Urinary incontinence, a condition where a person loses control of their bladder, is known to be common among older people. However, it is not a normal or inevitable part of ageing. When NTUC Health (Jurong West) - Nursing Home embarked on the Return to Continence Programme among their residents, one of their main objectives was to bust this misconception.
Their goal for the pilot? To wean 90% of 41 residents identified off diapers in 22 weeks.
Why NTUC Health (Jurong West) - Nursing Home started this project
While wearing diapers is one of the solutions for people with urinary incontinence, the project team noted that it may bring about side effects such as:
- Embarrassment (due to foul odour, diaper leaks and diaper changes)
- Loss of confidence
- Compromised dignity (during diaper-changing)
- Compromised skin integrity due to diaper rashes, dermatitis and pressure sores
The project was especially important to the NTUC Health nursing home in Jurong West as 87% of their residents were on diapers at that time.
The project team kicked off the project in April 2018 by setting these objectives:
- To educate residents, caregivers and the public that urinary incontinence is not a normal process of ageing
- To manage residents’ continence
- To reduce Urinary Tract Infection (UTI), diaper associated dermatitis, and pressure sores
- To restore and maintain bladder functions of the residents
- To provide dignity of care
- To improve quality of life and overall well-being of residents
First things first: Why residents wear diapers
To tackle the issue, NTUC Health identified the root causes of why a lot of residents in nursing homes wear diapers: some are on diapers due to medical conditions or mobility issues; some do it out of habit, while others are worried about urinary leakage and are afraid they won’t be able to rush to the toilet in time when they feel the need to urinate.
With this understanding , the team selected residents to go on the 22-week programme. These residents were deemed to have the potential to wean off diapers because of their cognitive status, bladder function and functional status.
The team initially faced apprehension from the residents, who were afraid of soiling their pants and beds if they couldn’t make it to the toilet on time.
However, they encouraged participants by constantly motivating them. They also presented residents who weaned off diapers with certificates of achievement during graduation ceremonies, and gave small rewards to the residents to acknowledge their efforts.
The team then implemented a structured programme, which could also be adjusted according to residents’ needs and ongoing learnings. The programme includes:
1. A multidisciplinary approach
The project team worked with involving doctors, nurses, allied health professionals to adjust the residents’ diet, exercise routine and medication, monitored the residents’ toileting habits, and encouraged them to forgo the diapers. They also had regular conversations and check-ins with the residents and their caregivers/next-of-kin.
2. Adjusting workflow
They had to ensure there was enough bladder scanners, urinals and commodes for use. The team also had to fine-tune their workflow to cater time for continence rounds.
3. Training and education
To ensure the programme’s success, the team appointed nursing staff, known as Continence Champions, to raise awareness about UI. These Continence Champions educate their colleagues, as well as residents and caregivers/next-of-kin, on the benefits of not wearing diapers and how they can live more comfortably without them.
4. Data mining
The team provided timely and accurate documentation of the residents’ progress. They also did weekly tracking and case reviews to identify challenges and key learnings through a tracking sheet. The Continence Champions used the tracking sheet to help residents plan their schedules around two-hourly toilet breaks and held regular one-on-one engagements to offer residents their support, encouragement and reassurance.
At the end of the programme, the NTUC Health nursing home in Jurong West saw 37 residents successfully weaning off diapers.
A few residents were so proud of their accomplishment that they stepped up to be Continence Ambassadors, and shared their personal experiences with their peers to encourage more to follow in their footsteps.
Nurse Manager Teo Ai Lian, who was one of the project leaders, said, “The residents are happier and more confident now. Their self-esteem improved and they also feel more comfortable without diapers.”
Why they were successful + learning points
Apart from meeting the project’s objectives, including improving the residents’ quality of life, the NTUC Health nursing home in Jurong West saw another benefit: the residents’ next-of-kin felt more confident about the care the nursing home delivers.
The project team also took home a few learning points, such as:
· A person-centred care approach works best to gain residents’ trust and confidence
· Start early upon admission, and start from residents who are easier to motivate
· Be practical and start small (e.g. three residents in a ward)
· Continuous motivation is extremely important for both staff and residents
The team also shared that the programme was successful and sustainable due to four factors:
1. A clear care philosophy
The team had strong and clear care philosophy to guide their beliefs and values. In this way, they find the tasks and projects they initiated more meaningful.
2. Strong leadership
The team received support and encouragement from the management, and guidance from nurse managers and clinicians who were always on the ground with them.
3. Open communication
There was an open, two-way communication when it came to case reviews, sharing sessions and feedback. This was key in helping the team overcome challenges.
4. Empowerment and inspiration
Rewarding and recognising the efforts of both the staff and Continence Ambassadors made them feel empowered and motivated to share their success stories. The graduation ceremonies also instilled in residents a sense of achievement, and inspired other residents to try weaning off diapers.
The Return to Continence Programme received the Team Award for Clinical Quality Improvement Award at the Community Care Excellence Awards 2020.
Find out more about the project through this video:
Images: NTUC Health