response

In the older adult population with people over the age of 65, what is the effect of using a frequent toileting schedule, in comparison to briefs or pads, on decreasing skin breakdown while in the hospital?

Heila Charen, ABSN Student Mara Michalski, ABSN Student Krysta Myers, ABSN Student Hally Uppleger, ABSN Student

College of Nursing and Health, Madonna University, Livonia, MI

Introduction

Nursing Theorist

PICOT Question

Relevant Evidence

Evidence-Based Practice Plan

References

Use of Change Theory

Evaluation Plan

Anticipated Outcomes

Acknowledgements

Marilyn Anne Ray’s Theory of Bureaucratic Caring -Why? Effective tool to combine caring and bureaucracy in nursing practice -How? Identify feelings towards current practice -Recognition of economic and technological impacts on quality incontinence devices -Recognition of cultural and ethical feelings towards incontinence measures -Different units will prioritize different aspects of caring (spiritual in oncology versus physical in rehab)

Population- The older adult population over the age of 65 is being examined. Intervention- The effect of using a frequent toileting schedule on these patients. Comparison-using briefs or pads on patients. Outcome- decreasing instance of skin breakdown while in the hospital or long-term care setting.

By implementing a proper toileting schedule, adults 65 years and older will experience less skin breakdown than with the use of pads or briefs

- Facilities that have established patients on a toileting prompting schedule showed improvement in continence in patients by 32% (Burgio, 1988) - Frequent incontinence has been shown to be a cause of incontinence associated dermatitis. Proper skin cleansing, skin protection, and incontinence prevention can prevent dermatitis from developing (Morgan, 2008). - Incontinence associated dermatitis can have serious effects on skin such as pressure ulcers and infection. This can be prevented by gentle cleansing, moisturization, and application of a skin protectant. The goals of the preventative measures taken in this study were removal of irritants from the affected skin, eradication of cutaneous infections such as candidiasis, and containment or diversion of incontinent urine or stool (Gray, 2010).  - An implementation of staff education, use of body wash and skin protectant, and reduced incidence of incontinence will decrease pressure ulcer injury and peritoneal dermatitis 98% of the time this protocol was used (Hunter 2003).

The perineal skin assessment tool is a set of 4 observations that are then used to rate the patient’s risk of perineal skin breakdown on a scale of 4-12. A score of 4 indicates there is a low risk, while a score of 12 indicates that there is a high risk. We plan to use this tool on both clients who are on a toileting schedule and clients who use pads and briefs to compare the difference of skin breakdown between the two groups.

Dr. Jean Watson & The Theory of Caring

1. Burgio, L., Engel, B. T., McCormick, K., Hawkins, A., & Scheve, A. (1988). Behavioral treatment for urinary incontinence in elderly inpatients: Initial attempts to modify prompting and toileting procedures. Behavior Therapy, 19(3), 345-357. 2. Morgan, C., Endozoa, N., Paradiso, C., McNamara, M., & McGuire, M. (2008). Enhanced toileting program decreases incontinence in long term care. The Joint Commission Journal on Quality and Patient Safety, 34(4), 206-208. 3. Swanson, K. M. (1993). Nursing as informed caring for the well‐being of others. Image: The Journal of Nursing Scholarship, 25(4), 352-357. 4. Gray, M. (2010). Optimal management of incontinence-associated dermatitis in the elderly. American journal of clinical dermatology, 11(3), 201-210. 5. Hunter, S., Anderson, J., Hanson, D., Thompson, P., Langemo, D., & Klug, M. G. (2003). Clinical trial of a prevention and treatment protocol for skin breakdown in two nursing homes. Journal of WOCN, 30(5), 250-258. 6. Nix DH. Validity and reliability of the Perineal Assessment Tool. Ostomy/wound Management. 2002 Feb;48(2):43-6, 48-9.

• Urinary incontinence is defined as the uncontrollable leakage of urine.

• Some of the causes of urinary inconsistency are due to a weak bladder, overactive bladder muscles, and damage to nerves that control the bladder.

• As a result of this many people have to use pads/briefs or a catheter which can lead to skin breakdown.

• 75% of pressure ulcers occur in the pelvic region (ischium, coccyx, etc.) 

Step 1 March 2021-April 2021: Relevant evidence of current practices in long term care facilities was acquired. Risk factors for skin breakdown related to the use of pads, briefs, and toileting scheduling was acquired.  Step 2 September 2021: Assessment of current interventions for incontinence was met by distributing a questionnaire to long term care facilities. The questionnaire includes factors related to the perineal skin assessment tool such as use of toileting schedules, types of pads and briefs used, and how often perineal skin is assessed. Step 3 September 2021- October 2021: Intervention includes providing the perineal skin assessment school to long term care facilities Step 4 October 2021 :Post intervention questionnaire is distributed to the same long term care facilities.  Step 5 November 2021: Evaluation of post intervention questionnaire

Source: Madonna University Source: Google

Thank you to Dr. McKenna DNP, APRN-BC, RN for the assistance and guidance throughout the completion of this project.