Incontinence Metamorphosis

By Debra J Birchman, RN, BS, WCC

Posted on: February 6, 2012

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Caterpillars go through a remarkable change as they transform into the beautiful butterflies we see and enjoy. Like these insects, long-term care didn't start off quite so lovely, but it's now experiencing a metamorphosis of its own. By emphasizing resident dignity, choice and self-determination, the culture change movement helps residents function at their highest practicable physical, mental and psychosocial levels. Today's culture is about making choices based on personal preferences, tastes, likes and dislikes, instead of a one-size-fits-all approach.

Stuck in the Cocoon
Despite these positive changes, one key area that has not caught up to this cultural revolution is incontinence care. Too many caregivers still believe that the old ways are still the best when it comes to product use, staff and resident education and empathy with residents.

That is not to say nursing home staffs are not well intentioned. They have compassion and the best intentions, but they often can't keep up with new education and products. Continence management must be incorporated into all facility's culture change transformations.

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Consider a resident who is dressed for an elegant dinner. Is she worried about how she'll maintain her dignity if she loses continence? How will she be kept dry while dining? How can she maintain comfort while having to wear an incontinence product without it showing or being detected by friends? These concerns can keep residents from leaving their rooms in fear of the indignity of incontinence.

Many adult brief products are still made with a one-size-fits-all strategy. Poor fitting products do not promote a high degree of confidence, comfort and continence management. They are uncomfortable and don't keep residents' skin dry, which can lead to skin breakdown, wet beds and increased risk for pressure ulcers.

Brighter Future
But incontinence products, like resident care techniques and education, are improving. More manufacturers are using enhanced technology along with a sharper focus on proper fit and comfort, to design products that work and feel better.
By combining better products with educational tools and resources, you will foster a culture of change that is designed with each individual's needs in mind. Better products and programs will inspire staff to embrace individualized continence management care, which will lead to enhanced levels of satisfaction for both staff and residents.

The Time is Now
When I ask administrators and directors of nursing what types of continence management programs or systems are in place, I am usually told: "We don't really have a system," or "We want to implement a system, but I'm too busy right now." Continence management is far too important to be ignored anymore.

In addition, with the recent change to MDS 3.0, facilities are missing the connection that bridges the MDS 3.0/Section H in implementing an effective individualized continence care program. Often, the MDS coordinator is not working closely with the continence management team. This is a missed opportunity for improved reimbursement, as well as a missed opportunity for culture change.

Culture change for continence management is evolving slowly, but its time has come. While many facilities are concentrating on physical changes to their buildings, they must now consider what types of changes will impact something so intimately related to individual residents as continence management.

Debra J Birchman is a clinical services manager for the personal care division at Medline Industries Inc., Mundelein, Ill.

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Containment of incontinence is not enough, the cause of the incontinence must be determined and an appropriate incontinence management program needs to be implemented based upon the type of inco.tinence. It's not acceptable to put everyone on a 2hr toileting regime. There are incontinence management experts out there and if you can't find one of us, ask your incontinence product vendor if they have any edicational materials available to you. You can also do a web search for educational materials or contact tthe Wound Ostomy Continence Nurse Association for more information.

Denise Howell, RN CRRN CWOCN	February 14, 2012
NY

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