Routines for Toilet Visits

Regular toilet visits can help many people stay dry, but it assumes that the staff assists those who cannot signal themselves that they need help to the toilet. The staff should never deny anyone a toilet visit when requested. The need might come at an inconvenient time, but the staff must still be helpful. It might often be urgent and for some people, it can be hard to hold it in if it takes too long to get to the toilet.

Temporary Incontinence

Temporary incontinence can have several causes. Urinary tract infection/cystitis is common among the elderly. Men who get urinary tract infections need to be treated as the prostate is often involved, which can lead to a serious upper urinary tract infection. Hygiene is something many elderly people need help with and good lower hygiene can prevent urinary tract infections. Often, urinary tract infections are caused by e-coli bacteria, which are found in the feces, getting into the urethra due to a lack of hygiene. Symptoms of a urinary tract infection can include feeling the need to urinate even though you just did, and stinging when urinating. Contact a nurse if anyone appears to have discomfort.

Avoiding Unnecessary Suffering

Another problem can be bladder overfilling. Men with prostate issues can sometimes not empty the bladder. Women can also suffer, for example, after childbirth or due to a blockage in the catheter. Having to wait for help is extremely painful. There is also a risk that the natural ability to empty the bladder gets damaged. This is a relatively common but completely avoidable care injury that causes lasting harm for the individual. For many, catheter placement is painful and there are reasons to wait a good while after the anesthesia is given before the catheter is inserted.

Incontinence Investigation

Toilet visits need to be made at regular intervals. It happens that older people with incontinence problems have incontinence protection without the symptoms being properly investigated. It also happens that estrogen treatment or other preventive measures for recurring urinary tract infections are missed. Likewise, it happens that the implementation of estrogen treatment or other preventive measures to prevent recurring urinary tract infections in women is missed.

There is a national quality program with guidelines for incontinence care. This care program contains guidelines for assessment, diagnosis, and treatment of different types of incontinence, such as stress incontinence, urge incontinence, and mixed incontinence. The program also includes measures to prevent and rehabilitate people with incontinence and recommendations for education and skills development of healthcare professionals in the area.

Before incontinence protection is prescribed, an investigation of the causes of the incontinence should be done. Whether the resident is only urine incontinent or both urine and fecal incontinent and to what extent. Incontinence protection should be specially tested and adapted for the individual. With the help of Nicola, the degree of incontinence issues can be determined. It can be urge incontinence with leakage, stress incontinence, or functional incontinence which can be both physical and psychological. Others may suffer from overflow incontinence due to an overfilled bladder, while others may have some form of mixed incontinence.

The manager should appoint at least one nurse to be responsible for prescribing incontinence aids and who is also responsible for ensuring that all residents with prescribed incontinence aids have also been investigated. By using Nikola, the operation gets a tool to ensure the quality of incontinence care.

Nikola www.nikola.nu is a network for bladder and bowel dysfunction that provides information, tips, and advice as a support in the work of investigating and shaping good incontinence care. Their quality program is truly a tool for good care. All nursing homes should also have at least one nurse with a prescribing education for incontinence aids.

Indwelling Catheter

It is sometimes necessary to have an indwelling catheter. Most often the underlying cause is a blockage in the urethra and the person therefore has difficulty emptying the bladder. The urine can then be left standing in the bladder, which often becomes painful for the individual and can also cause urinary tract infections.

In catheter care, it is important to keep the area around the catheter clean with mild soap and water daily to reduce the risk of infections. When draining or emptying the bag, one should observe if the urine is discolored, has an odd smell or is cloudy. Report suspected problems to the nurse. Also, make sure the flow is not restricted by kinks or other obstacles. During bladder training, the flow should be turned off periodically according to the schedule.

The catheter should be changed at regular intervals. Pain relief is given before changing the catheter to limit the patient's discomfort. If the patient has pain or discomfort from the catheter under normal use, consult a nurse or doctor.

Reflection Questions - Incontinence
Care Staff:
- Are the routines for toilet visits working well in the unit?
- Is the prescription of incontinence protection working well?  

Manager, Nurse, Occupational Therapist, and Physiotherapist:
- Has everyone who wears incontinence protection been investigated?
- Are there functioning routines to investigate residents with emerging incontinence problems?
- Do you use supplements to medication treatment for example in cases of constipation?
- Do you take support from Nikola?
- Do you have a nurse with prescribing training?  

Residents and Relatives:
- Do you find that the routines for toilet visits work in the unit?

Erland Olsson
Specialist nurse
Sofrosyne - Better Care Every Day