THE EFFECTS OF CHANGING PROMPTED VOIDING SCHEDULES IN THE TREATMENT OF INCONTINENCE IN NURSING-HOME RESIDENTS

Objective: To determine the effects of different prompted voiding sche dules on urinary incontinence on a continence unit (CU) and the mainte nance of benefits on normal nursing units. Design: Multiphase study wi th both intra- and inter-subject comparisons. Participants: Subjects w ere 41 consenting incontinent nursing home residents. Based on clinica l criteria, subjects were assigned to one of four treatment groups tha t varied as to the schedule of prompted voiding received. Measurement: The study used chart review, Katz ADL, and MMSE. Urologic status, sel f-initiated toileting, urine volumes voided, and incontinence assessed by pad/pants checks were measured by research nurses. Baseline pad ch eck data were collected on residents' normal nursing units. Residents were transferred to the CU where baseline measurement was repeated, an d the effects of different prompted voiding schedules were then assess ed. Indigenous staff were trained to use prompted voiding, and nurse s upervisors were instructed in special procedures for enhancing mainten ance of the intervention. Residents were returned to their normal unit s and the maintenance of improvements in continence status was assesse d at 2 weeks and 3 months post-CU discharge. Results: One of the four groups showed significant improvement on the CU in response to the 2-h our schedule; two groups improved on the less intensive 3-hour schedul e (P < 0.05). Two groups maintained this improvement on their normal n ursing units (P < 0.05); one group showed a nonsignificant trend towar d improvement. Self-initiated toileting decreased (P < 0.05) and volum e voids in an appropriate receptacle increased (P < 0.05) during train ing. Conclusions: Prompted voiding is an effective treatment for urina ry incontinence, and a less intensive S-hour schedule may be superior to the standard 2-hour schedule for some residents. These improvements in dryness can be maintained by normal nursing home staff if formal s taff management procedures are utilized by nurse supervisors.