Continence Care Part 1: Introduction for Practice Improvement

1. Scientific Inquiry & Evidence-Based Practice

This chapter will introduce the importance of a systematic approach to understanding phenomena using evidence-based methodologies. This begins with scientific inquiry, utilization of theoretical concepts and models in the review of the current body of knowledge, and interpretation of current evidence on the subject of inquiry. Identifying relevant recommendations from the evidence requires a degree of expertise when determining how to incorporate changes to current nursing practice.

2. Applying Evidence-Based Practice Principles to Continence Care

This chapter begins by introducing how to identify gaps in nursing practice in order to formulate a “burning question” (PICOTS question). Since this chapter provides an overview for the bowel and bladder management recommendations, samples of questions to guide scientific inquiry will be introduced along with the theoretical conceptual model: Competency Model for Professional Rehabilitation Nursing. The background to the proceeding educational content will be provided, including the literature review which resulted in the 6 evidence-based algorithms.

3. Theoretical Framework

This chapter will introduce the ARN Competency Model for Professional Rehabilitation Nursing as it is used to approach continence care. This model enhances the role of the rehabilitation nurse to lead the interprofessional team and impact patient outcomes through promoting self-management using nurse-led interventions: 1) Promotion of successful living, 2) Leadership, 3) Interprofessional care, and 4) Nurse-led interventions.

4. Sustaining Practice Improvement

This chapter will build an argument for nurse leaders and decision makers regarding the need to establish a bowel and bladder protocol for inpatient rehabilitation facilities. Data from prevalence studies regarding bowel and bladder dysfunction will be briefly introduced to build a strong case for implementing better care standards for bowel and bladder management. Reasons include: 1) Expenses related to poorly managed incontinence, 2) Impact on quality of patient experience, and 3) Impact on nursing perceptions of care delivery.

5. Policies and Procedures to Promote Adherence to Improved Practice

This chapter addresses the use of policy and procedures to establish a foundational expectation for nursing practice. This premise is to promote sustainable change of practice by setting standards of care. These standards include building a culture of continence (in which all team members value continence), maintaining a commitment to quality of care, setting goals for outcome measures (improved FIM scores, reduced frequency of accidents, discharge to community), and patient harm reduction/risk management.

6. Introducing Algorithms

This chapter will introduce the content remaining in the entire clinical module. Each algorithm will be introduced with a vision for use in organized care. Implementation strategies will be discussed, and a presentation of the supporting tools will be described.