Advancing Evidence-Based Nursing: The Updated German Expert Standard on Continence Promotion

Incontinence is a widespread and socially taboo phenomenon worldwide. Incontinence, with its various manifestations, is one of the most common illnesses in outpatient medical care and represents a serious health problem for those affected of all ages. As part of the second update of the German expert standard published in 2024 on continence promotion, a systematic literature review was conducted to identify, appraise, and synthesize current evidence on nursing interventions to promote urinary and fecal continence. The expert standard does not provide a gradation of recommendations, but rather that the criteria depicted in the standard have the highest possible recommendation character in the sense of the best available knowledge. The aim of this article is to present the examination of available evidence within the context of the second update of the expert standard.

A systematic literature review was conducted between September and December 2022 with additional guideline research in December 2023 in Medline (via PubMed), CINAHL (via EBSCO), and the Cochrane Library, using predefined inclusion and exclusion criteria. Additional guideline databases and organizational websites were searched manually. The review process and reporting were guided by PRISMA 2020 reporting standards. Eligible studies included qualitative, quantitative, and guideline publications in English or German published since 2012. Study selection, data extraction, and critical appraisal were conducted independently by two reviewers.

Of 2850 initial records, 60 studies met the inclusion criteria and were included in the review. The majority were systematic reviews and evidence-based guidelines. The central literature-based results of the expert standard are presented based on the steps of the nursing process. The findings were thematically synthesized along the steps of the nursing process and informed key nursing interventions for continence promotion and compensation, including assessment, patient education, pelvic floor training, and selection of continence aids.

There are a variety of evidence-based interventions that can be used to deal with urinary and/or fecal incontinence and the tasks that professional nurses take on in promoting continence are complex. Patients and their relatives want information and advice on treatment options, reliable contacts and individual support offers to make informed decisions.