awareness, when compared to their traditional student peers, regarding some of the psychological and social issues people with UI experience. The similar mean average belief scores between the two groups demonstrate a limited understanding of the negative implications of UI. This is congruent with the general public opinion that incontinence is a normal part of the aging process. This study suggests a need for nursing student education to facilitate awareness of the negative psychosocial consequences related to UI.
The sample size of 52 was a moderate response rate from the population of 200 students, and its smaller size is not sufficient to generalize to the entire population of student nurses. The sample size for this study was partially affected by time limitations. If a longer period had been feasible, more schools could have been involved, increasing the sample size and the likelihood of obtaining generalizable results.
The study tool Urinary Incontinence Scales was validated through Henderson's dissertation work; however, it should be noted that only a portion of the tool was used for this study (Henderson & Kashka, 1996). The entire tool was not used as originally developed. The purposeful exclusion of the practice and knowledge subscales acknowledged that student nurses would not have an established practice or uniform knowledge base until after graduation. The original instrument was validated in a population different from the current study population and limits the comparison with the original study group.
Implications and Recommendations
This study adds to the knowledge regarding baccalaureate student nurses attitudes and beliefs related to the care of the adult afflicted by UI. This study suggests different opportunities for future research exploring the phenomenon of student nurses' beliefs and attitudes related to the UI care practice gap.
This study implies that students not only need enhanced UI education to better understand associated sequela, but students expect to receive that education. The study participants identified that nursing education should prepare student nurses to care for patients with UI. For nurses to help patients who suffer from UI they must have a basic understanding of UI causes, assessment, diagnosis, and management techniques (Cooper & Watt, 2003), and some studies have identified a diminished focus of UI in the nursing curriculum (Rogalski, 2005). The formal inclusion of UI education into the BSN curriculum is needed, with an emphasis on the patient's feelings and experiences related to incontinence. A lack of knowledge has been recognized as a barrier to the implementation of patient-centered UI nursing interventions, not just for baccalaureate students but other levels of nursing practice as well (Ehlman et al., 2012; Keilman & Dunn, 2010). In a consumer-based society, nursing schools have an opportunity to adapt to their consumer needs by incorporating a stronger focus of continence education into curriculums and clinical experiences. The care of the incontinent patient crosses many settings increasing the relevance of providing additional education in the nursing curriculum. Focused baccalaureate curricular education may improve the practice gap between student nurses' knowledge and the implementation of urinary incontinence interventions. Enhanced UI education to students now may provide an opportunity after graduation for a change in work cultures that prioritize individualized continence care practices.
The sample size and methodology of this study limit generalizability, and it would be valuable to replicate this study on a larger scale, incorporating multiple baccalaureate nursing programs. But this study provides evidence that student nurses could benefit from further education regarding the psychosocial issues of patients afflicted by UI experience. Efforts should be taken to dispel the prevalent myth UI is a natural part of the ageing process, and therefore, does not require further assessment or treatment by health care clinicians.
The final recommendation from this study is for an increased awareness in practicing nurses' knowledge of UI assessment and interventions following evidence-based practice guidelines. Nurses need further education regarding appropriate interventions to assist patients afflicted by UI. Further education may help alleviate the disparity of current UI knowledge and may aid in the promotion of strong working environments that advocate for a continence-centered patient care. With further education, work cultures may be positively impacted by dispelling the view that continence care is a low priority. Enhanced education regarding UI assessment and treatment interventions may translate into improved practice, diminishing the fiscal burden of incontinence and increasing patient quality of life. Nurses also need supportive work environments that provide the tools and time to implement interventions.
Findings of this exploratory study underscore the challenges facing nurse educators in designing curriculum that address the complex needs of the aging population. Although UI is one aspect of aging, it can be a debilitating and embarrassing condition. This study emphasized the need for innovative curricula designed to not only improve UI management, but also to help student nurses understand its consequences.
Urinary incontinence is a debilitating condition causing social embarrassment and negatively affecting quality of life. Nurses' beliefs and attitudes can affect how they manage urinary incontinence.
This study explored the attitudes and beliefs of student nurses toward urinary incontinence to better understand the practice gap seen post-graduation.
A descriptive correlational design explored the attitudes and beliefs of student nurses. Fifty-two students, consisting of junior and senior student nurses enrolled in two universities, participated in the study. The instrument was a modified version of the Urinary Incontinence Scales and was administered via the students' online portal.
The cumulative findings demonstrated that overall, students in the study had a more positive attitude, with a mean average score of 4.77 on a Likert scale of 1 to 6 when caring for patients who have urinary incontinence. Findings also showed students had a moderate level of understanding regarding the associated psychosocial sequelae affecting people with urinary incontinence. A t-test analysis showed a significant difference between traditional and nontraditional students for some of the attitude and belief scale items.
Many opportunities exist for research regarding further exploration of student nurses' beliefs and attitudes related to the UI care practice gap. Formal inclusion of urinary continence education into BSN curriculum, with an emphasis on the psychosocial impact, may help students implement incontinence interventions.
Level of Evidence--IV
(Polit & Beck, 2012)
Acknowledgement: The authors wish to thank Jane Schade Henderson, PhD, RN, for the use of her tool--the Urinary Incontinence Scales--and her valuable insight regarding urinary incontinence-associated attitudes, beliefs, practice, and knowledge.
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., ... Wein, A. (2002). International Continence Society Standardization Documents. Neurological Urodynamics, 21(2), 167-178.
Agency for Healthcare Research and Quality (AHRQ). (1996). Overview: Urinary incontinence in adults: Clinical practice guidelines update. Rockville, MD. Retrieved from http://www.ahrq.gov/clinic/uiovervw.htm
Agency for Healthcare Research and Quality (AHRQ). (2009). Urinary incontinence in women. http://guide line.gov/content.aspx?id=10931
Albers-Heitner, P., Berghmans, B., Nieman, F., Lagro-Janssen, T., & Winkens, R. (2008). How do patients with urinary incontinence perceive care given by their general practitioner: A cross-sectional study. International Journal of Clinical Practice, 63(3), 508-515. doi:10.1111/j.1742-1 241.2007.01693.X
American Association of Colleges of Nursing (AACN). (2006). Caring for an aging America: A guide for nursing faculty. Retrieved from http://www. aacn.nche.edu/geriatric-nursing/monograph.pdf
American Association of Colleges of Nursing (AACN), & John A. Hartford Foundation Institute for Geriatric Nursing. (2000). Older adults: Recommended baccalaureate competencies and curricular guidelines for geriatric nursing care. Retrieved from http://www.aacn.nche.edu/Education/gercomp.htm
Anger, J.T., Saigal, C.S., & Litwin, M.S. (2006) The prevalence of urinary incontinence among community dwelling adult women: Results for the national health and nutrition examination survey. The Journal of Urology, 175(2), 601-604. doi: org/10.1016/S0022-5347(05)00242-9
Australian Government Department of Health and Ageing. (2007). What now? Helping clients live positively with urinary incontinence. Retrieved from http://www.bladderbowel.gov. au/assets/doc/helpingclients.pdf
Bradway, C., & Cacchione, P. (2010). Teaching strategies for assessing and managing urinary incontinence in older adults. Journal of Gerontological Nursing, 36(7), 18-26. doi;10. 3928/00989134-20100602-03
Collette, C., Leclerc, G., & Tu, L. (2003). Effectiveness of a geriatric urinary incontinence educational program for nursing staff. Nursing Leadership, 16(4), 99-109. doi:10.12927/cjnl.2003.16264
Cooper, G., & Watt, E. (2003). An exploration of acute care nurses' approach to assessment and management of people with urinary incontinence. Journal of Wound, Ostomy, and Continence, 30, 305-313. doi:10.10 16/mjw.2003.157
Coyne, K.S., Wein, A., Nicholson, S., Kvasz, M., Chen, C., & Milsom, I. (2014). Economic burden of urgency urinary incontinence in the United States: A systematic review. Journal of Managed Care Pharmacy, 20(2), 130-140.
Davis, C. (2008). The cost of containment. Nursing Older People, 20(3), 24-26.
Day, K. (2000). Urinary continence promotion: A role for all nurses. Collegian, 7(4), 40-42. doi:10.1016/S 1322-7696(08)60390-X
Dorfman, L.T., Murty, S.A., Ingram, J.G., & Li, H. (2008). Faculty and community partners in gerontological curriculum enrichment. Educational Gerontology, 34, 1087-1104. doi:10.108 0/03601270802201398
Dowling-Castronovo, A., & Specht, J.K. (2009, February). Assessment of transient urinary incontinence in older adults. American Journal of Nursing, 109(2), 62-71. doi:10.1097/01,NAJ.0000345392.52704.6d
Ehlman, K., Wilson, A., Dugger, R., Eggleston, B., Coudret, N., & Mathis, S. (2012). Nursing home staff members' attitudes and knowledge about urinary incontinence: the impact of technology and training. Urologic Nursing, 32(4), 204-213.
Ferrario, C.G., Freeman, F.J., Nellett, G., & Scheel, J. (2008). Changing nursing student's attitudes about aging: An argument of the successful aging paradigm. Educational Gerontology, 34, 51-66. doi:10.1080/036012 70701 763969
Gebhardt, M.C., Sims, T.T., & Bates, TA. (2009). Enhancing geriatric content in a Baccalaureate nursing program. Nursing Education Perspectives, 30(4), 245-248.
Heise, B.A., Johnsen, V., Himes, D., & Wing, D. (2012). Developing positive attitudes toward geriatric nursing among millennials and Generation Xers. Nursing Education Perspectives, 33(3), 156-161. doi:10.54 80/1536-5026-33.3.156
Henderson, J.S., & Kashka, M. (1996). Nurses' attitude, belief, practice, and knowledge regarding urinary incontinence in adults: Lisrel analysis of a model. Unpublished manuscript.
Henderson, J.S., & Kashka, M.S. (1999). Development and testing of the urinary incontinence scales. Urologic Nursing, 19(2), 109-119.
Henderson, J.S., & Kashka, M.S. (2000). Effect of knowledge, attitude, and belief on nurses' practice regarding urinary incontinence in adults. Urologic Nursing, 20(5), 291-294, 297-298, 305.
Herbruck, L.F. (2008). Stress urinary incontinence: Prevention, management, and provider education. Urologic Nursing, 28(3), 200-207.
Hu, T.W., Wagner, T.H., Bentkover, J.D., Leblanc, K., Zhou, S.Z., & Hunt, T. (2004). Costs of urinary incontinence and overactive bladder in the United States: A comparative study. Urology, 63(3), 461-465. doi:10.10 16/j.urology.2003.10.037
Karlowicz, K.A. (2009). Evaluation of the Urinary Incontinence Scales to measure change after experiential learning: A pilot study. Urologic
Nursing, 29(1), 40-46.
Karlowicz, K.A., & Palmer, K.L. (2006). Engendering student empathy for disabled clients with urinary incontinence through experiential learning. Urologic Nursing, 26(5), 373-379.
Keilman, L.J., & Dunn, K.S. (2010). Knowledge, attitudes, and perceptions of advanced practice nurses regarding urinary incontinence in older adult women. Research and Theory for Nursing Practice: An International Journal, 24(4), 260-279. doi:10.1891/1541-65 22.214.171.1240
Kelly, A.M., & Byrne, G. (2006). Role of the continence nurse in health promotion. British Journal of Nursing, 15(4), 198, 200, 202, 204.
Landefeld, C.S., Bowers, B.J., Feld, A.D., Hartman, K.E., Hoffman, E., Ingber, M. J., ... Track, B.J. (2008). National Institute of Health state of the science statement: Prevention of fecal and urinary incontinence in adults. Annals of Internal Medicine, 148(6), 1-10. doi:10.7326/0003-4819-148-6200803180-00210
Litwin, M.S., & Saigal, C.S. (2012). Urologic Diseases in America. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: U.S. Government Printing Office.
National League for Nursing (NLN). (2008). Percentage of minority students enrolled in basic RN programs by race-ethnicity and program type. Retrieved from http://www.nln.org/research/slides/topic_nursing_stud_ demographics.htm
Newman, D.K., Ee, C.H., Gordon, D., Srini, V.S., Williams, K., Cahill, B., ... Norton, N. (2009). Continence promotion, education, and primary prevention. In P. Abrams, L. Cardozo, S. Khoury, & A. Wein (Eds.), Incontinence: 4th International Consultation on Incontinence, Paris July 58th, 2008 (pp. 1643-1684). Retrieved from http://www.ics.org/Publications/ICI_4/book.pdf
O'Connor, A.B. (2006). Clinical instruction and evaluation: A teaching resource. Sudbury, MA: Jones and Bartlett.
Peplar, J., & Wragg, L. (2010). Development of a multidisciplinary continuing care continence assessment tool and continence care pathway. Australian and New Zealand Continence Journal, 16(2), 14-16, 18, 20, 22-23.
Polit, D., & Beck, S. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer Lippincott, Williams & Wilkins.
Rigby, D. (2003). The value of continence training: Does it change clinical practice?. British Journal of Nursing, 12(8), 484-492.
Rogalski, N.M. (2005). A graduate nursing curriculum for the evaluation and management of urinary incontinence. Educational Gerontology, 31, 139-159. doi:10.1080/036012705908 91531
Saxer, S., De Bie, R.A., Dasseb, T., & Halfens, R.J. (2008). Nurses' knowledge and practice about urinary incontinence in nursing home care. Nurse Education Today, 28, 926934. doi:10.1016/j.nedt.2008.05.009
Sharaf, A.Y., El Sebai, N.A., Ewieda, S.M., Shokry, M.S., & Salem, M.A. (2010). The impact of nursing interventions on the control of urinary incontinence among women. Journal of American Science, 6(10), 1256-1271.
Smith, A.L., Wang, P., Anger, J.T., Mangione, C.M., Trejo, L., Rodriguez, L.V., & Sarkisian, C.A. (2010). Correlates of urinary incontinence in community-dwelling older Latinos. Journal of the American Geriatrics Society, 58(6), 1170-1176.
Spencer, J. (2009). Reducing barriers and improving access to continence care: examining the evidence. Urologic Nursing, 29(6), 405-414.
Thompson, D., & Smith, D.A. (2002). Continence nursing: A whole person approach. Holistic Nursing Practice, 16(2), 14-31.
U.S. Department of Health and Human Services. (2012). Healthy people 2020 [Educational standards]. Retrieved from http://www.healthy people.gov/2020/default.aspx
Wilson, L. (2003). Continence and older people: the importance of functional assessment. Nursing Older People, 15(4), 22-28.
Wright, J., McCormack, B., Coffey, A., & McCarthy, G. (2006). Developing a tool to assess person-centered continence care. Nursing Older People, 18(6), 23-28.
Jennifer Hutchings, MSN, FIN, is a Nursing Instructor, College of Western Idaho, Nampa, ID.
Leonie Sutherland, PhD, FIN, is a Professor, Northwest Nazarene University, Nampa, ID.
Table 1. Student's Average and Cumulative Belief and Attitude Average Cumulative Mean Average Score Range Score Range Attitude 4.77 1 to 6 90.67 19 to 114 Belief 4.26 1 to 6 98.03 23 to 138 Table 2. Traditional and Non-Traditional Students Average Attitude and Belief Scores Attitude Belief Range Total group 4.77 4.26 1 to 6 Traditional 18 to 25 4.65 4.26 Non-traditional 26 to 50 4.94 4.27 Table 3. Significant Differences between Traditional and Non- Traditional Students Tradtional Non-Tradtional (n = 30) (n = 30) Mean SD Mean SD Attitude Subscale Working with men who have UI is an 4.03 1.21 5.0 1.11 unpleasant experience. Working with women who have UI is an 4.60 1.00 5.13 0.88 unpleasant experience. The doctor rather than the nurse should 4.56 0.93 5.18 0.85 discuss UI with the client. Beliefs In men UI is a hopeless situation. 4.53 1.04 5.09 0.83 UI is a depressing condition for men to 4.36 0.99 5.0 0.89 have. Having UI results in isolation. 3.46 1.30 4.47 1.47 Having UI is disgusting. 4.76 0.97 4.81 1.22 t P Attitude Subscale Working with men who have UI is an -2.97 unpleasant experience. Working with women who have UI is an -2.03 0.047 unpleasant experience. The doctor rather than the nurse should -2.46 0.019 discuss UI with the client. Beliefs In men UI is a hopeless situation. -2.05 0.045 UI is a depressing condition for men to -2.37 0.024 have. Having UI results in isolation. -2.52 0.013 Having UI is disgusting. 1.98 0.049 Note: These Attitude and Belief subscale questions demonstrated significance Figure 1. Urinary Incontinence (UI) Scales--Selected Questions on Attitude and Belief Attitude * Working with men who have UI is an unpleasant experience. * Working with women who have UI is an unpleasant experience. * The doctor rather than the nurse should discuss UI with clients. Belief * In men, UI is a hopeless situation. * UI is a depressing condition to have. * Having UI results in isolation. * Having UI is disgusting. Source: Reprinted with permission from Jane Schade Henderson, PhD, RN.
|Printer friendly Cite/link Email Feedback|
|Author:||Hutchings, Jennifer; Sutherland, Leonie|
|Date:||Nov 1, 2014|
|Previous Article:||Two sessions of behavioral urotherapy for bowel and bladder dysfunction: does it get any better?|
|Next Article:||Starting the conversation.|