The Problem
Bowel and urinary incontinence are some of the most widespread conditions found in patients around the world. Statistics say that approximately 8.7% of all people the planet are currently experiencing this condition. In an elderly population, the percentage of cases rises up to 40% (Aguiar & Franco, 2018).
The condition affects women more so than men due to a variety of reasons, some of which include physiology and after-pregnancy effects (Aguiar & Franco, 2018). In a nursing setting like the ICU, bowel and urinary incontinence is addressed by nurses meant to assist patients with their daily troubles (Danielis, Palese, Terzoni, & Destrebecq, 2020).
Nevertheless, in many cases, prolonged hospital stay may incur bowel or urinary incontinence due to infection, stress, physical trauma, or feeding regime changes, among many other reasons. Bowel and urinary incontinence can lead to a variety of health issues, ranging from acquired dermatitis to psychological vulnerability and depression as a result from having to rely on other people for managing embarrassing procedures (Danielis et al., 2020). Finally, management of BUI requires additional staff and equipment resources. An intervention to prevent the mismanagement or acquiring of BUI in an ICU is, thus, required.
The Setting
The setting for this intervention is the ICU unit, in which I am working. ICU units often get to tend to patients who either have or are at risk of developing BUI, such as patients with diabetes, stroke, post-pregnancy and post-operational patients, as well as individuals who suffered a trauma or an injury of the bowel or urinary tract (Kramer & Rabinstein, 2020).
The most common issues for BUI associated with the ICU treatment include misdiagnosis of the issue, failing to recognize the symptoms of a potential development, misuse or poor selection of treatment products, poor management of psychological issues, and a general lack of knowledge in regards to the condition (Kramer & Rabinstein, 2020).
Description
Within the ICU, the prevalence of BUI patients ranges from 9 to 37%, making it one of the most frequent conditions to be encountered by nursing specialists (Stokes, Crumley, Taylor-Thompson, & Cheng, 2016). The awareness of the clinical challenges associated with BUI among nurses is moderate to low, meaning that the majority of them do not pay significant attention or bother to research the issue despite encountering on a daily basis (Stokes et al., 2016).
According to the existing studies, the majority of nurses do not apply their knowledge beyond immediate remedying of the symptoms of BUI (secretion of fluids or feces) when it happens (Stokes et al., 2016). In some cases, a routine is adopted to teach the patient about behavioral toileting, which allows them to empty their bowels before they reach a point where they could no longer hold it in (Kawanabe, Suzuki, Tanaka, Sasaki, & Hamaguchi, 2018).
Diapers are frequently used to manage patients that could not utilize the toilet on their own (Stokes et al., 2016). Preventive measures against BUI-associated diseases, psychological issues, or equipment choices are typically overlooked.
Effects of BUI on Patients and Nurses
The inefficient care of BUI in the ICU unit leads to several effects on patients, nurses, and the state of health in general. Patients experience discomfort and tend to develop acquired infections, perineal dermatitis being one of the most common BUI-associated diseases (Mohammed & Nadr, 2018).
In addition, many patients feel ashamed about their condition due to a lack of care and adequate management from nurses, resulting in underreporting of the issue, anxiety, depression, and lowered self-esteem (Mohammed & Nadr, 2018). Finally, the exacerbation of the symptoms leads to increased workload on nurses, fatigue, burnout, and poor health outcomes for all parties involved.
Significance of the Topic and Implications for Nursing Practice
BUI is a condition frequently encountered in ICU and long-term care facilities, as well as home care interventions. Despite its frequency, the levels of understanding, care, and prevention are notoriously low. Complications resulting from BUI being mismanaged or neglected could have far-reaching effects on patient health, hospital expenditures, and the overall quality of care (Donnelly et al., 2018).
Therefore, researching effective methods to improve ICU care of patients with BUI would help lower the expenditures, protect patients from developing various physical and psychological diseases, reduce the number of readmissions, reduce the time of overall hospital stay, and increase the knowledge and quality of care delivered by nurses (Donnelly et al., 2018). The information acquired through this study would contribute to greater nursing practice by serving as referral material as well as providing recommendations for further practice.
Proposed Solution
The study proposes an educational intervention to increase the levels of knowledge about BUI in ICU nurses. They would be taught about the scope of the problem within their practice, the potential complications to patient health, the effects on their own work, and the proper advanced strategies to treat BUI, prevent its development in at-risk patients, and identify the symptoms of associated diseases in patients (Brown et al., 2019).
The training will include a theoretical part and practical application of knowledge, along with three tests to judge the level of understanding present as well as knowledge retention. The effectiveness of the intervention will be measured based on nursing feedback as well as the comparison of baseline BUI developments before and after the solution had been implemented.
References
Aguiar, L. M., & Franco, I. (2018). Bladder bowel dysfunction. Urologic Clinics, 45(4), 633-640.
Brown, H. W., Braun, E. J., Wise, M. E., Myers, S., Li, Z., Sampene, E.,… & Rogers, R. G. (2019). Small-Group, community-member intervention for urinary and bowel incontinence: A randomized controlled trial. Obstetrics and Gynecology, 134(3), 600-611.
Danielis, M., Palese, A., Terzoni, S., & Destrebecq, A. L. L. (2020). What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. International Journal of Nursing Studies, 102, 103491.
Donnelly, D. W., Donnelly, C., Kearney, T., Weller, D., Sharp, L., Downing, A.,… & Cross, W. R. (2018). Urinary, bowel and sexual health in older men from Northern Ireland. BJU International, 122(5), 845-857.
Kawanabe, E., Suzuki, M., Tanaka, S., Sasaki, S., & Hamaguchi, T. (2018). Impairment in toileting behavior after a stroke. Geriatrics & Gerontology International, 18(8), 1166-1172.
Kramer, C. L., & Rabinstein, A. A. (2020). Evidence-based critical care. Springer, Cham.
Mohammed, H. M., & Nadr, M. (2018). Perineal dermatitis: A neglected problem in patients at Critical Care Unit. EPH-International Journal of Medical and Health Science (ISSN: 2456-6063), 4(2), 66-71.
Stokes, A. L., Crumley, C., Taylor-Thompson, K., & Cheng, A. L. (2016). Prevalence of fecal incontinence in the acute care setting. Journal of Wound, Ostomy and Continence Nursing, 43(5), 517-522.