Impact Incontinence. Can We Put the Ambulance at the Top of the Cliff?

Abstract

Incontinence is a prevalent issue affecting over a quarter of the New Zealand population, yet it is a taboo subject - with many people suffering in silence. This research focuses on the development of a specialised assessment tool tailored for ambulance clinicians, aiming to facilitate the identification of continence concerns in the context of falls in the community.

The aim of this research is to answer the research question: How can the development of an assessment tool enable ambulance clinicians to assess the impact of incontinence on falls in the community?

Ambulance clinicians play a crucial role in responding to incidents of slips, trips, and falls. While there are many reasons a person falls, and ambulance clinicians are taught to assess for risk factors associated with a fall, one cause of falls that is not generally discussed is incontinence or continence concerns. A survey was designed and conducted to gain insights into ambulance clinicians’ knowledge and education regarding incontinence and their understanding of the relationship between falls and incontinence. This evaluation provided an in-depth overview of their comprehension of the sometimes-complex link between falls and incontinence. Following an analysis of the survey, an assessment tool was designed to identify continence concerns. This tool aims to streamline the assessment of continence-related issues in the context of falls within the community.

The methodology used for this research was critical participatory action research (CPAR), characterised by the active involvement of an action research working group (ARWG). Born from the early works of Lewin in the 1940s, CPAR entails iterative cycles of planning, implementing changes, observing outcomes, reflecting on processes, and re-planning. The ARWG was comprised of co-researchers who collaborated at multiple decision-making stages, thus empowering them to adopt a thoughtful approach to self-transformation, refining their practices, and enhancing the conditions under which they practice.

This study's significance lies in the potential role of ambulance clinicians as a link in the identification of continence concerns and subsequent referral to healthcare services. By addressing this gap, the research aims to provide a voice for people enduring the often-silent burden of incontinence. The empowerment of people through increased awareness and access to assistance can address their concerns, and as a result, there is the potential to reduce the risk of falls associated with incontinence or continence concerns. This comprehensive approach aligns with the broader goal of enhancing the overall well-being of individuals experiencing the multifaceted challenges of living with a continence concern.

Key findings from this research detail that ambulance clinicians support the inclusion of a clinical assessment tool to screen for continence concerns in their daily practice. They feel it should be integrated into an electronic reporting process for ease of use and referrals to specialist services. The ambulance clinicians felt that the time spent completing this tool with a patient is valuable and that it could make a difference for people who have fallen and experience a continence concern.

Reflections from the ARWG, ambulance clinicians and the researcher all demonstrate critical changes within their clinical practice that have occurred because of their involvement in this research project. This highlights the translation of research into practice, a key outcome of a CPAR project.