Nurse Perspectives on Urinary Incontinence in the Home Hospice Setting

Michelina D Stoddard; David Russell; Margaret V McDonald; Ritchell Dignam; Kathryn H Bowles; Holly G Prigerson; Bilal Chughtai

doi:10.1016/j.jpainsymman.2020.11.028

Nurse Perspectives on Urinary Incontinence in the Home Hospice Setting

J Pain Symptom Manage. 2021 Aug;62(2):383-390. doi: 10.1016/j.jpainsymman.2020.11.028. Epub 2020 Dec 1.

Authors

Michelina D Stoddard¹, David Russell², Margaret V McDonald³, Ritchell Dignam⁴, Kathryn H Bowles⁵, Holly G Prigerson⁶, Bilal Chughtai⁷

Affiliations

¹ Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York, USA; Weill-Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA.
² Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA; Department of Sociology, Appalachian State University, Boone, North Carolina, USA.
³ Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA.
⁴ Visiting Nurse Service of New York Hospice, New York, New York, USA.
⁵ Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
⁶ Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
⁷ Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York, USA. Electronic address: bic9008@med.cornell.edu.

PMID: 33271313
DOI: 10.1016/j.jpainsymman.2020.11.028

Abstract

Context: To date, no studies have characterized the impacts of urinary incontinence (UI) at the end of life in the home hospice (HH) setting. UI is highly prevalent at the end of life and adversely affects quality of life.

Objectives: To characterize HH nurses' perspectives on UI in HH patients.

Methods: We conducted a qualitative descriptive study of interviews between HH nurses and the study investigator. Thirty-two interviews with HH nurses were transcribed and analyzed. Nurses were mostly female, college-educated, and had several years of experience in HH nursing.

Results: We identified findings in four major themes: 1) HH nurses' definition and identification of UI, 2) the absence of formal guidelines for diagnosing UI in HH patients, 3) UI's adverse effect on HH patients and their families, and 4) the lack of standardized guidelines for the management of UI in the HH setting. We found that there was a general lack of clarity on the subtypes of UI and no standardized guidelines for management of UI in the HH setting. Nurses reported that UI was bothersome to HH patients and their caregivers, citing patient discomfort, loss of dignity, and additional labor burden as reasons for this. Management strategies for UI lacked standardization.

Conclusion: UI is a prevalent and debilitating condition in HH patients. There is a need for studies to further characterize the impacts of UI on HH patients and their caregivers. Formal training on UI subtypes and management is needed to facilitate proper documentation, research, and improve patient outcomes.

Keywords: Urinary incontinence; end of life; geriatrics; home hospice; nursing.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Female
Hospice Care*
Hospice and Palliative Care Nursing*
Hospices*
Humans
Male
Quality of Life
Urinary Incontinence* / diagnosis
Urinary Incontinence* / epidemiology
Urinary Incontinence* / therapy

Grants and funding

T32 GM007739/GM/NIGMS NIH HHS/United States