Culture, teams, and organizations: A qualitative exploration of female nurses’ and midwives’ experiences of urinary symptoms at work

Abstract

Aim To explore nurses’ and midwives’ experiences of urinary symptoms at work. Background Lower urinary tract symptoms are common in female nurses and midwives. There is limited understanding of the relationship between urinary symptoms, bladder health practices, and work. Design Qualitative design providing in‐depth exploration of nurses’ and midwives’ experiences of urinary symptoms at work through focus group discussions. Methods Twelve focus groups were held July–September 2016 with 96 Registered Nurses and midwives working at two tertiary‐referral hospitals in urban New South Wales, Australia. A semi‐structured question schedule was used. An inductive process guided thematic analysis of data using a socioecological framework of health behaviours. Results Nurses’ and midwives’ experiences of urinary symptoms at work primarily relate to delaying voiding. This practice is explained by a work culture of “patient‐first” care at expense of self‐care, relationships in the nursing team, demands of the nursing role, and inadequacy of workplace amenities. The first two themes reflect cultural and social caring dilemmas central to nursing. The second two themes identify issues with workforce management and physical workplace environments. Conclusion Nurses’ and midwives’ urinary symptoms and behaviours in response to sensory cues for bladder emptying are dependent on several socioecological influences. Occupational health initiatives in the workforce are required to break cultural norms that deter self‐care and to promote work environments that support healthy bladder practices. Workforce management and physical workplace environments are key influences on nurses’ timely and dignified access to amenities.

Delaying voiding, limiting fluids, urinary symptoms, and work productivity: A survey of female nurses and midwives

“…This may reflect the clinical workload of younger nurses (Perry et al, ) with less perceived opportunities to access the toilet. Perhaps younger nurses have not developed skills in time management related to self‐care, or lack the confidence to request support to leave duties to attend to personal needs (Pierce et al, ). Habitual suppression of the urge to void at work as these nurses’ age probably supports increased risk of LUTS in nurses compared with related general populations; however, we propose this with caution as further investigation with longitudinal studies is required to substantiate links.…”

“…Levels of influence on health behaviours for workers may include the local workplace environment (social work relationships and physical environmental factors) and system level or organizational factors such as workforce management, resources, and policies (Sallis & Owen, ). Identification of the various levels of influence on nurses’ workplace bladder behaviours through analyses of focus group discussions of Australian nurses working in busy urban settings has provided insights for organizations to develop strategies that promote healthy workplace behaviours and bladder health (Pierce et al, ).…”

“…Environmental barriers to toilet access include number, location, and cleanliness of amenities in the workplace (Pierce et al, ). Where amenities are inadequate, time to access other facilities needs to be provided.…”

“…A conceptual model of work‐related risk factors for the development of LUTS provided the theoretical framework this study (Figure ) (Liao et al, ; Pierce et al, ). In this model, work‐related factors restricting access to amenities such as adequate rest breaks and job conditions are acknowledged alongside individual characteristics and personal habits for maintenance of pelvic floor health and the experience of LUTS in women at work.…”

“…Despite national workplace health and safety legislations and regulations for the provision of adequate amenities (Australian Government, ; Worksafe Victoria, ) job demands and workplace environments of high‐income nations can restrict workers’ ability to meet these fundamental human needs (Linder & Nygaard, ; Palmer, Athanasopoulos, Lee, Takeda, & Wyndaele, ). Restricted access to toilets during work hours necessitates suppression of the urge to void, often accompanied by purposeful limitation of fluid intakes (Nygaard & Linder, ; Pierce, Perry, Gallagher, & Chiarelli, ). However, suppression of urinary urge to delay voiding may cause bladder discomfort, lead to bladder over‐distension, altered bladder sensation and increase the risk of urinary tract infections (Segal, Saks, & Arya, ).…”