Construction and validation of an instrument for the structural assessment of wards for urinary continence in older adults.

Roberta Pereira Góes,Camila Oliveira Valente,Juliana Bezerra Do Amaral,Fernanda Carneiro Mussi,Larissa Chaves Pedreira,Monaliza Lemos De Souza

doi:10.1590/1518-8345.3361.3374

Roberta Pereira Góes, Camila Oliveira Valente + Show 4 more

Open Access

https://doi.org/10.1590/1518-8345.3361.3374

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Abstract

Objective:to build and validate an instrument for structural assessment of wards for the preservation of urinary continence in hospitalized older adults.Method:this is a methodological study divided into two stages. The first corresponded to an integrative literature review that guided the construction of the instrument. The second consisted of the content validation stage of the instrument, by means of expert consensus, using the Delphi technique. The selected experts were recognized in the field and authors of the articles included in the integrative review.Results:six experts participated in the content validation, which resulted in the “Instrument for Structural Assessment of Wards for the Preservation of Urinary Continence in Older Adults”, composed of 27 items, distributed in three dimensions: “physical structure”, “human resources”, and “material resources”. Two Delphi rounds were carried out for validation, resulting in a final version with 83% agreement among the experts.Conclusion:the instrument reached content validity, requiring application for clinical validation. However, it can be used by researchers and health staff in hospital settings, in order to identify structural weaknesses and guide the priority of interventions for the quality and safety of this care.

Highlights

Urinary Incontinence (UI) may cause serious difficulties for the older adults, mainly related to decreased quality of life, depression, embarrassment, social isolation, and physical problems such as dermatitis and urinary tract infections(1)
The results obtained in this review revealed the impact of the “structure” pillar on the outcome of UI in hospitalized older adults, as well as the relevant aspects of the structure that can and should be assessed in the scenario through a validated instrument, aiming at the autonomy of independent use of the bathroom by the older adult
It is worth mentioning that aspects of the three categories permeate the dimensions of human resources, material resources, and physical structure, addressed in the construction of the instrument; category 2 raised in this review was crucial to justify the need for visibility of this problem by measuring and evaluating these aspects in the hospital setting, as proposed in the instrument constructed

Summary

Introduction

Urinary Incontinence (UI) may cause serious difficulties for the older adults, mainly related to decreased quality of life, depression, embarrassment, social isolation, and physical problems such as dermatitis and urinary tract infections(1). It affects about 20% of the older adult population living in the community, 50% of the older adults in long-term care institutions, and 30% to 60% of hospitalized older adults(2). Considering the three pillars (structure, process and result) of health care quality explored in Avedis Donabedian’s theory, the structure dimension consists of the component inherent to the relatively stable and necessary characteristics of the care process, covering from the physical area, human resources (number, type, distribution, and qualification), material and financial resources, information systems and technicaladministrative normative instruments up to political support and organizational conditions(5). In the case of the older adults, the influences of the environment and its possible consequences should be further monitored and prevented, since this population is in a situation of greater intrinsic vulnerability and fragility due to the process of senescence and senility(6)

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