Urinary incontinence (UI) is both a common and costly condition confronted in nursing and indeed the healthcare system worldwide. While UI is often considered a natural consequence of aging, there are physiological, psychological, and quality-of-life implications for all of those individuals living with UI. Sadly, UI often is ignored or stigmatized and becomes a taboo issue within most cultures.
Urinary incontinence is an issue present in all cultures. Moreover, in the literature UI is characterized as a problem that in situated within and influenced by culture (Kang, 2015; Karlowicz, 2010; Wilson, 2004). Conceptualizing UI is integral for the profession of nursing so that improvements can be made in nursing education and practice for this pervasive issue. Examining UI in many cultures is necessary for nurses to provide
culturally congruent care and facilitate health among patients. Moreover, UI is an issue that is important for patient outcomes, but it is also important from a health care systems perspective. Staffing and resources are intricately linked to UI and toileting practices (Gorina, Schappert, Bercovitz, Elgaddal, & Kramarow, 2014). The direct cost for UI and overactive bladder (OAB) in the US in the year 2000 was estimated at 19.5 billion dollars. Most of this cost came from direct UI management such as pads and briefs (Gorina, et al. 2014). If there is consideration of indirect costs, the statistic would be even more staggering. Proper management of UI in healthcare systems is important and has the potential to reshape the way that care is provided.
Care inquiries as described by Leininger (1991a) are modes of knowledge inquiry that examine caring phenomenon. Care inquiry regarding the nurse-patient management and perception of UI within cultures provides an in-depth point of analysis to understand gaps in knowledge and ways to improve patient outcomes for those with UI. This transcultural and transnational perspective provided through the American examination and Chinese examination is a novel way to conceptualize UI. This dissertation is therefore transnational and transcultural, because the broad worldview in areas of politics, health, etc., is addressed in order to contextualize the perceptions, experiences, and information that the nurse participants share.
The is to provide a better understanding of UI through exploration of the influences of culture. Grounding the research in data from the nurses’ perspective gives information regarding the caring relationships of nurses with patients who have UI. Broadly, these studies allow for care inquiry within the context of the culture in which they are situated. Finally, these studies were conducted from the theoretical perspective posited by Leininger (1991a), Culture Care Diversity and Universality.
Methods:
The study uses Corbin and Strauss’ (2008, 2015) grounded theory methods to examine hospital nurses’ perceptions as well as the management of UI in China (n=6) and the U.S (n=11). Semi-structured interview format was used to collect data and apply the methods. A theory and theoretical model were developed.
Results:
In China Several key themes emerged including the demedicalization of UI, the novice-to-expert trajectory of nurse's in UI care skill acquisition, and general lack of formal education. The study also highlighted the fact that UI is a multifarious issue (core category); there are many etiologies, management modalities, and treatment options. Chinese nurses saw the family as an integral participant in the management of UI, creating a triadic core of management. The Chinese nurses' process of managing the patient with UI involved two broad processes: taking-action and making sense.
In the United States, as a result of the interviews and grounded theory methodology, a grounded theory of the nursing process for managing UI was developed. Additionally, several themes were elucidated regarding the nurse’s management of and perceptions of UI in the hospital setting. In total seven themes were derived. The themes: new -onset UI and age, ‘passing the baton’ to the family, demedicalization of UI, novice- to-expert trajectory with experience, and minimal education regarding UI. The core category is the multifarious nature of UI.
Conclusion:
The study identified diversities and universalities between Chinese and American hospital nurses regarding the perceptions and manage of UI. The processes of taking-action and making sense were elucidated. Finally, individual and comprehensive models of the nurse’s management of patients with UI are proposed. This study highlights the important of considering the cultural context of health issues. There were numerous universal themes include the multifarious nature of UI, novice-to-expert trajectory, insufficient education, a presence of stigma around the issue of UI, and negative psychological impacts of UI. There were also number diversities which include, differences in the key players, differences in beliefs of the relationships between age and gender and UI and the perception of having a standardized assessment.