- Email: [email protected]
Evaluation of absorbent products for women with mild to moderate urinary incontinence
Research Briefs Evaluation of Absorbent Products for Women With Mild to Moderate Urinary Incontinence Jan Baker and Peggy N o r t o n
RINARY INCONTINENCE affects up to 40% of community-dwelling adult women in the United States (Diokno, Brode, Brown, & Herzog, 1986; Thomas, Plymat, Blannin, & Meade, 1980), and 7 billion dollars are spent annually on managing incontinence in the community (Hu, 1990). Many health care providers believe that surgery, medication, and behavioral modification are the major treatment options, but the use of absorbent products is the most common method of managing urinary incontinence (Herzog, Fultz, Normolle, Brock, & Diokno, 1989). This is reflected by the growth of the absorbent pad market from $9 million in 1972 to $496 million in 1987 (Urinary Incontinence Guideline Panel, 1992). Absorbent products have been evaluated for the institutionalized patient, but few studies have evaluated absorbent products for the community-dwelling woman (Brink, 1990). The purpose of this study was to evaluate eight absorbent pads for use by communitydwelling women with mild to moderate urinary incontinence.
U
PATIENTS AND METHODS
Women 18 years of age or older with mild to moderate urinary incontinence were recruited to evaluate six incontinence and two menstrual pads. Incontinence pads were selected for evaluation based on their commercial availability in Utah and are labeled for use in "light" to "moderate" urinary incontinence (Figure 1 and Table 1). The two menstrual pads are designated for "heavy flow." The manufacturers provided the pads but were otherwise not involved in the study. The needs assessment questionnaire and pad evaluation forms were developed during a pilot phase. Face and content validity of the questionnaires were reApplied NursingResearch,Vol, 9, No. 1 (February), 1996: pp 29-36
viewed by several researchers who were familiar with incontinence and absorbent products. Women were recruited between November 1991 and December 1993 from a urogynecology clinic and by advertisement in a tertiary care hospital, and represented a mixed clinical picture of stress or urge incontinence. For the purpose of this study, mild to moderate incontinence was defined as at least 4 but not more than 25 incontinent episodes a week. Women were excluded from the study if they were currently using three or more extraabsorbency incontinent pads a day to manage their incontinence because they more likely fit a classification of "moderate to severe." Subjects would be dropped from the study if more than 75% of the study pads were soaked, indicating incontinence of a moderate to severe degree. Other exclusion criteria included symptoms of dysuria, vaginitis, or an inability to comply with record keeping. Demographic data, incontinence symptoms, and a needs assessment questionnaire were obtained on each subject on entry to the study. This needs assessment questionnaire assessed each of l l pad characteristics on a scale of 1 (not important) to 10 (very important). The 11 characteristics were comfort, ease of application, ease of removal, dryness and confidence, discreetness (does not show through clothes), protection from skin irritation, ability to stay in place, no noise disturbance, odor control, ease of disposal, and cost (willingness to purchase). Subjects evaluated a different absorbent product each week for 8 weeks and were given 10 pads of the specific product to use over 1 week. Product sequence was preassigned using random numbers, and the commercial name of the pad was not blinded to the subject. Daily diaries were kept to record voiding frequency, number of incontinent episodes, and the amount of loss with each episode. The amounts were coded as small (few drops), moderate, or large (would soak clothes without a pad in place). To determine whether patients were using a pad appropriate for their degree of incontinence, the subject recorded in the diary whether the pads were dry, damp, or soaked. Diaries were reviewed every 2 weeks with the women for compliance and accuracy. 29
30
RESEARCH BRIEFS
Figure 1. The absorbent products used in the study. Serenity "C" appears smaller on figure because of its cup shape. Other pads shown are lying flat, The letter next to each pad corresponds to the description in Table 1,
At the end of each week, each product was rated on its performance on a scale of 1 (poor) to l0 (excellent) on the 11 characteristics from the needs assessment questionnaire. Pads also were rated on overall global performance (scale of I to 10). At the completion of the study, the women were asked which pad they would purchase and completed a poststudy needs assessment and poststudy needs assessment was the same as the prestudy needs assessment and was administered to evaluate any changes in the women's pad needs after completion of the study. Power calculation estimated that a sample size of 80 was needed to find a 2-point difference between the mean scores. A p value of <.05 was used to determine significance. RESULTS
The study group consisted of communitydwelling women, (n = 65) with a mean age of 52 (range = 28 to 84). Seventy-five percent were educated beyond high school, and 65% had a household income greater than $20,000. Forty-two percent of the women in the study had symptoms of
Table 1. Absorbent Products Brand Name A
Free &Active regular pad (Humanicareb)
B
Store-brand menstrual pad (Confab Companiesc) C Serenity guard (Johnson & Johnson d) D Always menstrual pad (Procter & Gamble e) E Surety shield (Confab Companiesc) F
Tranquility shield (Principle Business Enterprises, Inc.) G Attends insert pad (Procter & Gamblee) H Depends shield (Kimberly Clarkf)
PackageLabeling "Regular pad for lightto-moderate protection" "Super absorbency"
"Regular for moderate bladder control needs" "Double plus, extra long'" "Regular absorbency for light-to-moderate protection" "Regular absorbency holds up to 4 ounces" "Moderate protection" "Regular absorbency for light incontinence"
Unit Pricea $0.52
$0.10
$0.57
$0.20 $0.22
$0.85
$0.66 $0.25
aCost per pad based on average retail cost in Utah at start of study (1991). bNorth Brunswick, NJ. cKing of Prussia, PA. dMilltown, NJ. eCincinnati, OH. fNeenah, WI.
RESEARCH BRIEFS
31
pure stress incontinence, 12% had symptoms of pure urge incontinence, and 46% had mixed symptoms of both urge and stress incontinence. Of the 108 women recruited for the study, 43 evaluated fewer than eight pads, and 65 completed the evaluation of all eight pads. Results are reported using data from the completed subjects, although data from all 108 subjects were analyzed separately and found to be similar. No subject had to be dropped from the study for excessive soaking of pads. The women in the study used a mean of one-and-one-half pads per day (95% confidence interval [CI] = 1.4 to 1.6), voided an average of 7 times a day (95% CI = 6.4 to 7.6), and recorded a mean 2.0 incontinent episodes per day (95% CI = 1.7 to 2.4). Subjects reported a mean of 1.2 small incontinent episodes, 0.7 moderate episodes, and 0.5 large episodes a day. Thirty percent of the pads were reported as being soaked after use, 45% as damp, and 25% as dry. There was no difference in the pad brands as to the number of soaked pads reported. On the prestudy needs assessment, the most important characteristics of an absorbent pad were found to be (1) dryness and confidence, (2) odor control, (3) ability to stay in place, (4) discreetness, and (5) comfort (Table 2). On the poststudy questionnaire, odor control and ability to stay in place became less important, whereas comfort and discreetness became more important. Results of the pad scores are shown for the five characteristics determined to he important on both the prestudy and poststudy needs assessment. Also reported are the results on cost (willingness to purchase) and overall performance score (Figures 2 and 3). Serenity scored highest in overall score,
comfort, and discreetness. The two menstrual pads scored significantly higher than many of the incontinence products in all categories except dryness and confidence. Although the Attends pad scored high on being dry and confident, it was judged not to be discreet and comfortable. The Always menstrual pad scored significantly higher on staying in place than four other pads (Free & Active, Depends, store-brand menstrual pad, and Tranquility). Serenity and Surety scored significantly higher on staying in place than Free & Active. There were no statistical differences found between the pads on the characteristic of odor control. Of the 65 women completing the evaluation of all eight pads, 25 women chose Serenity, 9 chose the store-brand menstrual pad, 7 chose Attends, 7 chose Depends, 6 chose Surety, 6 chose Always menstrual pad, 3 chose Free & Active, and 2 chose Tranquility as the pad they would purchase for their personal use. No significant differences were found in pad choice according to age, weight, type of incontinence, or severity of incontinence. DISCUSSION
The least expensive products in the study, the menstrual pads, scored as well or better on their overall score than the more expensive incontinence pads and scored highest on cost (willingness to purchase). High price did not equate with high performance. Of the pads marketed for incontinence, Serenity scored highest on two of the five important characteristics and highest on the overall score but was less expensive than two other incontinence pads. The most expensive incontinence pad, Tranquility, scored only moderately well on the important characteristics. The commercially
Table 2. Scores on Characteristics From Needs Assesment Questionnaire a Prestudy
Poststudy
Characteristic
Mean Score
(95% El) b
Characteristic
Mean Score
(95% Cr)
Dry and confident No odor Stays in place Discreet Comfort Irritation Noise disturbance Cost Disposal Application Removal
9.7 9.5 9,3 9.1 8.7 8,7 8.3 8.0 7.7 7.4 7,3
(9.5-9.9) (9.3-9.8) (9,1-9.5) (8.8-9.4) (8.4-9.0) (8.3-9.1) (7.8-8.8) (7,5-8,5) (7.3-8.2) (7.0-7.8) (6,9-7.7)
Dry and confident Discreet No odor Comfort Stays in place Noise disturbance Irritation Cost Application Removal Disposal
9.5 9,4 9.1 9.1 9.0 8.4 8.2 7,7 7,1 7.0 6,9
(9.3-9,7) (9.1-9.7) (8.7-9.5) (8,8-9.4) (8.6-9.4) (8.0-8.8) (7,7-8.7) (7.2-8.2) (6.7-7.5) (6.6-7,5) (6.4-7.5)
Abbreviation: CI, confidence interval. aRanked in order. b95% CIs that are mutually exclusive imply statistical significance.
32
RESEARCH BRIEFS
OVERALL 10 ~'~
9
ro
8
L.~
7
+I
6 5
(1)
b
4
E
~
o
c
~
~
Ix.
U
0'3
3
o ©
2
~-
E
~-
2
~.
~
available products evaluated in the study only partially met the needs of this group of women with mild to moderate incontinence: The highest overall score was no better than 7.2 out of a possible 10. The number of incontinent episodes and pad usage confirm that subjects had mild to moderate incontinence as defined. Billions of dollars are spent annually on managing incontinence, yet little clinical research has been done to evaluate absorbent pads for community-dwelling women with mild to moderate incontinence. Bierwirth (1992) completed a personal evaluation of several absorbent pads and found that pantyliners and minipads held less than 5 mL before they leaked and judged them to be inappropriate for use in urinary incontinence. Fader, Barnes, Malone-Lee, and Cottendemn (1987) reported
'-'
-~ c
Figure 2. M e a n scores on scale of I (poor) to 10 (excellent) for overall score. 95% confidence intervals (95% CI) that do not overlap are statistically significant at p < .05.
that ambulatory British women choose a small, discreet pad regardless of the severity of their incontinence, preferring to change their pad more frequently if necessary. Dallas and Winston (1992) had subjects wear "patches" of pads that had been instilled with a synthetic urine. Each of the "patches" of pads were tested on their forearm for 2 hours. Numerous products labeled for "moderate to heavy" incontinence were tested. They reported that Tranquility scored significantly higher than many of the pads on keeping the skin drier by their testing standards. Inconsistent labeling might have led us to including products in this study that were not comparable and might account for differences seen in pad scores. An "extra absorbency shield," for example, may not be any more absorbent than a "regular DISCREETNESS
DRY AND CONFIDENT lO
lo
cJ e--
~
e
+1
+1
6
6:
=
e
f
c
COST (Wilfingness to purchose)
COMFORT lo
9 d
~7 m +T
6
Figure3. M e a n scores on scale of I (poor) to 10 (excellent) on characteristics of "dry and confident," "discreetness, . . . . comfort," and "cost."
5
§
4-
~, 4 q
3-
g~
2-
f
RESEARCH BRIEFS
33
absorbency guard." More information is needed to understand how type and amount of incontinence affects pad needs; for example, a woman who loses a small amount of urine multiple times a day may have different needs than a woman who loses a large amount of urine only once a day. IMPLICATIONS
A "maxi" menstrual pad is recommended for women who are initiating the use of pads to manage their incontinence. If the menstrual pad does not meet their needs, Serenity or a comparable "high-capacity" pad could be recommended. To assist the women in finding a pad that best meets her needs, it is recommended that a sample pack of six to seven different pads be given; menstrual pads should be included in this sample pack. Several mail-order companies currently offer a sample pack of different absorbent pads, but these do not include menstrual pads. Although absorbent pad use is often viewed negatively because it may delay treatment, not all incontinence can be cured. The use of absorbent products may be necessary during treatments for incontinence, and for those patients who continue to experience incontinence despite treatment. Therefore, it is important that research on absorbent products continue for the design of better absorbent products. REFERENCES Bierwirth, W. (1992). Which pad is for you? Urologic Nursing, 12(2), 75-77. Brink, C.A. (1990). Absorbent pads, garments, and management strategies. Journal of the American Geriatric Society, 38, 368-373. Dallas, M.J., & Wilson, EA. (1992). Adult incontinence products: Performance evaluation on healthy skin. INDA Journal of Nonwovens Research, 4, 26-32. Diokno, A.C., Brode, B.M., Brown, M.S., & Herzog, A. (1986). Prevalence of urinary incontinence and other urologic symptoms in the non-institutionalized elderly. Journal of Urology, 136, 1022-1025. Fader, M., Barnes, E., Malone-Lee, J., & Cottendenm, A. (1987). Choosing the right garment. Nursing Times, 83, 78-85. Herzog, A.R., Fultz, N.H., Normolle, D.E, Brock, B.M., & Diokno, A.C. (1989). Methods used to manage urinary incontinence by older adults in the community. Journal of the American Geriatric Society, 37, 339-347. Hu, T. (1990). Impact of urinary incontinence on health care costs. Journal of the American Geriatric Society, 38, 292-2955. Thomas, T., Plymat, K., Blannin, J.S., & Meade, T. (1980). Prevalence of urinary incontinence. British Medical Journal, 28, 1243-1245. Urinary Incontinence Guideline Panel. (1992, March).
Urinary incontinence in adults: Clinical practice guidelines. (AH-CPR Publication No. 92-0038). Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, Public Health Service.
From the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UZ Jan Baker, MS, APRN:Research and Clinical Nurse, Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Clinical Instructor, University of Utah College of Nursing, Salt Lake City, UT; Peggy Norton, MD: Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Supported in part by the Department of Obstetrics and Gynecology Development Fund, University of Utah, Salt Lake City, UT. Address reprint requests to Peggy A. Norton, MD, Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, UT 84132. Copyright © 1996 by W.B. Saunders Company 0897-1897/96/0901-000655.00/0
Humanistic Behaviors and Primary Nursing Practice Mary Jane Smith
p
RIMARY NURSING is enhanced by a humancentered nursing perspective. Additionally, a responsibility relationship is pivotal to primary nursing practice and to a human-centered nursing perspective (Manthey, 1980; Paterson & Zderad, 1976). The responsibility relationship is knowledge based, negentropic, reciprocal, and patterned (Rogers, 1992). This means that the nurse-person relationship extends in space-time, grows in complexity, and is centered. Nurse is fully present to the person in the here and now. Inherent in a responsibility relationship is a call to consciousness (Heidegget, 1962). It is a call to be authentic to others in relation to the challenge in the situation. Challenge in primary nursing is a choice to be responsible to the person in the context of environmental complexity over the course of the nurse-person relationship. It follows that where primary nursing is practiced, the challenge is met with an openness and sensitivity to others, a respect for persons, and a value for each person's fight to self-determination. The hypothesis tested in this study was that registered nurses (RNs) who perceive themselves practicing a high level of primary nursing will score
RINARY INCONTINENCE affects up to 40% of community-dwelling adult women in the United States (Diokno, Brode, Brown, & Herzog, 1986; Thomas, Plymat, Blannin, & Meade, 1980), and 7 billion dollars are spent annually on managing incontinence in the community (Hu, 1990). Many health care providers believe that surgery, medication, and behavioral modification are the major treatment options, but the use of absorbent products is the most common method of managing urinary incontinence (Herzog, Fultz, Normolle, Brock, & Diokno, 1989). This is reflected by the growth of the absorbent pad market from $9 million in 1972 to $496 million in 1987 (Urinary Incontinence Guideline Panel, 1992). Absorbent products have been evaluated for the institutionalized patient, but few studies have evaluated absorbent products for the community-dwelling woman (Brink, 1990). The purpose of this study was to evaluate eight absorbent pads for use by communitydwelling women with mild to moderate urinary incontinence.
U
PATIENTS AND METHODS
Women 18 years of age or older with mild to moderate urinary incontinence were recruited to evaluate six incontinence and two menstrual pads. Incontinence pads were selected for evaluation based on their commercial availability in Utah and are labeled for use in "light" to "moderate" urinary incontinence (Figure 1 and Table 1). The two menstrual pads are designated for "heavy flow." The manufacturers provided the pads but were otherwise not involved in the study. The needs assessment questionnaire and pad evaluation forms were developed during a pilot phase. Face and content validity of the questionnaires were reApplied NursingResearch,Vol, 9, No. 1 (February), 1996: pp 29-36
viewed by several researchers who were familiar with incontinence and absorbent products. Women were recruited between November 1991 and December 1993 from a urogynecology clinic and by advertisement in a tertiary care hospital, and represented a mixed clinical picture of stress or urge incontinence. For the purpose of this study, mild to moderate incontinence was defined as at least 4 but not more than 25 incontinent episodes a week. Women were excluded from the study if they were currently using three or more extraabsorbency incontinent pads a day to manage their incontinence because they more likely fit a classification of "moderate to severe." Subjects would be dropped from the study if more than 75% of the study pads were soaked, indicating incontinence of a moderate to severe degree. Other exclusion criteria included symptoms of dysuria, vaginitis, or an inability to comply with record keeping. Demographic data, incontinence symptoms, and a needs assessment questionnaire were obtained on each subject on entry to the study. This needs assessment questionnaire assessed each of l l pad characteristics on a scale of 1 (not important) to 10 (very important). The 11 characteristics were comfort, ease of application, ease of removal, dryness and confidence, discreetness (does not show through clothes), protection from skin irritation, ability to stay in place, no noise disturbance, odor control, ease of disposal, and cost (willingness to purchase). Subjects evaluated a different absorbent product each week for 8 weeks and were given 10 pads of the specific product to use over 1 week. Product sequence was preassigned using random numbers, and the commercial name of the pad was not blinded to the subject. Daily diaries were kept to record voiding frequency, number of incontinent episodes, and the amount of loss with each episode. The amounts were coded as small (few drops), moderate, or large (would soak clothes without a pad in place). To determine whether patients were using a pad appropriate for their degree of incontinence, the subject recorded in the diary whether the pads were dry, damp, or soaked. Diaries were reviewed every 2 weeks with the women for compliance and accuracy. 29
30
RESEARCH BRIEFS
Figure 1. The absorbent products used in the study. Serenity "C" appears smaller on figure because of its cup shape. Other pads shown are lying flat, The letter next to each pad corresponds to the description in Table 1,
At the end of each week, each product was rated on its performance on a scale of 1 (poor) to l0 (excellent) on the 11 characteristics from the needs assessment questionnaire. Pads also were rated on overall global performance (scale of I to 10). At the completion of the study, the women were asked which pad they would purchase and completed a poststudy needs assessment and poststudy needs assessment was the same as the prestudy needs assessment and was administered to evaluate any changes in the women's pad needs after completion of the study. Power calculation estimated that a sample size of 80 was needed to find a 2-point difference between the mean scores. A p value of <.05 was used to determine significance. RESULTS
The study group consisted of communitydwelling women, (n = 65) with a mean age of 52 (range = 28 to 84). Seventy-five percent were educated beyond high school, and 65% had a household income greater than $20,000. Forty-two percent of the women in the study had symptoms of
Table 1. Absorbent Products Brand Name A
Free &Active regular pad (Humanicareb)
B
Store-brand menstrual pad (Confab Companiesc) C Serenity guard (Johnson & Johnson d) D Always menstrual pad (Procter & Gamble e) E Surety shield (Confab Companiesc) F
Tranquility shield (Principle Business Enterprises, Inc.) G Attends insert pad (Procter & Gamblee) H Depends shield (Kimberly Clarkf)
PackageLabeling "Regular pad for lightto-moderate protection" "Super absorbency"
"Regular for moderate bladder control needs" "Double plus, extra long'" "Regular absorbency for light-to-moderate protection" "Regular absorbency holds up to 4 ounces" "Moderate protection" "Regular absorbency for light incontinence"
Unit Pricea $0.52
$0.10
$0.57
$0.20 $0.22
$0.85
$0.66 $0.25
aCost per pad based on average retail cost in Utah at start of study (1991). bNorth Brunswick, NJ. cKing of Prussia, PA. dMilltown, NJ. eCincinnati, OH. fNeenah, WI.
RESEARCH BRIEFS
31
pure stress incontinence, 12% had symptoms of pure urge incontinence, and 46% had mixed symptoms of both urge and stress incontinence. Of the 108 women recruited for the study, 43 evaluated fewer than eight pads, and 65 completed the evaluation of all eight pads. Results are reported using data from the completed subjects, although data from all 108 subjects were analyzed separately and found to be similar. No subject had to be dropped from the study for excessive soaking of pads. The women in the study used a mean of one-and-one-half pads per day (95% confidence interval [CI] = 1.4 to 1.6), voided an average of 7 times a day (95% CI = 6.4 to 7.6), and recorded a mean 2.0 incontinent episodes per day (95% CI = 1.7 to 2.4). Subjects reported a mean of 1.2 small incontinent episodes, 0.7 moderate episodes, and 0.5 large episodes a day. Thirty percent of the pads were reported as being soaked after use, 45% as damp, and 25% as dry. There was no difference in the pad brands as to the number of soaked pads reported. On the prestudy needs assessment, the most important characteristics of an absorbent pad were found to be (1) dryness and confidence, (2) odor control, (3) ability to stay in place, (4) discreetness, and (5) comfort (Table 2). On the poststudy questionnaire, odor control and ability to stay in place became less important, whereas comfort and discreetness became more important. Results of the pad scores are shown for the five characteristics determined to he important on both the prestudy and poststudy needs assessment. Also reported are the results on cost (willingness to purchase) and overall performance score (Figures 2 and 3). Serenity scored highest in overall score,
comfort, and discreetness. The two menstrual pads scored significantly higher than many of the incontinence products in all categories except dryness and confidence. Although the Attends pad scored high on being dry and confident, it was judged not to be discreet and comfortable. The Always menstrual pad scored significantly higher on staying in place than four other pads (Free & Active, Depends, store-brand menstrual pad, and Tranquility). Serenity and Surety scored significantly higher on staying in place than Free & Active. There were no statistical differences found between the pads on the characteristic of odor control. Of the 65 women completing the evaluation of all eight pads, 25 women chose Serenity, 9 chose the store-brand menstrual pad, 7 chose Attends, 7 chose Depends, 6 chose Surety, 6 chose Always menstrual pad, 3 chose Free & Active, and 2 chose Tranquility as the pad they would purchase for their personal use. No significant differences were found in pad choice according to age, weight, type of incontinence, or severity of incontinence. DISCUSSION
The least expensive products in the study, the menstrual pads, scored as well or better on their overall score than the more expensive incontinence pads and scored highest on cost (willingness to purchase). High price did not equate with high performance. Of the pads marketed for incontinence, Serenity scored highest on two of the five important characteristics and highest on the overall score but was less expensive than two other incontinence pads. The most expensive incontinence pad, Tranquility, scored only moderately well on the important characteristics. The commercially
Table 2. Scores on Characteristics From Needs Assesment Questionnaire a Prestudy
Poststudy
Characteristic
Mean Score
(95% El) b
Characteristic
Mean Score
(95% Cr)
Dry and confident No odor Stays in place Discreet Comfort Irritation Noise disturbance Cost Disposal Application Removal
9.7 9.5 9,3 9.1 8.7 8,7 8.3 8.0 7.7 7.4 7,3
(9.5-9.9) (9.3-9.8) (9,1-9.5) (8.8-9.4) (8.4-9.0) (8.3-9.1) (7.8-8.8) (7,5-8,5) (7.3-8.2) (7.0-7.8) (6,9-7.7)
Dry and confident Discreet No odor Comfort Stays in place Noise disturbance Irritation Cost Application Removal Disposal
9.5 9,4 9.1 9.1 9.0 8.4 8.2 7,7 7,1 7.0 6,9
(9.3-9,7) (9.1-9.7) (8.7-9.5) (8,8-9.4) (8.6-9.4) (8.0-8.8) (7,7-8.7) (7.2-8.2) (6.7-7.5) (6.6-7,5) (6.4-7.5)
Abbreviation: CI, confidence interval. aRanked in order. b95% CIs that are mutually exclusive imply statistical significance.
32
RESEARCH BRIEFS
OVERALL 10 ~'~
9
ro
8
L.~
7
+I
6 5
(1)
b
4
E
~
o
c
~
~
Ix.
U
0'3
3
o ©
2
~-
E
~-
2
~.
~
available products evaluated in the study only partially met the needs of this group of women with mild to moderate incontinence: The highest overall score was no better than 7.2 out of a possible 10. The number of incontinent episodes and pad usage confirm that subjects had mild to moderate incontinence as defined. Billions of dollars are spent annually on managing incontinence, yet little clinical research has been done to evaluate absorbent pads for community-dwelling women with mild to moderate incontinence. Bierwirth (1992) completed a personal evaluation of several absorbent pads and found that pantyliners and minipads held less than 5 mL before they leaked and judged them to be inappropriate for use in urinary incontinence. Fader, Barnes, Malone-Lee, and Cottendemn (1987) reported
'-'
-~ c
Figure 2. M e a n scores on scale of I (poor) to 10 (excellent) for overall score. 95% confidence intervals (95% CI) that do not overlap are statistically significant at p < .05.
that ambulatory British women choose a small, discreet pad regardless of the severity of their incontinence, preferring to change their pad more frequently if necessary. Dallas and Winston (1992) had subjects wear "patches" of pads that had been instilled with a synthetic urine. Each of the "patches" of pads were tested on their forearm for 2 hours. Numerous products labeled for "moderate to heavy" incontinence were tested. They reported that Tranquility scored significantly higher than many of the pads on keeping the skin drier by their testing standards. Inconsistent labeling might have led us to including products in this study that were not comparable and might account for differences seen in pad scores. An "extra absorbency shield," for example, may not be any more absorbent than a "regular DISCREETNESS
DRY AND CONFIDENT lO
lo
cJ e--
~
e
+1
+1
6
6:
=
e
f
c
COST (Wilfingness to purchose)
COMFORT lo
9 d
~7 m +T
6
Figure3. M e a n scores on scale of I (poor) to 10 (excellent) on characteristics of "dry and confident," "discreetness, . . . . comfort," and "cost."
5
§
4-
~, 4 q
3-
g~
2-
f
RESEARCH BRIEFS
33
absorbency guard." More information is needed to understand how type and amount of incontinence affects pad needs; for example, a woman who loses a small amount of urine multiple times a day may have different needs than a woman who loses a large amount of urine only once a day. IMPLICATIONS
A "maxi" menstrual pad is recommended for women who are initiating the use of pads to manage their incontinence. If the menstrual pad does not meet their needs, Serenity or a comparable "high-capacity" pad could be recommended. To assist the women in finding a pad that best meets her needs, it is recommended that a sample pack of six to seven different pads be given; menstrual pads should be included in this sample pack. Several mail-order companies currently offer a sample pack of different absorbent pads, but these do not include menstrual pads. Although absorbent pad use is often viewed negatively because it may delay treatment, not all incontinence can be cured. The use of absorbent products may be necessary during treatments for incontinence, and for those patients who continue to experience incontinence despite treatment. Therefore, it is important that research on absorbent products continue for the design of better absorbent products. REFERENCES Bierwirth, W. (1992). Which pad is for you? Urologic Nursing, 12(2), 75-77. Brink, C.A. (1990). Absorbent pads, garments, and management strategies. Journal of the American Geriatric Society, 38, 368-373. Dallas, M.J., & Wilson, EA. (1992). Adult incontinence products: Performance evaluation on healthy skin. INDA Journal of Nonwovens Research, 4, 26-32. Diokno, A.C., Brode, B.M., Brown, M.S., & Herzog, A. (1986). Prevalence of urinary incontinence and other urologic symptoms in the non-institutionalized elderly. Journal of Urology, 136, 1022-1025. Fader, M., Barnes, E., Malone-Lee, J., & Cottendenm, A. (1987). Choosing the right garment. Nursing Times, 83, 78-85. Herzog, A.R., Fultz, N.H., Normolle, D.E, Brock, B.M., & Diokno, A.C. (1989). Methods used to manage urinary incontinence by older adults in the community. Journal of the American Geriatric Society, 37, 339-347. Hu, T. (1990). Impact of urinary incontinence on health care costs. Journal of the American Geriatric Society, 38, 292-2955. Thomas, T., Plymat, K., Blannin, J.S., & Meade, T. (1980). Prevalence of urinary incontinence. British Medical Journal, 28, 1243-1245. Urinary Incontinence Guideline Panel. (1992, March).
Urinary incontinence in adults: Clinical practice guidelines. (AH-CPR Publication No. 92-0038). Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research, Public Health Service.
From the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UZ Jan Baker, MS, APRN:Research and Clinical Nurse, Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Clinical Instructor, University of Utah College of Nursing, Salt Lake City, UT; Peggy Norton, MD: Associate Professor, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT. Supported in part by the Department of Obstetrics and Gynecology Development Fund, University of Utah, Salt Lake City, UT. Address reprint requests to Peggy A. Norton, MD, Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, UT 84132. Copyright © 1996 by W.B. Saunders Company 0897-1897/96/0901-000655.00/0
Humanistic Behaviors and Primary Nursing Practice Mary Jane Smith
p
RIMARY NURSING is enhanced by a humancentered nursing perspective. Additionally, a responsibility relationship is pivotal to primary nursing practice and to a human-centered nursing perspective (Manthey, 1980; Paterson & Zderad, 1976). The responsibility relationship is knowledge based, negentropic, reciprocal, and patterned (Rogers, 1992). This means that the nurse-person relationship extends in space-time, grows in complexity, and is centered. Nurse is fully present to the person in the here and now. Inherent in a responsibility relationship is a call to consciousness (Heidegget, 1962). It is a call to be authentic to others in relation to the challenge in the situation. Challenge in primary nursing is a choice to be responsible to the person in the context of environmental complexity over the course of the nurse-person relationship. It follows that where primary nursing is practiced, the challenge is met with an openness and sensitivity to others, a respect for persons, and a value for each person's fight to self-determination. The hypothesis tested in this study was that registered nurses (RNs) who perceive themselves practicing a high level of primary nursing will score