Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gewählte Publikation:

Hödl, M.
Project INContinence care - Research focussing on Austrian nursing homes -
Doktoratsstudium der Sozial- und Wirtschaftswissenschaften; Gesundheits- und Pflegewissenschaft; [ Dissertation ] Graz Medical University; 2018. pp.


Autor/innen der Med Uni Graz:
Hödl Manuela
Lohrmann Christa

Incontinence is a highly prevalent and burdensome problem in the aging population. The overall aims of this doctoral thesis are to (1) describe influencing factors as well as the quality of care in the Austrian health care setting regarding incontinence and to (2) adapt evidence-based nursing recommendations for the conservative management of urinary incontinence, defined as any involuntary loss of urine, in nursing homes and test the effectiveness of their introduction. The first chapter provides general background information and presents the theoretical framework for this doctoral thesis, called P-INC (Project INContinence). Subsequently, the research problems, aims and research questions are illustrated and described. In the second chapter, an overview of methodological aspects of the studies with regard to their designs, sampling, settings, data collection methods and analyses is presented. Chapter three to six presents the studies 1A, 1B, 2 and 3 for this dissertation, that were published in/submitted to international peer reviewed journals. The results of the conducted studies indicate that a typical UI resident is care dependent, especially while dressing and undressing. A typical UI patient is older than 77.5 years and completely, or to a great extent, care dependent regarding hygiene. In summary, the revealed interactions affect the prevalence of incontinence and differ according to the type of incontinence and setting. Besides, the study findings also revealed that the prevalence of all types of incontinence was high and training interventions (e.g., bladder training) were only delivered to a small proportion of residents with incontinence. Due to this high prevalence and the low rate of training interventions used, ongoing efforts to improve the quality of incontinence care are warranted. In the next study the adaptation of international guideline recommendations for the conservative management of urinary incontinence (UI) in Austrian nursing home residents following the ADAPTE-process was done. We identified 116 guideline recommendations, of which 29 were applicable in the Austrian nursing home setting according to the external reviewers. In the last step the effectiveness of the introduction of conservative urinary incontinence management recommendations among female nursing home residents by a cluster RCT was performed. Residents in the intervention group (IG) had a lower risk of experiencing daily UI and were less likely to receive absorbent products than residents in the control group (CG). Residents in the IG were five times more likely to receive recommended interventions (e.g., bladder training for the management of UI) than residents in the CG. Based on the results of this study, the conclusion can be drawn, that introducing guideline-compliant management recommendations in nursing practice can increase the use of evidence-based interventions for the conservative management of UI. In Chapter seven, a brief summary and discussion of the main findings is provided. The limitations and strengths of the studies conducted are described and a methodological reflection on the whole thesis and the applied methods is performed. Finally, recommendations for nursing research and practice are presented.

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