Staff compliance with and ratings of effectiveness of a prompted voiding program in a long-term care facility

Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding.

This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes.

Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709).

Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.