‘To address pad culture, we must also tackle staffing shortages’

With an aging population, inevitably there will be an associated increase in people affected by continence problems and needing the care and support from services that are already stretched.

Therefore, every effort should surely be made to prevent more individuals becoming incontinent and needing those services and experiencing a reduced quality of life, as a result.

Sadly, a new study led by researchers at the University of West London has found dementia patients in acute hospital settings are at increased risk of developing incontinence during their hospital stay as a result of a widespread “pad culture”.

The study looked at continence care across six acute wards in three hospitals in England and Wales over a 12-month period. It found an “ingrained” culture where by continence pads were routinely used in people with dementia regardless of their level of continence at admission.

The researchers noted that continence pads were often introduced as a precautionary measure to prevent accidents. However, patients with dementia were then frequently expected to use the pads instead of going to the toilet normally.

“The scale of the problem is likely to be significant and, therefore, the need for learning at all levels significant too”

This allowed for fewer unscheduled interruptions on the ward, they said, but could put patients at risk of becoming incontinent, with a subsequent loss of independence on hospital discharge and a knock-on effect for nursing staff working in community settings.

Almost inevitably, there is a workforce issue at the root of this, with ward staff in the study saying they felt abandoned with responsibility for large numbers of patients with dementia and little support. They wanted to deliver high-quality person-centered care but felt unable to.

As ever, it seems to be pressure on the system that is creating a situation where there is a risk to patients and that staff are being left in the knowledge that they have provided substandard care, with its negative implications for morale and mental health. However, there is perhaps a small chink of light on the horizon.

The study was funded by the National Institute for Health and Care Research, which carries out research for the Department of Health and Social Care, and the researchers said they will use the findings to deliver open access training to staff, as well as working with trusts. and wards to improve care.

On what scale this is likely to be is unclear though. Given the number of patients with dementia in hospital, the scale of the problem is likely to be significant and, therefore, the need for learning at all levels is significant too. To put this into context, during 2017-18 there were 40,083 patients with dementia who remained in hospital for between a month and a year.

Of course, bladder and bowel problems do not just affect older people with dementia. Although not directly related, the research findings were released in World Continence Week.

The event is run each year by the World Federation of Incontinence and Pelvic Problems to raise awareness of incontinence-related issues. Its stated aim is to create a “world where people living with all forms of pelvic floor dysfunctions can enjoy a high quality of life, play an active role in society and have access to appropriate treatments”.

Meanwhile to further support World Continence Week, Nursing Times is running a series of five free webinars each day that can also be watched back on demand.

We began by focusing on male incontinence. Our presenter, urology specialist nurse Ruth Broom, highlighted it was an area that received less attention than others, often being just viewed as a consequence of aging.

On Tuesday, we heard about the challenges of continence and transgender people, for example, the heightened risk of urinary tract infections and common difficulties accessing appropriate toilet facilities, with the associated knock-on problems.

Continence in children, and in particular children with complex needs and the transition to adult services, was the focus of last night’s webinar.

The week will be completed with sessions on continence in acute stroke patients and the transition to community services, and how digital technologies can help improve access and support the care of patients with continence problems.

There are also many great resources available from organizations like the Association of Continence Advisors and ERIC, the children’s bowel and bladder charity.

But education and learning can only take you so far. Without adequate resources in place, the situation will not change for the better and simply lead to further frustration for nursing staff.

To effectively address the pad culture, we must also tackle staffing shortages and the way that hospital care for those with dementia is both viewed and organized. Not easy challenges, but ones that surely cannot be ignored, given that, by 2025, it is estimated that over one million people in the UK will have a diagnosis of dementia.

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