Grounded theory was used to acquire an understanding of older women's experience of urinary incontinence (UI). Women explained that accidents or other problems related to the UI were threats to their self-esteem. These threats provided strong incentives to develop an effective continence care system which would help to protect their self-esteem. If they were successful in developing an effective system, it was possible that they could accept the UI and lead "normal" lives. Examination of the data using the constant comparative method revealed the self-care system that the women in this study produced to manage the UI, but not how they developed or sustained it. Further investigation into how women with UI develop and sustain continence care routines is needed, so that nurses can provide better assessments and nursing care.

The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

Urinary incontinence (UI) is a common problem and requires adjustment to self-care. Noninvasive methods to manage UI should be tried first. Although many individuals restrict fluid intake to reduce incontinent episodes, clinical hunches suggest that adequate hydration is more useful in the management of UI. This study was conducted to determine the effects of hydration on the number of UI episodes. Women were randomly assigned to 1 of 3 groups: increase fluid intake by 500 cc, maintain fluid intake at baseline level, or decrease by 300 cc. Thirty-two women kept fluid intake and output diaries for 5 weeks. Adherence to fluid intake protocols was poor, and consequently, quantitative results were nonsignificant. However, follow-up interviews revealed that 20 women reported decreased UI episodes since participating in the study and felt that the most significant learning was their recognition of the need to increase fluid intake. Community health nurses can provide guidance in self-assessment of fluid intake patterns to help manage UI.

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