Nursing Care Plan for Urinary Incontinence
Proper nursing care plan for urinary incontinence is an important tool for improvement of healthcare delivery. Below is a sample care plan for urinary incontinence.
Normally, urinary incontinence is characterized as an inability of some patients to reach toilet by themselves in time.
Characteristics of the Condition
Urinary incontinence is considered to be closely related to functional disabilities of the patients. However, this connectionis not completely proved and remains debatable (Hunskaar et al, 1999). Even though functional limitations have certain influence on urinary incontinence, the problem should be also considered from the point of additional underlying factors. In most cases, they contribute to lowered functions of urinary tract.
Some of the related factors that can be outlined in relation to urinary incontinence include the following:
- Reduced vision;
- Psychological factors and cognitive disorders, including dementias, delirium, etc.;
- Reduced mobility of patients;
- Obstructions in the way to toilet;
- Weakness in limbs.
Nursing Outcomes Classification (NOC)
NO labels may include Urinary Elimination and Continence.
- The cases of urinary incontinence are supposed to reduce or to be eliminated completely;
- Obstructions on the ways to toilets have to be eliminated;
- In order to reduce or eliminate cases of urinary incontinence, specially developed devices should be used for containment of urine for patients with reduced mobility;
- Supportive equipment should be offered to patients with impaired mobility.
Nursing Interventions Classification (NIC)
Suggested label includes Urinary Incontinence Care.
- It is necessary to create a history of condition with indication its length, repetition, intensity and aggravating factors.
Importance of intervention:
Such approach will allow better understanding of the condition and will help in its future mitigation.
- Develop a log of patterns for elimination of nocturnal and diurnal urine. Develop a log of patterns for leakages.
Such logs will allow better verification of patterns and a basis, which can be further used by the hospital management for evaluation of the outcomes.
- Perform interviews with patients to indicate possible causes of incipient or temporary urinary incontinence. They may include sedatives, which may prevent patients from reaching toilet in time, UTI, impaction, antidepressants, which may result in improper functioning of detrusor, insipidus, alpha adrenergic antagonists, constipation, parasympatholytics or polyuria as a result of diabetes.
The condition under consideration can be reduced or completely eliminated by dealing with its causes (Urinary Incontinence Guideline Panel, 1996).
- Examine patients for different forms of urine loss (urine loss connected to stress, urge urinary loss, urinary incontinence as a result of reflexes or total urinary incontinence).
According to Gray (1992), the current condition often accompanied by another forms of urine loss. Such connection is mostly found in elderly people. Determination of additional forms of incontinence will help in overcoming the condition.
- It is important to check the availability and free access of patients to the toilets within health care facility, at homes and within any other care environment. The following things have to be considered in the process of checking: how far the toilets are from places where the patients rest; functionality of beds (includes height of beds, presence of side rails, etc.); the state of the way to the toilets (includes proper lighting, absence or presence of barriers, such as rags on the floor, stairs, etc.); the functionality of toilets (e.g., distance from the floor, lighting, availability of hand rails for disabled, availability of doors wide enough to let the wheelchair pass it through, as well as other supporting devices).
Properly equipped bathrooms, pathways, beds, etc., allow patients easier access to toilets and prevents them from urine leakage and, the so-called, functional incontinence (Wells, 1992).
- The other intervention of nursing care plan for urinary incontinence is to constantly examine patients for mobility. It is important to indicate their ability to move freely, get up from chairs and beds. In other case, usage of supportive equipment, such as, for example, wheel chairs, will be required.
Such examination will help identify level of patients' mobility and indicate who of them needs help and who can reach toilets on their own (Jirovec, Wells, 1990).
- Examine the level of patients' dexterity. In other words, it should be identified how good the elderly can cope with buttons, zippers, etc.
Such assessment will help identify if patients need assistance with removing their cloths while in toiled (Wells, 1992).
- The other issue in nursing care plan for urinary incontinencethat should be accessed is cognitive state of people suffering urine loss. It can be doneby means of applying NEECHAM scale of confusion.
In order for patients to realize that they need to go to the toiled, and actually reach and use the facility, they need to show absence of signs of mental disability (Colling et al., 1992).
- Proper urinary incontinence care plan also foresees removing all the barriers that can prevent people suffering urinary incontinence reach the toilet in time. It means to repair lighting in pathways, make sure that all loose rags are removed, etc.
Such activity will help patients reach the toiled without delays.
- Nurses role in urinary incontinence plan also foresees preparation of supportive devices for elderly who cannot move freely. Such devices may include hand-held urinal, etc.
It will allow patience urinate in a proper way even without going to the toilet (Rabin, 1998).
- Make sure that the patients choose the clothes that allows unhampered toilet access. The preference should be given to the element of wardrobe that do not contain zippers, buttons, etc. but rather to clothes with waist bands.
Such wardrobe will reduce time spend for undressing while going to the toilet.
- Preparation of the special program for patients with dementia in care facilities. Such program may include scheduling of toilet visits, setting alarms, praising patients after completing the procedure, avoiding any form of penalizing or punishment, etc.
Development of such program is a very important step in taking care of patients suffering from urinary incontinence problems. According to Colling et al. (1992), it helps reduce the number of incontinence cases in healthcare facilities significantly.
Interventions for Geriatric Patients
- Preparation of program for incontinence management among community-members patients. It should be done in cooperation with family members.
In case a patient experiences often cases of uncontrolled urine leakages, he may be placed to the healthcare facility instead of remaining at home. As a result, for those individuals who does not want to be hospitalized, this program can serve as an effective proactive measure.
- Controlling the level of hydration among patients both in healthcare facilities and at home.
It is indicated that dehydration serves as a reason for increased urine loss, especially among the older population (Collin, Owen, McCreedy, 1994).
Interventions for Patience under Home Care
- Develop a strategy to reduce the cases of uncontrolled urine loss. This strategy can include scheduling of toilet visits, using of supportive toileting devices for disabled patients, control over intake of fluid, etc.
Preparation of customized programs for patients is very important as each of them reacts differently to the condition. Such program can sufficiently reduce the number of urine leakage cases and improve overall health of the patients.
- Involvement of family members in the process of patients' treatment by educating them on the issues of fluids intake, the functioning of bladder, as well as the importance of keeping to the schedules.
Such education helps family members to become part of a treatment process and influence it positively.
- Educate family members on the ways of assisting patients that do not embarrass or humiliate them in any way.
Such approach towards providing care helps the affected individuals retain dignity.
- Educate family members on the ways of maintaining simple rules of hygiene. They include regular cleaning, using of moisture barriers, etc.
Daily cleaning and using of special cleaning products will help to keep skin integrity and prevent development of various infections (Fiers, Thayer, 2000).
- It is important to consider occupational therapy as a tool that can help create favorable conditions to the home care patients.
Adaptation of homes for patients is important for creating necessary conditions for health improvement.
- Education of family members on the issues of patient care is extremely important. It helps maximize the positive outcomes and create favorable conditions for health improvement.
- Family education helps create a working program that helps calculate time for toileting between usual activities, such as watching TV, taking meals, etc.
- It is important to teach family members to implement such systems, as, for example, alarm system for avoiding unpleasant episodes. Check and change method can also be used as a tool for controlling the condition of the patient.