caregiver with resident
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Nursing home providers should consider implementing better urinary incontinence management systems in order to keep more certified nursing assistants on board after a survey revealed that part of the job plays a key role in CNA turnover. 

The findings were published by a Pennsylvania-based research team in the July edition of the Journal of Gerontological Nursing. The study assessed the impact of urinary incontinence on both residents and staff from the perspective of directors of nursing. Investigators surveyed more than 100 DONs between February and May 2020. 

DONs reported that CNAs, who perform the most UI product changes, spent on average 56% of their shift alone managing urinary incontinence needs such as helping residents use the toilet and changing products. They also noted that a resident’s mobility also significantly impacts the amount of time CNAs spend.

Per shift, CNAs change an average of 36.6 UI products and assist with an average of 25.5 toileting episodes, which require on average between 12 and 13 minutes per episode, the survey found. 

The nursing leaders also reported that management of incontinence can impact staff turnover, with 59.2% reporting this to be “definitely a major cause,” “probably a significant cause,” or “some cause” of CNA turnover. 

Researchers also found a treatment gap around medications for urinary incontinence among residents. DONs reported that only 14% of their residents with the condition were currently receiving medication for it. 

They said the findings highlighted the need for improved treatment and management of urinary incontinence to ease caregiver burdens. Implementing a combination of toileting programs and limiting anticholinergic medication use are areas ripe for improvement, the researchers said.

“However, residents with mobility issues requiring staff assistance for toileting may benefit from safe and efficacious medication to control urgency, allowing more time to access the toilet,” they concluded.

“These steps can go a long way in reducing CNA stress, actively listening to their concerns, and expressing appreciation for their services. By making CNAs valued within the SNF, they are more likely to stay employed there and engaged,” lead researcher Richard G. Stefanacci, DO, told McKnight’s Long-Term Care News on Monday. 

More education was the advice offered by research investigator Diane Newman. 

“What we found, and other studies have shown, is that nurses [all staff] do not understand what causes incontinence or what can be done besides using absorbent products. Also, many staff feel that incontinence is to be expected in women and a normal part of aging,” she told McKnight’s Monday. “Most residents do not receive an assessment of bladder function at the time of admission to the facility and that is when a plan of care for toileting should be set in place.”