Incontinence and PPS: a new era.

Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Assessing residents with incontinence is necessary to determine the pathophysiologic causes and associated factors that can interfere with self-toileting. Nurses can perform this assessment at the bedside. Guideline tools have been developed to assist nursing home staff through the evaluation of UI and intervention. Treatment techniques, specifically behavioral interventions and toileting assistance programs, can be readily incorporated into nursing practice. Most nursing home staffs can easily implement interventions such as bowel and nighttime voiding management and dietary modifications. Nursing home research has demonstrated the effectiveness of toileting assistance programs; however, very little of this research and documented techniques has been used by nursing home staff. Scheduled toileting and bladder training programs can be successfully implemented in nursing home residents. The key to the success of these programs is identifying residents who should be targeted for each specific program. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.