Fecal Incontinence
Conditions
Keywords
Education, Nurses, Nursing homes, Fecal incontinence, Cluster-randomized controlled trial
Brief summary
Fecal incontinence (FI) has an increasing prevalence in the geriatric population which cannot be explained by co-morbidity or anatomical and psychological changes of aging alone. In the nursing home population previous studies suggest a prevalence between 10 and 69%, but is most often reported to be between 40 and 55%. FI leads to a high direct and indirect economic burden to the health-care system, and is an important cause og institutionalization of the elderly patients. In addition, FI is associated with shame, social isolation and reduced quality of life. The importance of identifying treatable causes of FI in the frail elderly, rather than just managing passively, is strongly emphasized. It is indicated that the level of awareness among health personnel regarding appropriate assessment and treatment options is limited, and that FI is considered a normal part of aging. This study is based on the assumption that FI among nursing home patients can be prevented, cured or ameliorated by offering nursing home staff knowledge of best practise. The primary objective of the study is to test the hypothesis that a multifaceted educational program for staff on assessment and treatment of FI, is associated with a reduction in patients' frequency of FI. The design of the study is a two armed cluster randomized trail (C-RCT) with a repeated cross-sectional approach.The results will be analysed according to multilevel and longitudinal modelling, and the study will use mixed effect models with the cluster treated as a random effect.
Interventions
BEHAVIORALMultifaceted educational program
Sponsors
Norwegian Nurses Organisation
Norwegian University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
Nursing homes with similar: * patients characteristcs * care staff/patients ratio * general practitioner consultancy Patients: \- All patients on long term care residency (residency \>month) Registered Nurses/authorized social educators: \- All working half time or more
Exclusion criteria
Nursing homes: \- With some kind of speciality (eks rehabilitation, dementia) Patients: \- Short term care residency Registered nurses/authorized social educator: * Working less than half time * Working only night shifts
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in frequency of fecal incontinence among patients | Baseline, after 3 months and after 6 months | As measured by The Long-Term Care Facilities Assessment System (interRAI-LTCF 2012), section H: Continence. Because of relatively high risk of death and movement out of clusters, a repeated cross-sectional opproach to analyses will be used. Frequency of FI will thereby be analysed on a across-sectional group level. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Remission of fecal incontinence among patients | Baseline, after 3 months and after 6 months | For remission of FI a cohort approach to data analyses with only those identified with FI at baseline and still present at 3 and 6 month follow-up, will be included in the analyses |
| Change in knowledge among registered nurses and authorized social educators | Baseline, after 3 months and after 6 months | Measured my a multiple choice test |
| Change in FI-related concerns among patients | Baseline, after 3 months and after 6 months | Relevant concerns as measured by The Long-Term Care Facilities Assessment System (interRAI-LTCF 2012) are: Mood and behavior, psycho-social wellbeing, urinary continence, constipation, diarrhea, skin condition, participation in activities |
| Correlates of FI among patients | Baseline, after 3 months and after 6 months | Relevant correlates as measured by The Long-Term Care Facilities Assessment System (interRAI-LTCF 2012) are: cognitive functioning, communication and vision, functionality and mobility, medical diagnosis, mouth and nutrition status, medications, treatment, examination/procedures |
| Change in behavior among health personnel | Baseline, after 3 months and after 6 months | Measured by analyses of patient assessments and interventions as documented by health personnel in the electronic patient record and by the Fecal Incontinence in Nursing Home Patients questionnaire |
Countries
Norway
Outcome results
None listed