Nurse perspectives on the psychosocial care of patients with urinary incontinence in home hospice: A qualitative study

Abstract

Background: Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. Aim: This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize patient and family comfort. Design: Qualitative descriptive study using semi-structured interviews. Setting/participants: Nurses employed at a large not-for-profit hospice agency in New York City. Results: Analyses of 32 interviews revealed three primary themes. First, nurses considered urinary incontinence to be associated with multiple psychosocial issues including embarrassment for patients and caregiver burden. Second, nurses described urinary incontinence as a threat to patient dignity and took steps to preserve their continence function. Third, nurses assisted patients and their families to cope with urinary incontinence through normalization, reframing incontinence as part of the disease process, mobilizing caregiving assistance, and encouraging use of continence supplies such as diapers and liners. Conclusion: Urinary incontinence influences the psychosocial care of patients receiving home hospice and nurses employ strategies to maximize patient and family comfort. Additional research is needed to examine the psychosocial benefits of facilitated discussions with patients and family members about incontinence, provision of caregiving support, and distribution of comprehensive incontinence supplies to patients with fewer resources.

Symptom Burden and Activity of Daily Living (ADL) Dependency Among Home Health care Patients Discharged to Home Hospice

“…25 While eligibility for HHC services is based on homebound criteria and need for skilled nursing or rehabilitative services, 3 hospice eligibility criteria is not based on needs for care. 26 For example, compared to HHC services, home hospice provides limited home health aide services, 27,28 which many homebound patients rely on for assistance with personal care needs under HHC system. Moreover, access to the hospice benefit is constrained by the requirement that patients’ forgo treatments directed at their terminal condition, and prioritize symptom-directed care.…”