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30th Anniversary Invited Editorial reflecting on Smith J.P. (1982) The problem of incontinence. Journal of Advanced Nursing 7, 409–410

  1. Top of page
  2. 30th Anniversary Invited Editorial reflecting on Smith J.P. (1982) The problem of incontinence. Journal of Advanced Nursing 7, 409–410
  3. References

Much has changed for the good since James P. Smith's Editorial in 1982 on ‘The problem of incontinence.’ Although much has changed, much remains the same. Continence nursing as a specialty has spread from the UK to other parts of the world. Advances have been made in the evaluation and treatment of incontinence. Yet, there remain substantial knowledge gaps regarding incontinence, both urinary and faecal. The nursing care of incontinent individuals, particularly those who are institutionalized, continues to be inadequate and interventions deemed effective by the Cochrane Collaboration are being underutilized. Evidence-based guidelines exist, but these are not being used universally (Watson et al. 2003). Nursing shortages, health policy issues, budget constraints, lack of knowledge and nurses’ attitudes of therapeutic nihilism are some of the barriers that play a role in why greater strides have not been made.

Smith, drawing on the recommendations of the landmark 1981 Workshop on Incontinence that had been held in UK, called for research to improve the management of incontinence for older adults, particularly those with dementia and mental health problems. Implicit in his editorial was also the need for cost-effectiveness studies in order to aid clinical decision-making regarding appropriate treatment, equipment and products for those with chronic incontinence. To date, relatively few cost-effectiveness studies have been conducted.

The 2003 international nursing research summit, sponsored by the University of Minnesota's Center for Gerontological Nursing and the John A. Hartford Foundation, identified new approaches for conducting research on incontinence in aging adults; strategies to better position nursing research on incontinence; and ways to attract and mentor nurse investigators. Those recommendations are highlighted in a supplement to Nursing Research (Wyman et al. 2004). Efforts are being made by the summit participants through the International Continence Society to continue communication on these recommendations. In addition, the need for a nursing education summit was identified, with preliminary plans being made to host one in Norway in 2006.

So, what is really needed to improve incontinence care? First, there needs to be a marketing campaign to recruit more nurses to become continence specialists. These nurses have an important role in providing direct care; educating students, nurses, administrators, payers and policy makers; and changing staff attitudes to therapeutic optimism. Secondly, there needs to be an organized, concerted effort by national nursing groups in raising awareness about incontinence and in disseminating educational competencies and resources in order to influence content and skills taught in basic, advanced practice and continuing nursing education programs. Thirdly, policy makers and healthcare organizations need to adopt quality indicators for incontinence and hold institutions to account. (For example, in the USA, the Centers of Medicare and Medicaid Services is implementing increased regulation related to urinary incontinence in long-term care facilities, with fines given to facilities that fail to meet basic standards). Fourthly, more nurse investigators who are engaged in incontinence research are needed. Research is needed to test interventions for preventing incontinence, and managing incontinence in select populations, such as the frail, elderly men, those with neurological disorders, and those who suffer from faecal incontinence. Cost-effectiveness studies as well as translation studies that apply clinical trial interventions to practice environments are also needed. If all this is accomplished, in another 30 years ‘the problem of incontinence’ may yet be under control.

References

  1. Top of page
  2. 30th Anniversary Invited Editorial reflecting on Smith J.P. (1982) The problem of incontinence. Journal of Advanced Nursing 7, 409–410
  3. References