Extending the Boundaries of Care

What does it take to turn the tide and restore dignity to seniors who experience urinary incontinence? This is what our team at NTUC Health’s Nursing Homes discovered.

A STRONG BELIEF

Urinary incontinence is not a normal process of ageing and relying on diapers should not be the solution. The nursing home team at NTUC Health held on to this strong belief as they launched the Return to Continence programme in 2018 to help our nursing home residents wean off diapers.

Staff saw how the prolonged use of diapers put many residents at risk of bedsores, urinary tract infections and other diaper-related skin conditions. They also observed that many residents continued to use diapers primarily out of habit, fear of urinary leakage and not being able to make it to the toilet on time.

A multi-disciplinary approach was adopted by a team of nurses, doctors and allied health professionals. They adjusted the diets, exercise routines, medication, and toileting habits of participating residents. While wearing diapers had left residents feeling embarrassed, uncomfortable and dependent on staff, many still had the misconception that this was a normal part of ageing.

Although this misconception posed a challenge, the staff gradually reassured the residents that it is possible to live without diapers. To overcome the residents’ fear of soiling themselves, the team designed a tracking sheet to help them plan their activities around two-hourly toilet breaks that helped to instil a good toileting routine and to monitor their progress.

A WIN FOR EVERYONE

After a 1-2 month period, the team’s efforts paid off. Many participating residents successfully weaned off diapers and appreciated the added layer of dignity that came with being diaper-free. The residents’ hard work was rewarded with certificates and prizes, marking their milestone achievement.

Ms Janice Tan, head of the residential care division at NTUC Health, said in a Straits Times article: “Without diapers, residents were observed to be happier and more confident. They also had more self-esteem and dignity, and felt more comfortable.”

In fact, some residents were so pleased with their success that they became ‘Continence Ambassadors’, and proudly shared their success stories at graduation ceremonies to encourage fellow residents to get on board. Since the first batch in 2018, the pilot programme has been rolled out across all three of NTUC Health’s Nursing Homes.

Our resident takes pride in completing the programme and was appointed a ‘Continence Ambassador’

Through this programme, the team discovered the importance of integrating “hardware” (i.e. clinical management) with “heartware” (i.e. communication, compassion, trust and patience). These two elements came together to effectively motivate residents and allow them time to gain the confidence to take a step towards independence.

The staff’s determination to extend the boundaries of care did not go unnoticed – at the Singapore Health Quality Service Awards in 2021, they won the Best Team Award (Clinical Practice Improvement) as a recognition of this successful initiative.

Watch their acceptance speech here: