Bowel and Urinary Incontinence Prevention and Care in ICU

Introduction

BUI stands for bowel and urinary incontinence. It is a disease classified by the inability of the patient to control the movement of their bladder and bowels, resulting in an uncontrollable act of urination and defecation (Stokes et al., 2016). Such a condition can be caused by a variety of factors that affect the body, including injury, trauma, psychological disorders, eating disorders, and others (Mohammed & Nadr, 2018). Most nurses are familiar with the disease but do not engage it beyond managing the patient’s immediate needs for cleanliness and hygiene. Because of such a basic approach, BUI can lead to various hospital-acquired infections, such as perineal dermatitis. Educating nurses on how BUI affects the patients, healthcare, and the hospital system would help improve the quality of care and the number of resources necessary to manage it.

Proposed Intervention

The proposed intervention to address the difficulties of managing BUI in the ICU relies on educating nurses and filling the gaps in their knowledge about BUI, as well as increasing their understanding of the disease and its effects on the patients, scheduling, and the hospital system in general. Naturally, the nurses that would be tasked with handling BUI patients are the primary target of the intervention. The knowledge imparted to them would involve the theoretical knowledge of the disease, the practical knowledge of prevention, managing, and maintenance. Finally, the organizational knowledge will help ensure that patients are addressed in a timely manner. The duration of the intervention is estimated between 6 to 12 months, including the knowledge-imparting and implementation phases.

Evidence from the Literature

In the US, the prevalence of BUI in the ICU units varies between 9% to 37%, according to Stokes et al. (2016). Despite such high familiarity with the disease, the degree of knowledge possessed by nurses beyond the immediate treatment procedures remains low (Stokes et al., 2016). One of the major diseases that affect individuals with BUI is perineal dermatitis, which infects the skin exposed to prolonged contamination by feces or urine (Mohammed & Nadr, 2018). According to Danielis et al. (2020), patients affected with BUI feel vulnerable and may develop various psychological disorders due to having to rely on others in such intimate matters. BUI increases the costs and workloads on nurses because it is a difficult and time-consuming task to assist individuals with their elimination on a daily basis (Donnelly et al., 2018). Increasing nurse education has a connection to the effectiveness of their labor and the realization of how important their job is, resulting in better patient outcomes (Garcia et al., 2015).

Objectives

The primary objective of the intervention is to improve the understanding of BUI in nurses. Should they know the disease better and realize the effect to which it affects the patients, themselves, and the hospital system as a whole, they would be more motivated to implement changes and engage in preventive practices. These measures should reduce the number of rehospitalizations due to HAI, which would, in turn, reduce the number of resources dedicated to BUI treatment. The overall improvements to the quality of healthcare are congruent with the overarching purpose of the hospital to promote community health.

Resources

Financial resources for this research will be required to procure the necessary materials and to support the researchers for the duration of the study. Material resources Include brochures, computers, test blanks, and other types of materials necessary for conducting the intervention. Human resources would include the researchers and the nurses participating in the study. It is a limited source. Time resource is also limited, as all participants will have to involve themselves in the intervention during their spare time. Finally, a space will be required to conduct classes and evaluate the results. All of these are necessary for the project (Sullivan, 2019).

Measurable Outcomes

The measurable outcomes for this intervention are several. The first important metric would be the level of nursing knowledge about BUI. The rate of BUI incidents would show the effectiveness of the implementation of said knowledge in the nursing field. Another similar parameter is the reduction of BUI-associated rehospitalizations, which bring additional expenses and time constraints on the patients and nurses alike. Finally, the perception of care would be evaluated using patient satisfaction scores (Sullivan, 2019).

Evaluation

The research will involve three methods of evaluation. Nursing knowledge during different steps of the intervention will be evaluated using standardized tests, which would demonstrate the current level of knowledge as well as that immediately after the intervention. Finally, a third test will be completed six months after the intervention to gouge knowledge retention levels. BUI and rehospitalization rates will be evaluated by comparing the statistics for the time period with that of previous years. Finally, patient satisfaction scores will be gouged using patient surveys (Sullivan, 2019).

Conclusions

BUI affects the patient’s health on multiple levels. It makes them uncomfortable, deteriorates their psychological health, and is a gateway to many other HAI. Teaching nurses to properly treat and prevent BUI would help reduce the morbidity of the disease and improve patient experiences in the ICU. Finally, the intervention would free up the much-needed patient hours and materials needed elsewhere. The proposed intervention will help improve the situation in the long run for hospitals and patients alike.

References

Danielis, M., Palese, A., Terzoni, S., & Destrebecq, A. L. L. (2020). What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. International Journal of Nursing Studies, 102, 103491.

Donnelly, D. W., Donnelly, C., Kearney, T., Weller, D., Sharp, L., Downing, A.,… Cross, W. R. (2018). Urinary, bowel and sexual health in older men from Northern Ireland. BJU International, 122(5), 845-857.

García, C. B., Binks, R., De Luca, E., Dierkes, C., Franci, A., Gallart, E.,… Gibot, S. (2015). Expert recommendations for managing acute faecal incontinence with diarrhoea in the intensive care unit. Journal of the Intensive Care Society, 14(4_suppl), 1-9.

Mohammed, H. M., & Nadr, M. (2018). Perineal dermatitis: A neglected problem in patients at Critical Care Unit. EPH-International Journal of Medical and Health Science (ISSN: 2456-6063), 4(2), 66-71.

Stokes, A. L., Crumley, C., Taylor-Thompson, K., & Cheng, A. L. (2016). Prevalence of fecal incontinence in the acute care setting. Journal of Wound, Ostomy and Continence Nursing, 43(5), 517-522.

Sullivan, D. A. (2019). How to choose and conduct a research project: some advice for young investigators. Arquivos Brasileiros De Oftalmologia, 82(1), 1-10.