Barriers to implementing a continence program in nursing homes

Urinary incontinence is a problem for over 50% of nursing home residents, but it can respond to toileting programs. Nursing home staff, however, do not always follow the toileting schedules. Dimensional analysis of research logs that were kept during the implementation of an individualized toileting regimen for incontinent residents revealed several barriers to staff adherence to the protocol. System barriers included staffing shortages and limited licensed staff reinforcement. Individual barriers included conflicting beliefs and goals and difficulty organizing care routines. Conclusions suggest that implementation of toileting programs by nursing assistants could be improved with adequate and stable staffing, incentives for staff, and assistance with organizing work load. Establishing continence as the standard of care in nursing homes is a crucial element to the success of any toileting program. More research is needed to better understand how staff perceive, organize, and prioritize their care.