Implementing a Systematic Voiding Program for Patients With Urinary Incontinence After Stroke

Abstract

We explored health professionals' views of implementing a systematic voiding program (SVP) in a multi-site qualitative process evaluation in stroke services recruited to the intervention arms of a cluster randomized controlled feasibility trial during 2011-13. We conducted semistructured group or individual interviews with 38 purposively selected nursing, managerial and care staff involved in delivering the SVP. Content analysis of transcripts used normalization process theory as a pre-specified organization-level exploratory framework. Barriers to implementing the SVP included perceived lack of suitability for some patient groups; patient fear of extending hospital stay; and difficulties with SVP enactment, scheduling, timing, recording, and monitoring. Enablers included the guidance provided by the SVP; patient and relative involvement; extra staff; improved nursing skill and confidence; and experience of success.Three potential mechanisms of consistency, visibility, and individualization linked the SVP process with improvements in outcome, and should be emphasized in SVP implementation.

Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis

“…We identified 16 high‐quality studies, in terms of their methodological conduct (a clear research question, clear theoretical underpinning, an appropriate study design to answer the research questions and adequately reported data collection or analysis) that reported on an experimental study into a new method of nursing care with strong theoretical underpinnings and/or aimed to reflect opinions on implementation of nursing care actions. Within this 16, we identified six conceptually rich papers (Boltz, Capezuti, & Shabbat, ; French et al, ; Jensen, Vedelo, & Lomborg, ; Lomborg, Bjorn, Dahl, & Kirkevold, ; Robison et al, ; Thomas et al, ) that made a greater contribution to our understanding of the context of high‐quality fundamental care. These six papers then formed our preliminary analytical framework, to which the data in the remaining high‐quality papers were added (Malpass et al, ).…”

“…Of the 16 high‐quality studies, study designs were reported as grounded theory (3), ethnography (2), phenomenology (1), soft systems approach (1) and interpretative description (1), or reported as content analysis (3), thematic analysis (2), or framework analysis (1) or did not name the methodological orientation (2). Papers reported qualitative data for observational studies ( n = 12) (Boltz et al, ; Bourret, Bernick, Cott, & Kontos, ; Coyer, O'Sullivan, & Cadman, ; Gaspard & Cox, ; Kitson, et al, 2013b; Kneafsey, Clifford, & Greenfield, ; Lafreniére, Folch, & Bèdard, ; Lomborg et al, ; Sjögren Forss, Nilsson, & Borglin, ; Taylor, Sims, & Haines, , ; Wardh, Hallberg, Berggren, Andersson, & Sorensen, ) and experimental studies ( n = 4) where new practices were introduced (French et al, ; Jensen et al, ; Robison et al, ; Thomas et al, ). Of these, two papers included patient data about a new nursing care method.…”

“…Nurses overcame difficulties and became enthused by working on a collective goal to rehabilitate patients. Nurses later recognised the benefits of improving incontinence for patients and the potential for reduction in their incontinence care workload (French et al, ; Thomas et al, ). One study suggested that patients with stroke preferred nurses who demonstrated sensitivity and provided full explanations about the process of using incontinence aids (Kitson et al, 2013b), and another indicated patients want assistance getting to the toilet to prevent incontinence (Lafreniére et al, ).…”

“…Strong leaders were able to “counteract established perceptions” (French et al, ) and make judgements on nursing care plan changes that others would follow (Thomas et al, ) and were seen as influencing change by encouraging others and pushing practice forward (Taylor et al, ). People that had influence on nurses were senior nurses, physiotherapists (Kneafsey et al, ; Taylor et al, ), research nurses (French et al, ) and experienced nurse colleagues or peer leaders (Gaspard & Cox, ; Taylor et al, ; Thomas et al, ). We derived four concepts from author themes about nurse leaders ' actions that were associated with nurses consistently performing essential nursing care, these were “generating buy‐in,” “nurse learning and competency,” “defining and enabling nurse roles” and “teamworking.”…”

“…Whole team buy‐in facilitates a “standardised consistent approach” (Robison et al, p141) by all members, including administrative staff (Boltz et al, ). Studies reported buy‐in and staff commitment when “key people” (French et al, p1398) led change by advocating and demonstrating the importance and advantages of the proposed care practices (Boltz et al, ; French et al, ; Thomas et al, ).…”