Abstract
Urinarsy incontinence involves difficulty in retaining urine, making it a problem with multiple consequences. The purpose of this chapter is to encourage reflection on this situation and identify potential action with a view to promoting self-care in the elderly with urinary incontinence. The authors undertook an ethnographic survey in convalescence units in which they observed and interviewed elderly patients with urinary incontinence and healthcare professionals. Implementing an “observation, reporting, and reflection” approach, they carried out a content analysis. Three cultural dimensions emerged affecting self-care. Functional dependence and vulnerability led to an impaired attitude to the body, which constituted the primary challenge in the process. The promotion of self-care was marked by difficulties, strategies, and modes of action where the nurses played a significant role in liaison with the multidisciplinary team. The preparation for discharge was marked by points of contention and negotiations that decided whether the patient would return home or be the subject of referral.
TopIntroduction
We are living increasingly long lives and population ageing is a recognised phenomenon. It is estimated that, in Europe, by 2080, the percentage of people aged over 80 will more than double, reaching 13% of the total population (Eurostat, 2018). However, if these additional years represent a victory, we must bear in mind that ageing is not always a successful process, especially where associated with conditions that lead to dependency.
Where during the ageing process bodily functions change or deteriorate as the result of a pathological phenomenon, there is a risk of increased vulnerability. Urinary Incontinence [UI] is an example of such a situation due to the multiple physical, psychological, economic and social implications with which it is associated. If the forecasts point to continued growth in the number of elderly in Europe, the presence of co-morbidities that will lead to situations of deficiencies in self-care is inevitable. UI will certainly feature among these, with all its repercussions on the different Daily Life Activities (DLA). These consequences will be felt not only by the elderly person, but also by his or her carer, particularly as it involves an intimate part of the body and the relationship between dirty and clean is not always easy to manage.
Mindful of the adversities that underly the condition, the International Consultation on Incontinence and the Ostomy and Continence Nurses Society [WOCN] state that it is necessary to pay attention to the situation in order to be able to intervene more effectively (WOCN Continence Committee 2008-2009, WOCN Professional Practice Committee 2008-2009, Kupsick, Lawrence & Sadler, 2009; Abrams, Cardozo, Khoury & Wein, 2013). However, even though it forms part of the Geriatric Giants like the risk of falls, confusion and sensory limitations, UI is still not regarded as a priority, and is even hidden in many cases, leading to it going undiagnosed and, consequently, not being treated (Foley et al., 2012).
Accordingly, the need to construct a process of self-care that observes physical, psychological and sociocultural aspects is extremely important given the trilogy of “ageing, urinary incontinence and care”. This approach will always require the mobilisation of a multidisciplinary team, where nursing, due to its characteristically holistic vision and approach, plays an essential role with the elderly people and the carers, due to the careful attendance it encourages. Therefore, and because it will be necessary to act on the co-morbidities and promote convalescence and rehabilitation, the objectives of this chapter are as follows: I. To describe the process of constructing care, with a view to promoting self-care in the elderly person with urinary incontinence within a context of convalescence; II. To identify modes of action, taking into account cultural aspects and socially organised behaviour with a view to promoting self-care in the elderly person with incontinence. This chapter emerges from the results of a study carried out for the Report of the Doctoral Thesis in Nursing, which was conducted by the first author under the guidance of the second.
Key Terms in this Chapter
Process: Sequence of actions, carried out in a systematized manner taking into account an objective, in the case of this article, the promotion of self-care for the elderly with urinary incontinence.
Urinary Incontinence: A condition resulting from an inability to store and control the excretion of urine.
Promotion of Self-Care: Planning and definition of nursing interventions aimed at the promotion of care and well-being, conducted through the implementation of methods of analysis and assistance through action geared towards acting for and/or with people. They aim at the provision of self-care, conducting, guiding and teaching through physical and psychological support, taking into account environmental and sociocultural conditions, while seeking personal development.
Self-Care: Practice of the activity of caring as a learned behavior within a sociocultural context, which progresses according to the person’s development, contributing to the maintenance of health and disease prevention through healthy functioning, personal development and wellbeing.
Elderly: Chronological age of at least 65 years, from which, in developed countries, a person is considered elderly.
Compensatory System: Includes compensation for that which is deficient or insufficient.
Self-Care Deficit: Includes the relationship between needs for self-care and the capacity to provide it. It is always found where people cannot provide their own self-care or provide it for their dependents.