Urinary incontinence (UI) significantly impacts the quality of life for older adults, particularly those in long-term care (LTC) facilities. Accurate assessment and effective management of UI are crucial in this population. This article delves into the implementation and utilization of bladder scanners as a valuable tool in nursing care to improve continence management for older adults in LTC settings. We will explore the knowledge gaps among nursing staff regarding continence care and bladder scanner technology, highlighting the importance of education and training to optimize patient outcomes.
The Growing Need for Effective Continence Care in Long-Term Care
The global population is aging, with a significant rise expected in the number of older adults requiring long-term care. In Canada, adults over 65 are projected to constitute nearly a quarter of the population by 2031. This demographic shift necessitates robust and effective healthcare services tailored to the unique needs of older adults, especially in LTC environments.
Within LTC, residents often face complex health challenges. Reports indicate that a substantial majority of LTC residents experience cognitive impairment and functional limitations impacting their daily living activities. Alarmingly, a high percentage, around 69%, suffer from bladder incontinence.
Older adults are inherently more vulnerable to UI due to factors such as reduced mobility, cognitive decline (including dementia), urinary retention, and increased susceptibility to infections. It’s estimated that millions of Canadians are affected by UI, and prevalence increases with age. More than half of older adults in LTC experience UI, leading to significant healthcare costs and increased risks of infections, falls, and behavioral issues. Therefore, prioritizing continence care is paramount for enhancing the well-being of older adults in supportive care settings.
The Challenge of Urinary Tract Infections and Catheterization
Aging-related changes in the bladder elevate the risk of urinary tract infections (UTIs). Importantly, UTI symptoms often present differently in older adults compared to younger individuals. Behavioral changes may be the primary indicator of a UTI in older adults, particularly in LTC, rather than typical symptoms like urgency and frequency.
Unfortunately, catheterization remains a prevalent method for managing UI in older adults. While necessary in some cases, routine catheterization, especially intermittent catheterization to assess post-void residual volume, can cause trauma and significantly increase the risk of UTIs. Indwelling urinary catheters are associated with a large proportion of UTIs, approximately 80%.
Bladder Scanners: A Non-Invasive Solution for Better Assessment
Portable bladder ultrasound scanners, or bladder scanners, offer a promising alternative to reduce unnecessary catheterizations. These devices are non-invasive and accurately measure bladder volume, aiding in the assessment of bladder function. Studies suggest that utilizing bladder scanners can effectively decrease the incidence of UTIs.
Bladder scanners are recognized for their accuracy in determining urine volume, regardless of patient positioning, diagnosis, or scanner model. Their use is well-established in acute care settings, demonstrating clear benefits. However, LTC facilities have been slower in adopting bladder scanners as a standard practice for continence care.
Evaluating Bladder Scanner Implementation in Long-Term Care
Recognizing the potential of bladder scanners, initiatives like the General Practice Services Committee (GPSC) in British Columbia have funded the purchase of these devices for LTC homes. This initiative aimed to address the high prevalence of UI in LTC, reduce associated complications, and prevent hospital transfers, ultimately improving patient care.
An evaluative study was conducted to assess the implementation of bladder scanners in LTC settings. This study not only focused on the practical use of the scanners but also explored nursing staff’s knowledge and decision-making processes concerning continence care and the integration of bladder scanners into their practice. The goal was to determine the extent to which bladder scanners were being utilized and identify areas where enhanced staff education could improve the quality of life for older adults through better continence management. The findings from this study hold implications for policy development and broader implementation strategies for bladder scanners across LTC facilities.
Mixed-Methods Approach to Understanding Bladder Scanner Use and Nursing Knowledge
A mixed-methods research design was employed to evaluate the implementation of bladder scanners in six LTC homes. Nursing staff, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Health Care Assistants (HCAs), participated in the study. Data collection involved:
- Demographic Questionnaire: To gather information about the participants’ roles and experience.
- Bladder Care Knowledge Survey: Adapted from an existing survey, this tool assessed nursing staff’s understanding of UI and bladder scanner use through true/false questions.
- Focus Group Discussions: These sessions provided qualitative data, exploring in-depth nursing staff’s knowledge, attitudes, and experiences related to continence care and bladder scanners.
This multi-faceted approach allowed for a comprehensive understanding of both the quantitative aspects of knowledge and the nuanced perspectives of nursing staff in real-world LTC settings.
Key Findings: Knowledge Gaps and Varied Bladder Scanner Utilization
The study involved 28 nursing care staff members. The results revealed significant variations in continence care knowledge among different professional roles. Notably, the use of bladder scanners was influenced by staff knowledge, training levels, and perceived scopes of practice.
Survey Results: Identifying Knowledge Deficits
Analysis of the bladder care knowledge surveys highlighted potential knowledge gaps. A concerning percentage of nursing staff incorrectly believed that UI is a normal part of aging. This misconception was more prevalent among HCAs. Similarly, a significant number of participants lacked awareness regarding urinary retention in older adults and the potential for UI to be addressed and improved.
Perhaps most critically, a large majority of participants incorrectly indicated that “in and out” catheterization is the best method for determining post-void residual volume, demonstrating a lack of understanding of less invasive alternatives like bladder scanning. This misconception was particularly pronounced among LPNs.
The survey results underscored the need for targeted education to address specific knowledge deficits related to continence care and the appropriate use of bladder scanners.
Focus Group Insights: Barriers and Facilitators to Bladder Scanner Use
Focus group discussions provided valuable qualitative data, revealing key themes related to bladder scanner implementation:
- Limited Bladder Scanner Use: Participants reported that bladder scanners were primarily used during admission assessments, rather than as a routine tool for ongoing continence management. Assessments were often based on existing records or visual checks rather than proactive bladder scanning.
- Role and Training Influence Use: HCAs, who constitute a significant portion of LTC nursing staff, generally reported not being trained to use bladder scanners and thus did not incorporate them into their practice. RNs and LPNs were more likely to use scanners, often triggered by specific symptoms or physician orders.
- “Spidey Sense” vs. Objective Assessment: The reliance on intuition (“spidey sense”) for assessing urinary issues was mentioned, highlighting a potential gap in consistent, objective assessment practices.
- Training Variability and Needs: Training on bladder scanners was inconsistent across facilities. Some staff received formal training from product representatives or designated champions, while others received minimal or no training. HCAs expressed interest in receiving training, recognizing the value of bladder scanners.
- Lack of Specific Policies: A significant finding was the absence of specific policies and procedures guiding bladder scanner use in LTC settings, contributing to inconsistent application.
- Accessibility Challenges: Physical accessibility to bladder scanners emerged as a barrier. Limited numbers of scanners per facility and storage issues hindered timely access when needed.
- Scope of Practice Concerns: Some participants, particularly RNs and LPNs, raised concerns about whether using bladder scanners fell within their defined scopes of practice, highlighting potential confusion or restrictions.
These qualitative findings illuminated the practical challenges and organizational factors impacting the effective integration of bladder scanners into daily nursing care routines in LTC.
Discussion: Bridging the Gap Between Evidence and Practice
This study reinforces the evidence supporting the benefits of bladder scanners in reducing unnecessary catheterizations and UTIs, particularly in vulnerable populations like older adults in LTC. However, the findings also reveal significant barriers hindering the widespread and effective adoption of this technology in LTC settings.
Addressing Barriers to Bladder Scanner Adoption
Several factors contribute to the limited uptake of bladder scanners in LTC:
- Insufficient Training and Education: Lack of adequate training on both bladder scanner operation and comprehensive continence care knowledge is a primary obstacle.
- Accessibility and Logistics: Limited equipment availability and logistical challenges in accessing scanners when needed impede their routine use.
- Lack of Clear Protocols and Policies: The absence of specific guidelines for bladder scanner use in LTC creates ambiguity and inconsistent practices.
- Scope of Practice Uncertainty: Unclear or restrictive scopes of practice may prevent some nursing staff from fully utilizing bladder scanners.
Overcoming these barriers requires a multi-pronged approach focusing on education, policy development, and resource allocation.
Maximizing Nursing Expertise and Scope of Practice
The increasing complexity of care needs in LTC necessitates leveraging the full potential of all nursing staff roles. This includes expanding the scope of practice for HCAs, who are integral members of the care team and have close relationships with residents. HCAs’ expressed interest in bladder scanner training and their understanding of its benefits highlight an untapped resource.
Empowering HCAs with appropriate training and clearly defined roles in continence care, including bladder scanner use, can significantly enhance the capacity of LTC facilities to provide proactive and person-centered care. This requires collaborative efforts to define and expand scopes of practice, ensuring all team members can contribute to their fullest potential.
The Crucial Role of Continence Care Knowledge
Effective continence management goes beyond simply using technology like bladder scanners. It requires a solid foundation of knowledge about UI, its causes, assessment methods, and evidence-based interventions. The study revealed knowledge deficits among nursing staff regarding basic continence care principles, such as the misconception that UI is a normal part of aging.
Addressing these knowledge gaps through targeted education programs is essential. Improving nursing staff’s understanding of continence care will not only enhance their ability to utilize bladder scanners effectively but also foster a more proactive and person-centered approach to continence management overall. Education should emphasize evidence-based assessment techniques, individualized care planning, and strategies for preventing and managing UI.
Moving Forward: Education, Policy, and Research
The findings of this study underscore the critical need for comprehensive strategies to improve continence care in LTC. Key recommendations include:
- Developing and Implementing Standardized Continence Care Education Programs: These programs should target all levels of nursing staff and encompass both fundamental continence care knowledge and practical training on bladder scanner use.
- Establishing Clear Policies and Procedures for Bladder Scanner Utilization in LTC: Facilities should develop specific guidelines outlining when and how bladder scanners should be used, ensuring consistent and appropriate application.
- Addressing Scope of Practice Issues: Clarifying and potentially expanding scopes of practice to enable all qualified nursing staff to utilize bladder scanners to their full potential is essential.
- Improving Bladder Scanner Accessibility: Facilities should assess the number and placement of bladder scanners to ensure timely and convenient access for nursing staff.
- Further Research on Educational Interventions: Future research should focus on evaluating the impact of continence care education programs, including bladder scanner training, on patient outcomes, staff competence, and cost-effectiveness in LTC settings.
By prioritizing education, policy development, and ongoing research, we can bridge the gap between evidence and practice, maximizing the benefits of bladder scanning technology and ultimately improving the quality of life for older adults in long-term care.
Limitations of the Study
It’s important to acknowledge the limitations of this study. The Bladder Care Knowledge Survey used was not formally validated, and the small sample size limited the ability to perform advanced statistical analyses. Therefore, the survey results should be interpreted cautiously. However, the mixed-methods design, incorporating qualitative focus group data, strengthened the findings through data triangulation.
Additionally, the study findings may not be directly generalizable to all LTC facilities due to the specific context of the participating homes. Finally, the inclusion of all nursing staff roles in the same focus groups could have introduced a power dynamic, potentially influencing open sharing of views.
Despite these limitations, this study provides valuable insights into the real-world challenges and opportunities associated with bladder scanner implementation and continence care in LTC.
Conclusion: Advancing Continence Care Through Bladder Scanning and Education
This evaluative study highlights the potential of bladder scanners to enhance continence care for older adults in LTC. However, realizing this potential requires addressing critical gaps in nursing staff knowledge, training, and organizational support. Effective implementation of bladder scanners is not solely about technology acquisition; it is fundamentally linked to comprehensive staff education, clear scopes of practice, and supportive policies.
Investing in robust continence care education programs that include bladder scanner training is crucial for empowering nursing staff to provide optimal care. Future research should focus on the impact of such educational interventions on improving patient outcomes and fostering a culture of evidence-based continence management in long-term care. By prioritizing these areas, we can significantly improve the lives of older adults in LTC, ensuring dignity, comfort, and enhanced well-being through effective bladder scanning and comprehensive nursing care.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a Canada Institutes of Health Research – Institute of Community Support: Planning & Dissemination Grant #402832.
Ethical Approval: Ethical approval and certification (101558) was granted by the Thompson Rivers University’s Research Ethics Board.
ORCID iD
Tracy M. Christianson https://orcid.org/:0000-0003-3161-9466
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