Rehabilitation nurses practices in relation to urinary incontinence following stroke: a cross-cultural comparison

AIM: To explore nurses' practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China.

BACKGROUND: Urinary incontinence following stroke is common, under-recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses' current management approaches and cultural influences is required.

DESIGN: Qualitative.

METHODS: Semi-structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants' first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face-to-face discussions.

RESULTS: The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors' safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function.

CONCLUSIONS: Nurses' reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries.

RELEVANCE TO CLINICAL PRACTICE: The dearth of evidence-based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience-based endeavour. This study explains the nurses' focus on containment and social continence and highlights the need to systematically assess stroke survivors' bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.