The design and feasibility pilot of a model to guide continence care in Australian residential aged care homes

Abstract

To co-design and pilot test a best practice model of continence care and knowledge translation resources for Australian residential aged care, a mixed methods study was undertaken. The study had four stages: (1) a scoping review of literature;(2) a survey, interviews and co-design workshops with residential aged care stakeholders; (3) the co-design of a draft model and knowledge translation resources; and (4) a pilot trial of an education program and qualitative interviews with residents. The pilot trial involved a convenience sample of 22 staff (registered and enrolled nurses and personal care assistants) from two Australian residential aged care homes. Staff completed one pre-and two post-education surveys, and 13 aged care residents were interviewed about their views about continence care. Pilot test data revealed post-education improvements in staff knowledge for eight of the ten questions, and 100% agreement on the feasibility, appropriateness and acceptability of the model and education program. Of the 22 participants, 63% rated the education as 'very helpful' in applying the model to practice and 37% rated it as 'somewhat helpful'. There was no statistically significant difference between the results of any of the three assessment surveys. A content analysis of resident interviews validated the importance of evidence-based, safe, clinically-informed, person-centred continence care that optimises a resident's functional abilities and responds to their individual needs, choices and dignity. The Continence Foundation of Australia has used these findings to design Continence SMART Care (CSC), which represents best practice continence care, meets the Aged Care Quality Standards, and aligns with current reform strategies for the aged care sector. Further research is required to determine the impact on practice and resident outcomes, and its relevance for use in other settings or countries.

Art of connectedness: Value‐creating care for older persons provided with toileting assistance and containment strategies—A critical interpretive synthesis

“…The first construct, co ‐ created care , highlights the importance, for the healthcare professional, of establishing a relationship with the older person before providing them with toileting assistance and containment strategies (Borglin et al, 2020; Buswell et al, 2017; Jansen et al, 2013; Ostaszkiewicz et al, 2016b). An equally important requirement is building trust , as receiving toileting assistance can create feelings of embarrassment (Borglin et al, 2020; Kristiansen et al, 2011; Ostaszkiewicz et al, 2012, 2018; Roe et al, 2013).…”

“…An equally important requirement is building trust , as receiving toileting assistance can create feelings of embarrassment (Borglin et al, 2020; Kristiansen et al, 2011; Ostaszkiewicz et al, 2012, 2018; Roe et al, 2013). Following this is the construct respecting preferences of the older persons , as it is essential that the person's preferences are considered (Borglin et al, 2020; Buswell et al, 2017; Ostaszkiewicz et al, 2012, 2014, 2018; Ostaszkiewicz et al, 2016a; Roe et al, 2013).…”

“…Being responsive to the older person was likewise seen as important (Borglin et al, 2020). Moreover, to strengthen the relationship, older persons and healthcare professionals suggested using humour when receiving or providing assistance (Jansen et al, 2013; Ostaszkiewicz et al, 2016b).…”

“…Taking account of and understanding older persons’ individual preferences for assistance with their incontinence needs were highlighted as important both by the participating older persons and by the healthcare professionals (Borglin et al, 2020; Buswell et al, 2017; Ostaszkiewicz, et al, 2016a; Ostaszkiewicz et al, 2018; Roe et al, 2013). For example, healthcare professionals can develop such understanding by having a dialogue with the older person regarding their use of continence aids (Borglin et al, 2020; Ostaszkiewicz et al, 2014) and listening to older persons communicate their thoughts on how to manage the incontinence (Ostaszkiewicz et al, 2012). Borglin and colleagues suggest’ individualising the continence aids , by asking the patient to try out and fit them based on their preferences and experience of absorption’ (Borglin et al, 2020, p. 6).…”

“…Providing assistance has been described as a challenge for informal caregivers, that is family members, because of the change in relationships; also, a risk for abuse of older persons with incontinence receiving assistance has been described (Ostaszkiewicz, 2018). Furthermore, family members have been reported to expect formal caregivers to provide assistance in time and show empathy as part of delivering quality of continence care (Ostaszkiewicz et al, 2016). To support formal caregivers in providing toilet assistance for older persons, the Dignity in Continence Care Framework has been developed for upholding dignity (Ostaszkiewicz, 2017).…”