O**nuO Caregivers’ and Care Recipients’ :@j * Perceptions of Dealing with Urinary ~ Q , , ~ . ~

Incontinence

Martha Gallagher, MSN RN CNS Linda L. Pierce, PhD RNC CNS CRRN

A phenomenological study was conducted to answer the question: What can you tell me about dealing with urinary incontinence (UI)? This study was a pilot research project by the Maumee Bay Chapter of the Association of Rehabili- tation Nurses. Four dyads, caregivers and care recipients, living in home settings in northwestern Ohio composed the purposive sample. Transcription of each I-hour interview was reviewed with Colaiuis (1978) method of data analy- sis. The analysis ident$ed two themes: coping with care deficits, and supporting care abilities in the caregiver-care recipient dyads. Caregiver suggestions were found that en- hanced abilities to manage problems with UI. The study’s

Urinary incontinence (UI) is the involuntary loss of urine in sufficient amount or frequency to constitute a social problem, or a health problem, or both (Kane, Ouslander, & Abrass, 1999). An estimated 17 million Americans have UI (Tunis, Whyte, & Bridger, 2OOO), with 1 in 10 individuals over age 65 experienc- ing this disorder (National Institute on Aging, 2001). Often, se- niors view UI as an inevitable consequence of aging; thus, many people hesitate to seek information about the problem (Skelly & Boblin-Cummings, 1999). Once UI is accepted as being a prob- lem, individuals must deal with such barriers to care as lack of access to services and resources. Although it is not a cause of mortality, UI imposes significant morbidity, with negative phys- ical, emotional, and psychosocial effects on affected individu- als (DuBeau, Levy, Mangione, & Resnik, 1998; McFall, Yerkes, Belzer, & Cowan, 1994; Gallagher, 1998; Skelly & Boblin- Cummings).

The effects of UI are far reaching. Ottoway (1999-2OOO) de- scribed how he and his wife dealt with UI issues on a daily ba- sis, and voiced their frustration with the lack of help, advice, and assistance in managing UI successfully. He stated that “. . .life runs at a slower pace and things take longer to accom- plish” (p. 35). According to DuBeau, Levy, Mangione, and Resnick (1998), 30 community-dwelling older adults dealing with UI reported decreased emotional well being and intermp- tion of activities as a consequence of UI. Similarly, Dugan et al. (2000) found in a study of 668 adults over age 60 that 35% of people with UI reported some depressive symptoms, and that approximately 30% indicated that UI interfered with their day- to-day activities. In addition, family caregivers of persons with UI claim that the problem is a severe stressor (Ebersole & Hess,

Key words phenomenological study, urinary incontinence

findings contribute to rehabilitation nursing by providing important insights into dealing with UI from the perspec- tives of both caregivers and care recipients, by o$ering di- rection for nursing practice and education, and by being an impetus for further nursing research.

Marth Gallagher is an assistant professor at Medical College of Ohio School of Nursing. Linda L Pierce is an associate pro- fessor at Medical College of Ohio School of Nursing. Address correspondence to Martha Gallagher; Medical College of Ohio School of Nursing, 3015 Arlington Avenue, Toledo, OH 43614- 5803, or e-mail mgallagher@ buckeye-express.com.

1998) that often results in the costly institutionalization of the in- continent person (Reno & Batchelor, 1998). An estimated 50% of residents in extended care facilities have UI (Tunis, Whyte & Bridger, 2000); the direct, indirect, and intangible costs of UI in individuals 65 and older were calculated at $26.3 billion in 1995 (Wagner & Hu, 1997).

The descriptive study presented here differs from previous research on UI that, for the most part, described prevalence, cause, or treatment. This study explored the thoughts of home- dwelling adults4aregivers and care recipients-about deal- ing with UI. Information gained from this study expands nurs- ing knowledge about how caregiver-care recipient dyads cope with UI, and adds to the knowledge about nursing interventions that are designed to address that diagnosis. The study’s purposes were to gain the family caregivers’ perspective of dealing with UI for the care recipient who lives in a home setting, and to gain care recipients’ perspective on the UI care given by family care- givers in a home setting.

Method Design and conceptual approach: For this study, we used

a phenomenological approach, which attempts to understand the life experiences of another (Morse & Field, 1995). Through phenomenology, we examined the experiences of caregivers and care recipients in their attempts to understand the multiplicity of internal and external events they encounter while coping with UI in a home setting.

Sample: After obtaining institutional review board approval, we recruited a purposive sample of 4 families in northwestern Ohio that were providing care in their home settings for a member with

Rehabilitation Nursing Volume 27. Number I Jan/Feb 2002 25

Dealing with Urinary Incontinence

UI. The rehabilitation nurse selected these families on the basis of her personal judgment about which ones would be most coopera- tive in sharing information about coping with UI. Other general inclusion criteria are listed in Table 1.

The four dyads included three husband-and-wife combina- tions and one mother-daughter combination from two partici- pating rehabilitation hospitals. A brief description of these dyads is provided in Table 2.

Specific procedures: Recruiting the participants. Potential sets of participants (caregiver and care recipient dyad) were in- vited by telephone to participate by the rehabilitation nurse who was familiar with the care recipients and their families. Data were collected through in-depth, semistructured, audiotaped in- terviews.

Interviewing the participants. Because the research team members involved in data collection had varying levels of ex- perience with interviewing techniques, the entire team attended informal classes over 6 months led by the team member who had a doctorate in nursing and experience in phenomenological research. These sessions centered on conducting open-ended in- terviews, listening for key words spoken by the participants, and asking probing questions, so that the experience of dealing with UI could be explored in its fullest dimensions.

Each dyad was interviewed once. A nurse investigator inter- viewed the caregiver while a rehabilitation nurse interviewed the care recipient. Interviews began with, “What can you tell me about dealing with UI?” Subsequent questions, formed by re- sponses to this question, were worded so as not to lead the par- ticipant to a particular focus, and were directed to topics the par- ticipants introduced. Participants were encouraged to expand the discussion through additional open-ended questions. We be- lieve that the prolonged contact between the rehabilitation nurse and the participants helped establish trust and rapport before and during data collection. Interviews continued until no new infor- mation was offered. All participants were contacted a second time to clarify as needed any information given in the first in- terview and to let them add other information. However, no new information was provided.

Analyzing the interview. Our analysis of the transcribed in- terviews followed Colaizzi’s (1978) protocols for rigorous analy- sis of data, which are as follows:

1. Read each interview. 2. Extract significant phrases or sentences. 3. Formulate meanings from significant statements. 4. Cluster meanings into general themes or theme clusters. 5 . Define the essential structure of the concept.

This approach does not attempt to fit the data into prescribed categories, but permits them to emerge naturally.

In preparation for data analysis, four members of the research team met to discuss the rationale for content analysis, to exam- ine different approaches to coding, and to experience the data analysis process. Each team member then read and coded every interview to establish a baseline impression of the entire dialogue, but no variables were identified beforehand. When team mem- bers met to discuss their analyses, it was apparent that each had identified several common significant phrases from the data, thus strengthening the validity of the themes. Because the specific

Criteria All participants could speak, read, write and under- stand English. Dyads of participants were composed of 1 care recipi- ent and 1 caregiver from each family. All participants resided in home settings. Care recipi- ents were discharged from rehabilitation programs be- tween June 30, 1997 and June 1, 1998, and had a 3- month program evaluation screening that included the Uniform Data System for Medical Rehabilitation rat- ings (UDSMR, 1996). Care recipients Comprehension rating was a FIM’” score of 4 or higher, indicating that both written and spoken com- munications about basic daily needs are understood between 75% to 90% of the time (UDSMR, 1996). Expression rating was a FIM score of 4 or higher, indicating either intelligible speech or clear expres- sion of language when writing or using a communica- tion device, and the person can express basic daily needs 75% to 90% of the time (UDSMR, 1996). Sphincter control rating was a FIM score of 5 or lower. In bladder management, the person requires su- pervision of equipment to maintain a satisfactory void- ing pattern or to maintain an external device or, be- cause of failing to get to a bedpan or the toilet in time, has an occasional voiding accident, or bedpan or urinal spills, but less often than every 2 weeks. In bowel management, supervision or setup of equipment is necessary for an individual to maintain a satisfactory excretory pattern or to maintain an ostomy device; the person may have an occasional bowel accident, but less often than every 2 weeks (UDSMR, 1996).

content of the participants’ dialogue often addressed two or more subthemes, the team disentangled these themes and identified representative content that completed the analysis.

Findings Our findings indicate that dealing with UI involves daily chal-

lenges for each caregiver-care recipient dyad. The two main themes we found were coping with care deficits and supporting care abilities. These themes were further separated into sub- themes with internal and external aspects to make possible a bet- ter understanding of the dyads’ experiences with care deficits and support systems. The themes are shown in Table 3.

Coping with care deficits For the caregiver, coping with care deficits encompasses his or

her struggle to maintain balance between self and caregiving tasks and role expectations. For care recipients, it involves dealing with

26 Rehabilitation Nursing Volume 27, Number 1 Jan/Feb 2002

Event Necessitating Family Support Dyad Relationship/Age Care Home Environment Available

One CG-W and CR-H Married Stroke 1 year ago One story condominium Yes

Two CG-W and CR-H Married Stroke 2 years ago Two story condominium Yes

Three CG-D / 52 years old Stroke 1 yearago One story ranch home Yes

Four CG-H and CR-W Married Multiple sclerosis, One story ranch home Limited

52 years/Both in 70s

49 years/Both in 70s

CR-M / 87 years old

30 years / Both in 50s 20 years’ duration

Caregiver

Care Recipient

Dyads: Caregiver and Care Recipient

Coping with care deficits

Internal Aspects Frustration Depression Financial concerns Continuous nature of caregiving role Emotions

Frustrations/concerns re- lated to dependence for care Personal hygiene and in- dependent toileting Physical losses Role losses

Loss of personal time/spaceJindependence

~ ~~

External Aspects Uncertain schedule Insurance coverage Hired caregivers Expenses Loss of patience

Different caregivers

Embarrassment r/t urinary incontinence (UI)

UI / toileting in social situations

Supporting care abilities

Internal Aspects Self-confidence

Hope Humor Personal motivation

~ ~~~~

Prayer Friendships

External Aspects Reliable hired caregivers

Spouse

Friends Relatives Church members Physicians

the loss of physical capabilities and independence caused by UI. Internal aspects of coping with care deficits: The internal

aspects of coping with care deficits are the personal components that originate from within the individual, for example, frustra- tion, dependency, and loss of personal time and space.

Caregivers said, “I’m coping so far.. . ” At times during the interviews, the caregivers appeared burdened and sad, at times needing to compose themselves as they talked. They expressed a range of feelings about coping with UI care deficits. One wife described this experience:

... I just accept, I guess I’m being very accept- able. I guess i t is because Iffigure I can’t change him, so I have to accept it. It is the same way with the bit of time I get when I go shopping. I’m on my own, but it’s not the same because I’m going grocery shopping or I’m going to the drug store for something. I’m not shopping for clothes. I can’t go all day long and just try on clothes for me. I just, I can’t. ... I just accept that this is how it is. And

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Dealing with Urinary Incontinence

that way, it doesn’t drive me crazy. You see what I’m saying? Because you could get real- ly frustrated if you sat around and thought, ‘boy I wish I could do this.’ And you know, shopping or traveling or doing this, doing that, I just can’t let it get to me. Because I have to maintain my sanity and it would really bother me if I let it. And I can’t. So I just accept it.

Care recipients said, “ [ I ] just do the best I can.. ..” The care recipients also coped with internal aspects of care deficits; how- ever, their emotions and frustrations were related to being de- pendent on others. One person said that the most difficult part of being the care recipient was “asking people to do things for me.” Daily, the care recipients dealt with the lack of indepen- dence related to physical losses. Some losses involved the in- ability to maintain personal hygiene and independent toileting activities, or continue with a previous spousal or parental role because of the UI. One person stated, “One of the things that bothered me the most in the whole affair was using the com- mode and not being able to wipe myself. That really bothered me initially when I had the stroke, that I couldn’t manage that.. ..” Another UI care recipient stated, “I feel that in my life, I have had three lives. One [as] a mother, a wife, and a mess of changes all the time.. .but I feel in this world, you just have to go through it and make the best you can.”

Dyads said, “I don’t have time for me...and I’m here all the time, 7 days a week, everyday.. . .” Coping with loss of person- al time and space while giving or receiving care was a strong theme; both individuals in the dyad had to cope with this loss, but for different reasons. The caregiver had lost independence because of the continuous nature of caregiving and having some- one dependent on them. In contrast, the care recipients had lost personal independence because of their physical and function- al losses and their almost continuous dependence on others for UI management.

The need to have time for one’s self was voiced by each care- giver interviewed. They felt that their role required them to be available 24 hours a day, every day. Even if caregivers had time away, they carried the concerns of the role by never being men- tally removed from caregiving and the issue of UI management. As one caregiver said, “I just wish I had 24 hours to not hear any human voice and just be by myself and just, you know, sleep. I don’t know what it’s like to sleep 8 hours.. .and this is every night.” Toileting was a never-ending process throughout the day and night.

Comments by care recipients reflected their loss of indepen- dence because of physical and functional disabilities. One care recipient said, ‘!I can’t go [urinate] when I feel like I have to go.. . .You can tell your body you want it, but it doesn’t always listen.”

External aspects of coping with care deficits: External as- pects of coping with care deficits originate from events related to giving or receiving care for UI. Examples are the uncertain- ty of schedules and the need to interact with hired caregivers.

Caregivers said, “...start at the bottom and work your way up.. . . ” The caregivers’ days appeared riddled with uncertainty resulting from lack of a regular schedule of activities because of

changing levels of energy or cooperation on the part of the care recipient. These external aspects of care strained the patience of the caregiver. A daughter commented:

She is never tired. Never tired .... I make her stay up until at least 10. So bedtime is 10-1 1 because, I mean, she is up all night. Last night it was like 12:30, 2:OO and 3:30. I said come on now, this is enough.. .[she gets up] because she does not want to wet the bed. ... During the day it’s not so much the incontinence as she is going to the bathroom all the time.. .she is just constantly going to the bathroom.

Insurance coverage to provide outside help with caregiving was an external factor adding to frustrations and instability for caregivers. Using hired help eased caregiving tasks, but finding reliable personnel created additional management and financial responsibilities and concerns. Caregivers repeatedly said that they needed to “start at the bottom and work your way up” with the hired services. Once found, high quality, reliable services fa- cilitated the caregiver’s role and provided needed help for the care recipient. Only one caregiver stated that she successfully used home healthcare services 4 hours a day, 7 days a week, and that it helped her deal with UI.

Care recipients said, “One day might not be the same as the next.. ..” Care recipients had to cope with new care delivery styles and with unfamiliar people who were providing the care. One recipient’s comment is representative:

I pray for those that are the caregivers, that they go into a situation knowing, yes they are going to help, and they are going to do what they can, and one day might not be the same as the next [such as with UI]. It might be a whole lot better and it might be a whole lot worse.

Internal and external coping with care deficits: Dyads said, “It [UI] bothers me... . ” Social situations involved aspects both internal (embarrassment at having UI) and external (find- ing methods to conceal UI). Social situations for these dyads in- cluded dealing with UI in public or private places and with oth- er people. Revealing the care recipient’s incontinence was a concern for both individuals in the.dyad; two older caregivers were embarrassed by their care recipients’ incontinence. The solution for one dyad was to socialize only with friends of long standing. This, however, could potentially socially isolate the dyads. One caregiver reported:

If something comes up and I don’t think we would be able to cope with the situation as far as that part [toileting activities] of the aspect is concerned, we just don’t go. We don’t go out very often unless I know there is some- body that can help him [into the bathroom].

28 Rehabilitation Nursing Volume 27. Number I Jan/Feb 2002

Another said: ... But we still get out. It’s with people that we have known for a long time. I don’t discuss it with them and I wouldn’t, but I’m sure that if something happens, they would know that there is a [UI] problem.

One care recipient commented, “I sure don’t want to have to use the bathroom away from here [home]. . . . I come back here.” Another care recipient said, “. . .[My son] takes care of me and [my wife] doesn’t have to be involved [with toileting] in pub- lic.” Coping with UI and in social situations was made easier for the dyads because of the variety of available support systems.

Supporting care abilities Support is a mechanism available to caregivers and care re-

cipients that alleviates or prevents stress in dealing with UI, and enhances their ability to continue to live in their home environ- ments. Support care abilities emerged as a second major theme.

Internal aspects of supporting care abilities: Internal as- pects are mechanisms that originate within the individual. These personal management abilities alleviate stress, and so positive- ly impact a dyad’s total care abilities and, more specifically, those related to UI. Examples include self-confidence, hope, and hu- mor and comfort received from prayer and friendships.

Caregivers said, “I t gives me all this confidence.. . ” Physi- cians affirm the caregivers’ ability to provide care that includes dealing with UI, thus enhancing confidence. One caregiver ex- plained, “He [the physician] says, ‘you know what you are do- ing.’ It gives me all this confidence.”

Care recipients said, ‘ I Ifigured out ... I’d ‘recover’ quick- er.. . ” The care recipients found internal aspects of support in managing UI issues from humor, hope, and personal motivation. These were additional resources that optimized rehabilitation outcomes and alleviated stress. One person used humor to cope with managing UI. She said: “ ... I just have to deal with it.. .I thank God we do have these Depends@. I feel like a commer- cial.” She then laughingly described the Depends commercial for dealing with incontinence. Another care recipient said, “Ac- cept or get through [situations like UI]. . .laugh a little bit.. .but [do] not make fun of yourself or others.” Hope and personal mo- tivation in living with UI was displayed by another care recipi- ent. He noted, “I figured out that if I got out and about I would recover quicker than [I would] sitting around feeling sorry for myself.” One care recipient described dealing with UI, and life in general, in a hopeful manner, noting that “. ..you just have to go through it and make the best you can.”

Dyads said, “lpray.. .andfriends help.” For the dyads, prayer and friendships were common internal aspects of support that helped in managing daily life. A caregiver commented:

Prayer.. .every day I pray for strength and pa- tience for one more day, my friends, coopera- tion ... and being able to get out. ... They are old friends and some have become closer friends because of this, because they really want to help.. .very sincere.

Care recipients concurred about these internal aspects of sup- port as they talked about UI. One person said, ‘‘. . .All I can say

is to have a good, I guess, spiritual side to you. Without that, you really are in this alone.” Another person stated, “...My friends, there’s a lot of friends. Everybody wants to help.. . .”

External aspects of supporting care abilities: External mechanisms of support for care abilities are systems of physi- cal aid that originated from other people or institutions. This type of support originated from relatives, friends, church mem- bers, or dependable caregivers hired from agencies.

Caregivers said, ‘ I . . .[help] relieves some of the stress.. . . ” In- formal caregivers said the relief they gained from care respon- sibilities was provided by a hired caregiver. One caregiver ex- plained, ‘‘There was only a shot a day, maybe a couple, 3 days a week [for hired care] . . . one time I didn’t have to do it all.”

Care recipients said, “She’s [spouse] very helpful.” Spousal support was especially important for the care recipients as they talked about day-to-day management issues. Three of four dyads were long-time married couples. In particular, a male care re- cipient noted repeatedly the need for his wife to help with con- tinence issues and management with comments such as, “She is very helpful. If it weren’t for that, I’d have trouble here by my- self.”

mads said, “I really appreciate it [help].” Friends, children, and dependable hired caregivers offered physical support to both dyad individuals. This allowed for secure social opportunities for the care recipient while also providing respite from daily ac- tivities for the caregiver. Two caregivers said:

My son, he’s excellent. He takes care of all the business for her, finances.. . when grandma (my mother) was falling a lot; he was always there to pick her up [i.e., falls going to and/or in bathroom]. ... I don’t know what I would have done without him, because, you know, he doesn’t do a lot, but what he does, it relieves some of the stress.

It helps a lot. Even pushing the wheel- chair ...[ and taking him to the bathroom ...] when we go out is a help. I really appreciate that. A while ago last fall, I joined a caregiv- er’s support group and that was not a lot of help.. .in that it pushed me to feel this way: to appreciate what people do and also to get my- self out and that told me it was okay to want to get out and to have somebody come in and stay with him.

The care recipients concurred. A woman said, “My youngest [child age 20 years]. . .helps me get ready for bed / change these plastic things [Depends]. She has been rather understanding.. .she shouldn’t have to deal with this [UI] ... but she does.. .and she does a good job.” A man commented, “We’ve been very fortu- nate in having home care.. . . They were here everyday at 7:30 am.. . .. And they get me up and get a shower [i.e., personal hy- giene activities] every morning.. .. I’m pretty fortunate.”

Discussion and implications for nursing Urinary incontinence influenced the lives of the caregivers

and care recipients in this study. The findings about coping with

Rehabilitation Nursing Volume 27. Number 1 JanFeb 2002 29

Dealing with Urinary Incontinence

care deficits and supporting care abilities were congruent with conclusions reached by Skelly and Boblin-Cummings (1999). Dealing with UI involves barriers to receiving care like lack of insurance coverage, and difficulty identifying and using resources such as friends, relatives, church members, and physicians (Skel- ly and Boblin-Cummings). The results are also similar to what Ottoway (1999-2OOO), DuBeau et al. (1998), and Dugan et al. (2000) described as decreased well being andor depression and interruption of activities. Both Ottoway and the caregivers and care recipients in the DuBeau et al. study told of issues of frus- tration and loss of personal time and space, as well as role changes, in handling UI on a day-to-day basis. The findings of the present study differ from Ebersole and Hess (1998) and Reno and Batchelor (1998) in that, at this point in the participants’ lives, UI had not become a severe inconvenience andor they managed the UI successfully and long-term care placement was not a consequence.

Extrapolating the findings to a wider population must be done with caution. The pilot study was small and the participants, al- though representative of people dealing ,with UI, were purpo- sively selected. Additionally, true data saturation may not have occurred, in that more information about UI might be learned from a larger sample. Nonetheless, the results have an impact on nursing practice, education, and research.

Nursing practice: Rehabilitation nurses must be aware of the perceptions of caregivers and care recipients who are deal- ing with UI in the community setting; this information must be incorporated into treatment interventions. The themes that emerged from this study support the need for rehabilitation staff to include the primary home caregiver and the care recipient in all aspects of home care, especially those aspects of support and respite care interventions that bolster continence care abilities. Both givers and receivers of care should be aware of each oth- ers’ coping issues if UI management is to be optimized. In de- scribing their experiences in dealing with UI, caregivers offered many suggestions for enhancing management abilities. Sug- gestions ranged from making simple physical modifications to making complex emotional and value-driven adaptations. These are presented in Table 4. The strongest, most frequently-heard recommendations were to accept help and to find time to be away from caregiving and dealing with UI for one’s personal renew- al. Future cohort dyads dealing with continence issues who fol- low these suggestions may have less frustration, enhanced care abilities, and improved personal well being. Institutionalized long-term care for the person with UI may be delayed.

Nursing education: Teaching rehabilitation nurses and nurs- ing students to put clues together about UI and its meaning for caregivers and care recipients presents a challenge. Nurses and students must be prepared to teach clients about the behavioral and pharmacologic treatments available for UI. Successful UI treatments have been reported by others (Bo & Berghmans; 2000, Burgio et al., 1998; Kane, Ouslander, & Abrass, 1999; McFall, Yerkes, Belzer & Cowan, 1994; Mattiasson, 2000; Nygaard, Kreder, Lepic, Fountain, & Rhomberg, 1996; Payne, 2000; Tu- nis, Whyte & Bridger, 2000), and are not discussed here. Nurs- es and students must realize the importance of stressing to care- givers and recipients the psychosocial components and treatment

Problem Urine loss

Physical environment

Care assistance

Lack of personal time

Suggestions Use absorbent briefs (e.g., Depends@) Put urine collecting bag from catheter in a bucketkontainer Move from a two-story home to a home, condominium, or apartment [all on 1 floor] before it is needed Go to an adult care center, use respite care Accept formal help [hired] and infor- mal [family/friends]

Find someone to help who is de- pendable, gives good care, is able to deal with urinary incontinence (UI) management, and who listens Hire competent people and fire those who are not competent

Make and keep plans for time-off for self for caregiver

Escape for a while; physically and mentally from caregiving role and dealing with UI issues

Do something by yourself; either within or outside the home

options that can minimize the negative impact of UI. Nursing research: As research findings identify successful

new methods of treatment and intervention, nurses, staff, and students should incorporate these new methods into their prac- tices. This study points to the need for additional research to un- derstand the experience of dealing with UI in home and com- munity settings from the caregivers’ and care recipients’ perceptions. More study is required in different settings and ge- ographic areas, and across many different medical diagnoses to understand commonalities and differences in UI concerns and issues. If these common elements are incorporated by nurses in practice, new strategies for dealing with UI may be developed. Additionally, further study is warranted to explore if manage- ment of UI in home settings reduces the frequency of long-term care placement.

Conclusion Although much has been published about UI, little informa-

tion is available that gives the points of view of caregivers and care recipients. Rehabilitation nurses can have a significant im- pact on how successfully both caregiver and care recipients deal with UI by providing assistance and promoting insight to en- hance positive care outcomes. Providing education and support about UI is one step in that direction.

30 Rehabilitation Nursing Volume 27, Number 1 Jan/Feb 2002

Acknowledgments The Maumee Bay Chapter of the Association of Rehabilita-

tion Nurses (ARN) research team conducted this study. The team is grateful to the caregivers and care recipients for their partici- pation. The authors wish to recognize and thank team members M. Cathy Benninghoff, MSN RN CRRN; Stephanie Bonnett, BSN RN CRRN; Kim Coughlin, BSN RN CRRN; and Marilyn Umlauf, BSN RN CRRN, for their early work on the proposal development and data collection and analysis processes. Jeri Milstead, PhD RN CNS CNAA, Dean and Professor, Medical College of Ohio School of Nursing, Toledo, and Lynne Hamer, PhD, Associate Professor, Bowling Green State University, Bowling Green, OH, are recognized for their critical reviews of this manuscript.

The project was funded by a grant from the Maumee Bay Chapter of ARN.

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Skelly, J., & Boblin-Cummings, S. (1999). Promoting seniors’ health: Con- fronting the issue of incontinence. Canadian Journal of Nursing Lead- ership, 12(3), 13-17.

Tunis, S., Whyte, J., & Bridger, P. (2000, October 6). Biofeedbackfor treatment of urinary incontinence. In Medicare coverage policy deci- sions, Health Care Financing Administration. Retrieved October 9, 200 I from http://www.hcfa.gov/coverage/8b3%2Dw4.htm

Uniform data set for medical rehabilitation (UDSMR) - version 5.0. section Ill: Functional independence measure. (1996). NY: UB Foundation Ac- tivities.

Wagner, T., & Hu, T-H. (1997). Economic costs of urinary incontinence in 1995. Urology, 51,355-361.

Continuing education articles discuss current trends and issues affecting reha-

tion offering (code number RNC- 190) will bilitation nursing. This continuing educa-

provide 1 contact hour to those who read this article and complete the application form on page 38. This independent study offering is appropriate for all rehabilitation nurses. By read- ing this article, the learner will achieve the following objec- tives: 1. Discuss support mechanisms to promote care abilities

2. Incorporate suggestions to enhance UI management

3. Recall themes of dyad’s experiences with UI.

o*anQ

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for caregivers and care recipients dealing with UI.

abilities into client teaching.

Rehabilitation Nursing Volume 27, Number 1 lan/Feb 2002 31