Consider Your Continence Consciousness

In a recent column in Wounds,¹ Laura Bolton explored preventing injury due to patient falls in the acute care setting.^2,3 As a Faller (pun intended), I was amused to see how at-risk patients were identified as fallers; that’s my family. As a certified wound ostomy continence (WOC) nurse, I was delighted to see how assisted toileting was considered a fall intervention. WOC nurses should be pleased about suggestions to time trips to the bathroom or to remind a patient to ask for bathroom help. Both interventions will go a long way in promoting continence, as well as preventing falls.

Additional interventions that can be used in the acute care setting to promote continence address Accessibility and Visibility, Comfort, and Privacy. Ask yourself the following questions and consider whether these interventions can be instituted at your facility.

Accessibility and Visibility 

• Are toileting aides (urinals and commodes) left near the patient’s bedside?

• Are mobility aides (walkers and canes) left near the patient’s bedside?

• Do you find out how the patient indicated a need to toilet prior to admission?

• Do you use plain, age-appropriate verbiage when asking to toilet?

• Do you have a communication system for nonverbal patients?

• Have you alerted your patients to the location of the bathrooms?

• Are your bathrooms readily visible with adequate signage at eye level?

Comfort

• Do you arrange pain medication schedules that allow comfortable ambulation?

• Do you have female urinals?

• Do you stand males to void?

Privacy

•  Do you close doors and pull curtains when the patient is toileting?

•  Do you provide appropriate clothing (to cover the johnny split) if the bathroom is in the hall? 

There are many reasons why patients who enter the acute care setting continent may leave incontinent with an absorbent product or an indwelling catheter. These tools must not be our first line of defense. Thelma Wells, RN, PhD, FAAN, FRCN, a nursing continence trailblazer, once said more attention is paid to protecting the environment from urine than using the environment to promote continence; she also said an adequate number of positive-thinking caregivers is necessary to promote continence.⁴ 

Are you putting your hospital environment to its best use? Do you have a team of Continence Champions in your hospital? I challenge you: Look for coworkers who have an interest in promoting continence. Start your own continence squad. Be a continence diva.

We also need to think beyond acute care and be attentive to the needs of patients who are admitted with incontinence. Using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT) model,⁵ we must be prepared to refer the patient to postacute care services in the home or a clinic. As such, you need to know your community resources.

I am grateful to Laura Bolton for bringing this research to our attention; to Wound Management & Prevention for providing me the opportunity to take the soapbox regarding incontinence; to Katherine Feagin Jeter, EdD, ET, (my mentor), for instilling in me a passion for continence; and to all the WOC nurses who are dedicated to incorporating continence into their daily scope of practice. Let’s start the new year determined to be more conscious of and act upon the fact that there is more to continence than diapers!