Continence management in acute stroke :a survey of current practices in Australia

Aim.  The aim of the study was to determine current national urinary incontinence management practices in Australian acute stroke units and their concordance with the National Stroke Foundation guidelines. Background.  Urinary incontinence is a common consequence after stroke and a statistically significant indicator of poor outcome, including disability and admission to institutional care. The National Stroke Foundation has produced guidelines for the acute and post-acute phase of care, offering Australian nurses evidence-based recommendations regarding stroke management including the management of urinary incontinence. Method.  In 2007–2008, dedicated acute stroke units in Australia were identified and a senior nurse from each unit was invited to participate in a 10-minute telephone survey to ascertain their current urinary continence management practices. Results.  Representatives from 41 acute stroke units participated in the survey (response rate 98%). Participants from less than half of the units reported that they had a formal plan for urinary incontinence management (n = 19, 46%), and the majority of those who did not would find a formal plan useful (n = 15, 79%). Two-thirds of respondents stated that they would manage urinary incontinence with indwelling catheterization (n = 25, 61%). Only 30% (n = 12) were ‘satisfied’ or ‘very satisfied’ with urinary continence management in their acute stroke unit. Conclusion.  A large proportion of acute stroke units were yet to establish formal urinary incontinence management plans. The implementation of evidence-based urinary incontinence management plans after stroke is integral to improving patient outcomes. An increase in resources for professional development in the assessment, treatment and management of urinary incontinence is essential to improve and maintain skills in after-stroke care

How has the profile of Australian nurse practitioners changed over time?

Aim: To examine longitudinal changes in the profile of Australian nurse practitioners surveyed in both 2007 and 2009 (‘resurveyed respondents’) and to determine differences between nurse practitioners who completed the census only in 2009 (‘new respondents’) and resurveyed respondents. Background: The nurse practitioner role is integral to the development and sustainability of advanced practice roles in healthcare systems. However, its success depends upon support from policy makers, health services and nursing. A census of Australian nurse practitioners previously was conducted in 2007 to obtain national data on the role and scope of practice of nurse practitioners in Australia. Design: A quantitative self-administered survey. Methods: Questionnaires were sent to all authorised Australian nurse practitioners in 2009. Results/findings: A total of 408 surveys were administered with 293 questionnaires completed (response rate 76.3%). Of these, 49% of participants also had completed the 2007 survey. There were no differences in the limitations and enablers identified in 2007 compared to 2009, indicating that perceived barriers had not been addressed over time, nor had there been substantial improvements. New respondents were more likely to have worked as a nurse practitioner in the previous week (p < 0.004). There was a significant increase in the number of nurse practitioners waiting on approval for some or all clinical protocols (p = 0.024). Conclusions: Conditions enabling work to full scope of practice continue to be perceived as suboptimal by Australian nurse practitioners. Supportive strategies are needed to enable the role to be effectively utilised