Urinary Incontinence in Older Adults: A Nursing Perspective

This assignment focuses on urinary incontinence in older adults, examining the various factors influencing its prevalence and management within a nursing context. Students will critically appraise qualitative and quantitative research studies related to this topic, focusing on self-management programs, medication considerations, and the lived experiences of both patients and caregivers. The analysis will culminate in a comprehensive understanding of evidence-based practices for providing effective care to older adults experiencing urinary incontinence.

Running Head: Nursing assignment
Nursing assignment
Name of the Student
Name of the University
Author Note

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Introduction
The aim of the report is to respond to the case study of Mr. Brian experiencing
incontinence. The contributing factors to the incontinence and the continence issues are
discussed. To promote continence in Brian, health promotion involves the process of increasing
his control over and improves the health. For this purpose two-research articles on one initiative
or innovation program is critically analysed and based on the evidence obtained the report
recommends how registered nurses can improve personal practice and the practice of others.
Contributing factors to Brian’s continence problems
Incontinence and the problems related to continence are the indicators of the bladder and
bowel dysfunction. It is the most common problem occurring in the old age but is never normal.
Thus, age is not causative e but contributing factor for incontinence, which is also found in case
of Brian (Watt et al. 2014). He is 82 years old man and his age may be considered contributing
factors for his continence problems.
According to Johnson and Chang (2014), urinary and faecal incontinence in elderly
patients is caused by strokes. From the patient history, it can be interpreted that the ischemic
heart diseases and heart failure is the contributing factor of Brian’s faecal and urinary
incontinence. Bladder dysfunction also results from the spinal disorders and osteoarthritis
(Bedretdinova et al. 2016). In neurogenic bladder disorder there is damage to the nerve tissues
that control the functioning of the bladder and the muscles involved in urination and bowel
movement. Brian’s, spondylitis may be the other contributing factor (Panicker et al. 2015). The
possible complications of spondylitis are the urinary and faecal continence (Bagnola et al. 2017).

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Not drinking enough water is the contributing factor for inflamed bladder wall. In case of
Brian, it was seen he consumed more of wine and coffee and less of water. Drinking tea or
coffee aggravates the bladder, which makes the incontinence a likely occurrence (Watt et al.
2014). Wine acts as a bladder stimulant (Johnson and Chang 2014). Faecal incontinence can be
caused by constipation. Brian opens his bowel every 2-3 days. Thus, constipation may be the
contributing factor for the continence issues observed in Brian. According to Loening‐Baucke
and Swidsinski (2015) faecal impaction causes difficult bowel moment and is the cause of the
lower gastrointestinal tract obstruction. It is commonly found in elderly people with the
constipation. The same may be the causative factor of Brian bowel problems and it was found
from the case study that his abdominal examination showed lower left abdominal faecal masses.
Since, Brian is undergoing treatment and medication for his ailments; the side effects of
the medicines are having adverse effects on his bladder function. Brian is taking frusemide and
spiractin, which is diuretic that increases urine volume. Amiodorone taken by him shows the beta
blocker-like and calcium channel blocker-like actions and is known for urinary incontinence and
constipation. Brian also takes tramadol which is the opioid that causes the reduce bladder
contractions, constipation (Hussain and Gill 2016).
Main continence issues
The main urinary incontinence issues faced by Brian is the voiding of urine 9-12 times a
day and 2-3 times overnight, he feels the urgency to void on most occasions. Sometimes Brian is
not aware of leakage. He opens his bowel every 2-3 days and each bowel action is associated
with straining and urgency. These issues can be categorised as urge continence in Brian. Urge
continence refresh to the condition where the loss of urine is accompanied with the urgent need

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to urinate. This mainly occurs due to involuntary actions of the bladder after stroke (Johnson and
Chang 2014). Brian condition can also be related to the overflow continence. It is the condition
where the bladder never completely empties. It is due to this reason that Brian voids urine 3-4
times a day with small volume of urine loss. Brian’s functional incontinence that is unable to
make up to the bathroom at night. It can be caused by the stroke complications and the
neurological disorder that he is having. His mind cannot carry or plan the trip to bathroom (Watt
et al. 2014).
Incontinence in elderly patients is difficult to treat, as they are reluctant to seek help due
to embarrassment. Lack of awareness and effective communication with the health care
providers is the other major cause of poor services (Watt et al. 2014). It can be concluded that
Brian needs comprehensive health care plan because he is having chronic heart illness along with
several comorbidities that result in interrelated complications. This demands the multifaceted
approach. Thus, the nursing care plan must address the health issues using evidence-based
practice. There is a need of joint approach and strategies for achieving the best outcome for
Brian considering his age, coronary heart disease, spondylitis, incontinence, walking disability
and overall weakness (De Gagne et al. 2015).
Critical analysis research articles
Article 1
In the article by De Gagne et al. (2015), the aim of the pilot study is to develop,
implement and determine the effectiveness of the self-management program that is evidence
based for community-dwelling older women (aged 55 years) with urinary incontinence in South
Korea. The rational for conducting this study is evident from the succinct background provided

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by the author that demonstrates the through literature review being conducted (Schneider and
Whitehead 2013). Thus, the objective of the paper is justified by the following objectives-
 Evaluation of the participants outcomes regards to the severity of the symptoms
of incontinence
 Evaluation of the fidelity of the implemented programs
 Determine the participants response or satisfaction with the program
Considering the research objectives the research topic was well justified although there
was no hypothesis given.
The study uses quantitative research paradigm and involves a one-group pre- post-test
design. The instrument used for the data collection includes “Sociodemographic questionnaire,
knowledge scale and attitude scale, ICIQ-SF, Short Assessment Patient Satisfaction, Fidelity
evaluation checklist. The research design is justified as the methodology is well described in
terms of the participants and each of the instrument used for data collection is well explained. It
constitutes the strength of the study as it eliminates the limitations by detailed description of
participants, the inclusion and exclusion criteria that were found justified (LoBiondo-Wood and
Haber 2017). The author had clearly mentioned the setting of the research as Sosa community
(Korean rural community) but the lack of details on it is inconvenient for the readers. The
research seems to be reliable. Obtaining ethics approval implies that the ethical issues were taken
into considerations (Moralejo et al. 2017).
In the study, 17 women participated and completed weekly 90-min group sessions for 5
weeks. The strength of intervention emerges from the teaching topics that are described in lucid
language. However, drawback involves lack of details on the sampling method (LoBiondo-Wood

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et al. 2014). It includes self-management principles, behavioral and lifestyle factors on bladder
health, effective communication, myths and facts about UI, and interactions with family and
friends.
The limitation of the study is the lack of sufficient description of data analysis. However.
It was justified that the study used descriptive statistics and paired t-tests. The results are well
documented by the author in form of tabulated charts with flawless presentation of the statistical
values (p < 0.05). The presentation of the results under individual subheadings gives the readers
an in-depth insight of the study outcomes. Acknowledgement of the limitations adds to the
strength of the study (Coughlan et al. 2007).
The findings of the study showed an improved outcomes with the implementation of the
self-management program of the urinary incontinence despite the scarce resources in the rural
communities for urinary incontinence management and treatment. The findings are clearly stated
by the author emphasising on the potential of this program and its widespread implementation in
the nursing practice. This constitutes the strength of the study as the results were found to be
statistically significant. However, there should have been more details on validity although the
research appears reliable (Moralejo et al. 2017).
Overall, it can be concluded from the quantitative study that increase in the self-
management of the disease was found by an increase in the knowledge and positive attitudes
toward it.
Article 2
In the article by the Wilde et al. (2014), the aim is to discuss the “the principles of self-
management and their application in treating urinary and faecal incontinence”. The objective of

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the paper justifies the research aims and appears relevance. The objective is to describe the
patient’s benefits by applying the self-management techniques to address incontinence together
with the case scenario.
The author initially detailed the key elements of the self-management and highlights on
the patient management of the physical, psychosocial, emotional, and functional aspects of
health. The need of patient self-efficacy and participation in the collaborative process of care
implies for the role of the nurse. The strength of the review paper is emphasis on the three
processes that a patient requires for self-management of illness. It includes “focussing on illness
needs, making use of health care resources, and living with the chronic illness”. The strength of
the paper is the thorough literature review along with the support of relevant theories (Aveyard
2014).
The author further elucidates the precondition for success for self-management of urinary
or faecal incontinence. The treatment of any underlying etiologies is the precondition. The author
highlights the six specific self-management behaviours that come into play during the self-
management. It includes-
 Problem identification- which in this case is incontinence
 Seeking evidence-based knowledge- about the range of interventions
 Decision-making for resource use and interventions by the patent
 Development and implementation of the action plan- by the patient
 Self monitoring- of self management strategies
 Goal setting and attainment

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The strength of the paper further emerges from the explanation of each of six steps that
acts as a framework for the nurses and the patients to promote the continence and self-efficacy in
patients (Kisely and Kendall 2011). This can be considered advantage as it is not possible to
deliver the supporting interventions without these strategies. Highlighting these options may be
considered the merits of research.
The limitation of the review paper comes from the use of case scenario from author’s
persona experience. It makes the results and conclusions unreliable. The author had not
mentioned search strategy for other papers used in the study and there is no details on the
validity and reliability of study (Aveyard 2014).
The results of the paper showed that the patient Donna Spencer, 69, diagnosed with
urinary incontinence, after six week of self-management found improvement in her condition.
The patient modified the amount of the fluid intake (less tea, and coffee and more water),
engaged in exercises for pelvic floor muscle, the rapid pelvic contraction exercises, underwent
the bladder training (cognitive motivation), including modifying voiding intervals, reduced
weight, and lastly constipation management (Wilde et al. 2014). The strength of the paper comes
from the strategies for managing faecal or dual incontinence such as dietary modification use of
toilet supplies to prevent leakage etc. This informs the readers on how to implement the
strategies.
Overall, this article provides evidence, even though of low quality on improvement of
urinary incontinence by self-management using evidence based strategies.

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Recommendations and conclusions
Based on the above discussion it can be concluded that the registered nurses should not
only focus on the Brian’s medical aspects but also on the psychosocial, functional, and
behavioural aspects of wellbeing. While implementing the intervention the role of the nurses for
patients like Brian in promoting the urinary incontinence should be to educate patients on self-
management of urinary incontinence (De Gagne et al. 2015). The nurse must help Brian focus
on illness, make use of social, spiritual and environmental support and help the patients to make
practical lifestyle modifications. It may include decrease coffee consumption for Brian. The
nurse can promote the six specific self-management behaviours for patients with urinary
incontinence mentioned in the above article.
The nurse must implement person-centered care and encourage other nurses to do the
same. In this approach, the nurse demonstrates sensitivity to changes in care delivery. In
personal practice, the nurse must increase engagement in “Clinical, educational, managerial,
audit and research activities” (Hägglund et al. 2017). The rationale for this engagement is to
implement the evidence-based practice. It will enhance their contribution to continence care.
Evidence based practice helps the nurses feel more comfortable to asses patients with faecal and
urinary incontinence. The nurses must collaborate with their colleagues who are Specialist
Continence Physiotherapist (Hägglund and Olai 2016). Implementing this recommendation will
help a nurse to influence the practice of other nurses as well.
It can be concluded from the critical analysis that care plan for Brian must involve
educating patient on self-management strategies for urinary incontinence. The self-management
may include adequate fluid intake, a healthy diet, healthy lifestyle, effective toilet habits and
pelvic floor muscle maintenance.

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References
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McGraw-Hill Education (UK).
Bagnola, E., Pearce, E. and Broome, B., 2017. A Review and Case Study of Urinary
Incontinence. Madridge J Nurs, 2(1), pp.27-31.
Bedretdinova, D., Fritel, X., Zins, M. and Ringa, V., 2016. The effect of urinary incontinence on
health-related quality of life: is it similar in men and women?. Urology, 91, pp.83-89.
Coughlan, M., Cronin, P. and Ryan, F., 2007. Step-by-step guide to critiquing research. Part 1:
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De Gagne, J.C., So, A., Wu, B., Palmer, M.H. and McConnell, E.S., 2015. The effect of a
urinary incontinence self-management program for older women in South Korea: A pilot
study. International Journal of Nursing Sciences, 2(1), pp.39-46.
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Johnson, A. and Chang, E., 2014. Caring for older people in Australia: Principles for nursing
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