Home' Australian Ageing Agenda : AAA Sept-Oct 2017 Contents T
he adoption of an innovative new framework that
aims to overhaul continence care for older people is,
according to its developer Dr Joan Ostaszkiewicz,
a “huge” but vital undertaking, if society values the
dignity of its most vulnerable citizens.
The Dignity in Continence Care Framework is described in
Ostaszkiewicz’s 2017 research Reframing continence care in
care-dependence, which also suggests strategies for its use.
Ostaszkiewicz, a leading researcher in the quality of
continence care in the aged sector, is keen to test the
framework in partnership with HammondCare, the
Continence Foundation of Australia and the National Ageing
Research Institute (NARI). The group has applied for funding
for a four-year trial.
Ostaszkiewicz says the framework has been designed to improve
the choice, autonomy and dignity for people requiring assistance
maintaining their continence or managing their incontinence.
However, the framework will need to be tested in
partnership with organisations that have a proven track record
in delivering dignity in care, promoting continence, and
research into the quality of life of older people, she says.
Ostaszkiewicz’s motivation for developing the framework
and her research underpinning it, had its beginnings more
than 30 years ago when she was working as a registered nurse
in the aged care sector. It became apparent to her on night
duty, while conducting the prescribed two-hourly “turns” of
residents, that the care provided to those with incontinence
was far from satisfactor y.
“The residents were often saturated – back then pads
weren’t as good as they are today – and some were distressed
from being woken up. And then there was the smell. I
thought, ‘we have to do better than that,’” she tells Australian
Matters have clearly improved as far as the quality of
incontinence pads goes, but the appropriateness of continence
care in residential aged care facilities through the ensuing
decades, has never been properly questioned, Ostaszkiewicz
says, “because of the private nature of incontinence”.
Ostaszkiewicz’s 2016 research, Night-time continence care
in Australian residential aged care facilities, suggests that
routine night-time pad checks still occur in some facilities, and
that the reasons behind these practices are not always based on
the best available evidence.
Her qualitative research was based on obser vations of night-
time practices by nursing and personal care attendant (PCA)
staff at a Victorian (75-bed) and South Australian (50-bed)
residential aged care facility, and inter views with nursing and
PCA staff working in other, similar facilities.
Dr Ostaszkiewicz found that most residents wore
incontinence pads at night and were checked up to three times
overnight. In one facility, six per cent of residents were helped to
use the toilet, while none were offered this option at the other.
Further to this, the information gathered via interviews
revealed firmly held beliefs about incontinence that shaped the
deliver y of care. For example, Ostaszkiewicz found that, if staff
viewed incontinence as an intractable and inevitable condition
of old age, they were more likely to view incontinence pads as
the only solution.
Ostaszkiewicz believes that the benefit of her use of qualitative
research methods was that it allowed for unexpected findings, and
provided new insights into taken-for-granted beliefs and practices.
Her study revealed that staff often found themselves
conflicted about deciding between protecting residents from
harm and upholding their right to choice and autonomy.
For example, a duty of care to protect residents from falling
could inadvertently result in practices that restricted their
autonomy to walk to the toilet. Similarly, a desire to protect
residents from pressure injuries could result in overzealous
night-time continence checks that would disrupt the quality
and duration of their sleep.
The challenge for aged care workers, she believes, is
to maintain a positive but realistic attitude that optimises
residents’ abilities and skills, including their toileting abilities
and subsequent continence.
“We know that up to 25 per cent of people admitted to
a residential aged care facility are continent at the time of
admission. There are also studies telling us that many people in
residential aged care homes have reversible causes of incontinence.
And we know that daytime toileting assistance programs are
effective in reducing residents’ rates of incontinence.”
Ostaszkiewicz’s findings, backed by a large body of evidence
about incontinence, dignity and care from biomedical,
nursing, psychological and sociological research, formed the
basis from which she developed the framework.
A new approach
The Dignity in Continence Care Framework, Ostaszkiewicz
says, is underpinned by the two core concepts of “dignity” and
“care”. It will challenge existing values and beliefs that have
A new approach to continence care
focusing on the right of choice and
autonomy challenges existing values
and beliefs, writes MARIA WHITMORE.
A major aim of the new framework is to provide aged care nurses
and care workers with education that will better equip them.
Valuing their dignity
46 | SEPTEMBER – OCTOBER 2017
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