A systemwide formula for continence care: Overcoming barriers, clarifying solutions, and defining team members' roles

Objective: To seek input from long-term care (LTC) administrators and staff on solutions for overcoming established barriers to continence care and the roles each team member must play in implementing them. Design: Cross-sectional, qualitative study using in-depth semi-structured individual interviews. Setting: Four LTC institutions in Montreal, Quebec. Participants: Sixteen health administrators, including the general director, the medical director, the director of nursing and the head nurse of the 4 institutions were interviewed. As well, 16 front-line health care workers including 8 nurses and 8 nursing assistants participated in the interviewing process. Intervention: During the interviews, participants were asked to comment on a list of established barriers to continence care and to recommend solutions, involving themselves or other members of the LTC team, for overcoming these barriers. The interviews were recorded and transcribed verbatim. Data obtained during the interviews were analyzed and specific solutions to each barrier were identified, as well as the roles each team member should play in implementing them. Results: Analysis of our data revealed 10 solutions, involving administrators as well as staff members: (1) setting continence care as an institutional priority; (2) establishing a continence committee; (3) involving the staff from the onset; (4) tailoring the continence program to each institution and resident; (5) providing training on incontinence; (6) elevating the standard of care for incontinence; (7) creating an incontinence-efficient working environment; (8) improving communication around continence care; (9) supervision, feedback and accountability; (10) championing the effectiveness of continence care. Typically, top-down solutions were proposed, but the value of bottom-up processes was included as part of the systemwide approach. Conclusion: Implementing and maintaining a continence program in LTC requires a systemwide approach involving LTC administrators and staff. The results of our research provide guidance for overcoming barriers to the implementation and maintenance of a continence program and for defining team members' roles in this endeavour.