Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Night-Time Continence Care in Australian Residential Aged Care Facilities: Findings from a Grounded Theory Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Night-Time Continence Care in Australian Residential Aged Care Facilities: Findings from a Grounded Theory Study

Article excerpt


Fifty-four per cent of individuals living in Australian residential aged care facilities experience more than three episodes of urinary incontinence a day, and 34% experience more than four episodes of faecal incontinence per week (Deloitte Access Economics and the Continence Foundation of Australia, 2011). The majority of these residents also have impaired mobility and degenerative neurological and psychiatric conditions, including dementia and depression. Therefore, they require high levels of assistance in order to manage their incontinence. Indeed, an analysis of data from 2003 by the Australian Institute for Health and Welfare (2006) indicated there were 146,639 (94%) Australians living in residential aged care facilities who required assistance with bladder or bowel management or to use the toilet. It is highly likely that their continence care needs extended throughout the 24 hour day.

International guidelines about managing incontinence among frail older adults promote an individualised approach to care, and recommend that decisions about night-time continence care should not only be based on information about the frequency, severity and type of the person's incontinence, but also on an assessment of their personal preferences, skin health, sleep/wake status and ability to spontaneously move in bed (Wagg et al., 2013). To the best of the researchers' knowledge, there is no research about night-time continence care practices in Australian residential aged care facilities. However, research conducted over 30 years ago, suggested night-time continence care in US long-term aged care facilities was anything but individualised. Continence care 'rounds' were performed at regular pre-defined intervals and failed to accommodate residents' individual sleep/awake status (Cruise, Schnelle, Alessi, Simmons, & Ouslander, 1998; Ouslander, Schnelle, Simmons, Bates-Jensen, & Zeitlin, 1993; Schnelle, Alessi, Al-Samarrai, Fricker, & Ouslander, 1999; Schnelle, Newman, et al., 1993; Schnelle, Ouslander, Simmons, Alessi, & Gravel, 1993a, 1993b). In addition, although some facility administrators and staff documented they conducted rounds every two hours, observational data indicated the actual number of rounds varied considerably. In the absence of more recent research, it is unclear if the findings reflect current care in US long-term care facilities. Moreover, as the research did not include a qualitative component to determine how staff beliefs and practices were produced and reproduced, the rationale for staff practices was not explicated.

Although continence care may be necessary for some residents at night, it unavoidably disrupts the duration and quality of their sleep (Cruise et al., 1998; Ouslander et al., 1993; Schnelle et al., 1999; Schnelle, Newman, et al., 1993; Schnelle, Ouslander, et al., 1993a, 1993b), which may, in turn, increase residents' risk of falling (Conn & Madan, 2006), and trigger distress and challenging behaviours (Voyer, Verreault, Mengue, & Morin, 2006). Despite the potentially negative impacts of conducting routine night-time continence care rounds, there is a paucity of research about how staff determine which residents require assistance with incontinence and/or bladder and bowel control, and how staff individualise care that complies with international guidelines.


As part of a larger qualitative and Grounded Theory study that described and explained how staff working in Australian residential aged care facilities determined, delivered and communicated residents' daytime and night-time continence care needs, the aim of this paper was to describe a subset of findings about nurses' and Personal Care Attendants' (PCAs) beliefs about, and experiences of providing, continence care at night.



The study was conducted using Grounded Theory methods which involved theoretical sampling; constant comparative data analysis; open, theoretical and selective coding techniques; theoretical sensitivity and memo writing. …

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