This presentation examines the need to challenge all nurses about attitudes, in order to ameliorate the pejorative ageist perceptions that abound regarding proactive continence care. A twelve week online course which addresses nurses' knowledge, attitudes and practice regarding incontinence was evaluated in relation to its impact in altering the decisions nurses make regarding continence care, thus breaking new ground in continence education.

A factorial survey design was employed, augmented by a content analysis of qualitative data, collected to explore the knowledge and practices of nurses who undertook the course (n = 39) before and after the intervention. In the factorial survey the unit of analysis is the vignette, which included nine independent variables, presenting patient characteristics related to incontinence, each with a number of levels which were randomly selected within each unique vignette. The total vignette population was 82,944, of which 1794 were randomly selected. The dependent variables measured the judgement of nurses and were related to knowledge, attitudes and practice. The utilisation of the factorial survey to establish the effectiveness of the educational intervention expands its usage as a research methodology.

This course resulted in nurses' altered decision making in continence care. Prior to the educational intervention the provision of pads explained 21.7% of the variance, after the intervention this reduced to 11.2%. The effect of age on nurses' judgement was mediated following the intervention, where mean ratings statistically changed from 6.02 to 2.36, where 85 year olds were less likely to be prescribed pads.

This study demonstrates that while education can lead to changes in decision making regarding continence care, other factors such as the motivation of the patient and the context of care are important. It is concluded that continence education can alter ageist perceptions and needs to be integrated into general nursing programmes.