• Dowling-Castronovo A, Bradway C. Urinary incontinence. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, editor(s). Geriatric nursing protocols for best practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; 2003. p. 83-98. [26 references]

This is the current release of the guideline.

Assessment Parameters

• Document the presence/absence of urinary incontinence (UI) for all patients on admission.
• Document the presence/absence of an indwelling urinary catheter. Determine appropriate indwelling catheter use: severely ill patients, patient with Stage III to IV pressure ulcers of the trunk, urinary retention unresolved by other interventions.
• For patients who are incontinent:
  • Determine whether the problem is transient, established, or both.
  • Identify and document the possible etiologies of the UI.
  • Elicit assistance with assessment and management from interdisciplinary team members.

Nursing Care Strategies

• General principals that apply to prevention and management of all forms of UI:
  • Identify and treat causes of transient UI.
  • Identify and continue successful pre-hospital management strategies for established UI.
  • Complete bladder diary.
  • Develop an individualized plan of care using data obtained from the history and physical examination, and in collaboration with other team members.
  • Avoid medications that may contribute to UI.
  • Avoid indwelling urinary catheters whenever possible.
  • Monitor fluid intake and maintain an appropriate hydration schedule.
  • Modify the environment to facilitate continence.
  • Provide patients with usual undergarments in expectation of continence, if possible.
  • Prevent skin breakdown by providing immediate cleansing after an incontinent episode and utilizing barrier ointments.
  • Use absorbent products judiciously.
• Strategies for specific problems:

  Stress UI

  • Teach pelvic muscle exercises (PME).
  • Provide toileting assistance and bladder training.
  • Consider referral to other team members if pharmacologic or surgical therapies are warranted.

  Urge UI

  • Implement bladder training or habit training.
  • Teach pelvic muscle exercises to be used in conjunction with the above strategy.
  • Consider referral to other team members if pharmacologic therapy is warranted.
  • Initiate referrals for those patients who do not respond to the above.

  Overflow UI

  • Allow sufficient time for voiding.
  • Instruct patients in double voiding and Crede maneuver.
  • Consider use of external collection devices for men.
  • Provide sterile intermittent or indwelling catheterization.
  • Initiate referrals to other team members for those patients requiring pharmacologic or surgical intervention.

  Functional UI

  • Provide scheduled voiding or habit training.
  • Provide adequate fluid intake.
  • Collaborate with other team members to eliminate any medications adversely affecting continence.
  • Refer for physical and occupational therapy.
  • Modify environment to be conducive to maintaining independence with continence.

Follow-up to Monitor the Condition

• Provide patient/caregiver discharge teaching regarding outpatient referral and management.
• Incorporate continuous quality improvement (CQI) criteria into existing program.
• Identify areas for improvement and enlist interdisciplinary assistance in devising strategies for improvement.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Dowling-Castronovo A, Bradway C. Urinary incontinence. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, editor(s). Geriatric nursing protocols for best practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; 2003. p. 83-98. [26 references]

Not applicable: The guideline was not adapted from another source.

2003

Hartford Institute for Geriatric Nursing - Academic Institution

The guidelines were developed by a group of nursing experts from across the country as part of the Nurses Improving Care for Health System Elders (NICHE) project, under sponsorship of The John A. Hartford Foundation Institute for Geriatric Nursing.

Supported by a grant from The John A. Hartford Foundation.

Not stated

Primary Authors: Annemarie Dowling-Castronovo, APRN-BC, Gerontolgical Nurse Practitioner, New York University, The Steinhardt School of Education's Division of Nursing; Christine Bradway, PhD, APRN-BC, Gerontologic Nurse Practitioner, University of Pennsylvania School of Nursing

Not stated

This is the current release of the guideline.

None available

None available

This summary was completed by ECRI on February 2, 2004. The information was verified by the guideline developer on February 26, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.