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

Abstract

Aim To examine the relationships between workplace bladder practices, urinary symptoms, and work productivity. Design Cross‐sectional observational survey. Methods Surveys were distributed June–November 2016 to at least 600 female nurses and midwives at three urban hospitals in New South Wales, Australia. Nurses self‐reported restricted workplace access to toilets, delaying voiding, limiting of fluid intakes and urinary symptoms at work. Logistic modelling was used to examine whether nurses’ bladder practices impaired their time management, ability to concentrate or perform physical demands. Results Of 353 useable surveys, one in five nurses (22.4%; N = 79) reported restricted access to toilets at work, most (77.1%; N = 272) delayed voiding and one in four (26.9%; N = 95) limited fluid intakes to delay voiding at work. Almost half the sample had urinary symptoms at work (46.7%; N = 165); delaying voiding increased the likelihood of impaired mental concentration and limiting fluid intakes increased the likelihood of impaired time management. Conclusion As workplace access to toilets and related bladder practices are modifiable, associated urinary symptoms and productivity loss may be preventable. Impact Nurses’ often experience restricted accesses to amenities due to job demands and workplace environments. The impact of nurses’ poor bladder practices in the workplace is not known. In this study most nurses delayed voiding and many purposefully limited fluid intakes at work. These behaviours impacted a nurse's ability to manage time and/or concentrate at work. Results have implications for nurses’ personal health, the design of workplace environments, workforce management, occupational health policy, and patient care.

Toileting Behaviors Related to Urination in Women: A Scoping Review

“…The authors located one randomized controlled trial (RCT), one repeated measures study, three methodological studies, three qualitative studies (i.e., semi structured interviews and focus groups), and 17 cross-sectional studies. Seven studies reported using online questionnaires [7,8,9,10,11,12,13], 14 used a field survey or postal delivered questionnaire [2,3,14,15,16,17,18,19,20,21,22,23,24,25], and one study combined both a field survey and online questionnaire to collect information [26]. Three studies used uroflowmetry and sonography to measure multiple uroflowmetric parameters (e.g., maximum flow rate, Qmax and average flow rate, and Qave) and used postvoid residual (PVR) urine volume as one of the outcomes [14,15,21]; see Table S2 for an overview of the studies reviewed.…”

“…Clinical nurses and/or midwives and advanced practice providers were enrolled in seven studies [3,8,17,18,24,26,27], nonpregnant women working in academic medical centers were enrolled in three studies [7,9,10], and full-time working women without a specific job description were enrolled in one study [11]. The mean age of these women ranged from 30.2 to 51.2 years old and standard deviations ranged from 6.8 to 13.6 years old.…”

“…Authors of 19 quantitative studies reported that they used established measures or individual questionnaire items to quantify women’s toileting behaviors [2,3,8,9,10,11,12,13,14,15,17,18,19,20,21,22,23,24,26]. One study used two questionnaire items; the first item included multiple choice questions to elicit information about toileting behaviors used at work and the other item queried the adequacy of bathrooms at work [24].…”

“…One study used two questionnaire items; the first item included multiple choice questions to elicit information about toileting behaviors used at work and the other item queried the adequacy of bathrooms at work [24]. One study employed three questionnaire items; the first item included multiple choice questions to track how often the participants delayed passing urine at work and the second and third items queried participants’ access to a toilet whenever needed and frequency of reducing fluid intake to delay or avoid passing urine at work [26]. Most studies ( n = 17) used the Toileting Behavior–Women’s Elimination Behaviors (TB–WEB) scale [2,3,7,8,9,10,11,12,13,16,17,18,19,20,22,23,25].…”

“…The English language version of the TB–WEB scale had acceptable construct and criterion validity and demonstrated similar acceptable reliability (i.e., Cronbach’s α coefficient > 0.7) for all domains [13,18], except in one study where α = 0.582 was reported for position preference for urination [18]. The 14-item Chinese language version and 17-item Korean language version of the TB–WEB scale had acceptable reliability for domains and construct validity, and the Korean language version also had acceptable criterion-related validity [26,29]. The 19-item Swedish language version had acceptable construct validity and acceptable reliability for all domains (α > 0.7), except for position preference for voiding (α = 0.540) [20].…”