"WE DO CONTINENCE!" Nurses and Therapists Collaborate to Provide Simple Continence Care to Home Care Patients

Clinical Problem: Incontinence is a primary reason for leaving one’s home. On average, women wait 6 ½ years to seek help for incontinence. Many patients with incontinence are prematurely placed on medication or referred to the urologist. Home health clinicians have an opportunity to provide continence care in the home which can greatly improve quality of life, reduce fall risk, decrease expenses, and maintain patients at home, yet continence care is often ignored.

Clinical Approach: The Continence Certified Nurse instructed more than 150 staff in nine home health offices on basic continence care. Therapists were taught simple pelvic floor strengthening exercises, not Kegels. Nurses were taught lifestyle interventions, diet and medication adjustments to improve continence, which were summarized on a one page instruction sheet prepared by the Continence Nurse.  Eighteen twice weekly tips were sent to all staff over a two month period to explain simple continence care. The home health agency provided patient kits that contained supplies for the exercises and a relaxation CD to calm bladder urges. Patient progress was tracked at the start and finish of the pelvic floor exercises using the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).

Outcome: Nurses and therapists noted that the interventions were simple to use.  Of the 21 patients tracked, 100% had improved final GSE-UI scores compared to initial scores; the average improvement in 3 to 8 weeks of treatment was 34.14 points, ranging from 11 to 83 points.

Conclusion: With simple and thorough instruction in continence care, therapists and nurses can work together to provide continence care to home care patients. Pelvic floor exercises can be effective without teaching Kegel exercises.  Continence Nurses can educate clinicians in continence care, just as is done with wound and ostomy care.