Bowel and Urinary Incontinence Prevention and Care in ICU

Evidence-Based Solution

Bowel and urinary incontinence have been recognized as one of the most frequent issues to occur in a hospital setting (Aguiar & Franco, 2018). According to Stokes, Crumley, Taylor-Thompson, and Cheng (2016), nurses encounter BUI in 8% to 37% of all patients to enter the ICU. At the same time, the understanding of the processes behind the condition, consequences for patient health, and the effects of negligent handling of BUI on the greater healthcare picture are limited. Practical skills of utilizing catheters and other tools also remain rudimentary despite plenty of hands-on experience with patients (Stokes et al., 2016). Therefore, the solution to the problem must lie in the realm of theoretical knowledge and education to inform the existent standards of practice. Nurses must be made aware of potential diseases accompanying BUI (such as perineal dermatitis, among others), as well as physical and psychological effects on the patient’s health (Mohammed & Nadr, 2018).

Nursing Intervention

The proposed intervention is that of an educational nature and will involve the gradual increase of nursing knowledge through the means of relevant information provided to nurses working in the ICU. Educational interventions are some of the most affordable types of intervention, as they require very little in terms of material support (Kramer, 2020). At the same time, educational interventions have shown to have a positive effect on the quality of provided care in nearly any aspect of healthcare, thus making it the best possible candidate to achieve the announced objectives of the inquiry. The intervention will be comprised out of three stages, involving the following (Brown et al., 2019):

  • Intervention: Nurses will be provided with the necessary knowledge about BUI, its effects on the patients and the hospital in general, the potential diseases contracted as a result of BUI, and proper management of tools and equipment;
  • Application: Nurses will apply their newfound and refreshed knowledge into their clinical setting, to improve the quality of treatment, reduce the number of hospital-acquired infections, and achieve better patient health outcomes;
  • Evaluation: The results of the intervention and the retention of knowledge in nurses are to be evaluated post-factum.

Patient Care

The intervention suggests improved results in patient care. If nurses understand the greater scope of their labor, they are less likely to act irresponsibly towards it, which should increase the chances of positive patient outcomes in the ICU unit. If patients receive better care, they are less likely to contract hospital-acquired infections, such as perineal dermatitis, and would be able to leave the ward earlier, improving the action economy of the hospital in general. Finally, patients will save time and money from receiving better quality of care for the same price, thus lowering the barrier of quality care for economically disadvantaged individuals.

Healthcare Agency

One of the most important aspects of care is the patient’s healthcare agency. It stands for the ability to make informed decisions about one’s treatments and ensuring a degree of autonomy (Danielis et al., 2020). Bedridden patients that are diagnosed with incontinence typically have low agency and are forced to rely on nurses for emptying their bladder and bowels, which is considered a highly private and embarrassing matter for many (Donnelly et al., 2018). As a result, patients are likely to develop psychological disorders and a physical aversion to the procedure. If nurses are aware of such issues, they would be able to approach it appropriately and get the patient involved in decision-making, thus increasing their healthcare agency (Kawanabe et al., 2018).

Nursing Practice

The proposed intervention will have a multitude of implications on the contemporary nursing practice. First of all, it will improve the quality and standards of care for BUI in the ICU unit, where the process will take place. Second, it will show if the proposed educational approach warrants the results sought in the selected timeframe. Finally, its findings would help other researchers to justify their own approaches and build up on the existing body of knowledge to improve the quality of care for patients as well as the educational support for nurse specialists.

PICOT Question

  • P (Population): ICU populations suffering from bowel and urinary incontinence;
  • I (Intervention): Information campaign providing knowledge on BUI, its effects on the hospital system, potential infections, and various outcomes;
  • C (Comparison): Baseline with no dedicated interventions aimed towards them;
  • O (Outcome): Improved quality, reduced rehospitalization rates, reduced HAI rates;
  • T (Time): 12 months.


Aguiar, L. M., & Franco, I. (2018). Bladder bowel dysfunction. Urologic Clinics, 45(4), 633-640.

Brown, H. W., Braun, E. J., Wise, M. E., Myers, S., Li, Z., Sampene, E.,… & Rogers, R. G. (2019). Small-Group, community-member intervention for urinary and bowel incontinence: A randomized controlled trial. Obstetrics and Gynecology, 134(3), 600-611.

Danielis, M., Palese, A., Terzoni, S., & Destrebecq, A. L. L. (2020). What nursing-sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. International Journal of Nursing Studies, 102, 103491.

Donnelly, D. W., Donnelly, C., Kearney, T., Weller, D., Sharp, L., Downing, A.,… & Cross, W. R. (2018). Urinary, bowel and sexual health in older men from Northern Ireland. BJU International, 122(5), 845-857.

Kawanabe, E., Suzuki, M., Tanaka, S., Sasaki, S., & Hamaguchi, T. (2018). Impairment in toileting behavior after a stroke. Geriatrics & Gerontology International, 18(8), 1166-1172.

Kramer, C. L., & Rabinstein, A. A. (2020). Evidence-based critical care. Springer, Cham.

Mohammed, H. M., & Nadr, M. (2018). Perineal dermatitis: A neglected problem in patients at Critical Care Unit. EPH-International Journal of Medical and Health Science (ISSN: 2456-6063), 4(2), 66-71.

Stokes, A. L., Crumley, C., Taylor-Thompson, K., & Cheng, A. L. (2016). Prevalence of fecal incontinence in the acute care setting. Journal of Wound, Ostomy and Continence Nursing, 43(5), 517-522.

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