Zhongguo quanke yixue (Jun 2024)
Effectiveness Analysis of Two Incontinence Care Plans Based on Guidelines for Elderly COVID-19 Patients with Incontinence
Abstract
Background The elderly are at high risk for COVID-19 and incontinence, as well as a vulnerable population for incontinence-associated dermatitis (IAD). There has been a continuous exploration of how to provide good incontinence care to improve the effectiveness of preventing and treating IAD. Objective To investigate the effectiveness of two incontinence care plans based on guidelines for elderly COVID-19 patients with incontinence, in order to provide a reference basis for good incontinence care and prevention of IAD in such patients. Methods Using an exploratory intervention study design, 60 eligible patients with COVID-19 were selected as the study subjects from the surgical and internal medicine departments of Eastern Theater General Hospital, PLA, Daping Hospital, Amy Medical University, PLA, and Sir Run Run Hospital, Nanjing Medical University from December 26, 2022 to March 30, 2023. The study subjects were nonrandomly divided into the intervention group and control group, with 30 patients from the Eastern Theater Command General Hospital of PLA included in the intervention group and 30 patients from the other two hospitals included in the control group. Patients with IAD in both groups were also included in the intervention and control subgroups. The characteristics and types of incontinence in elderly COVID-19 patients were analyzed, the "AIMS Four Step Improved Incontinence" care plan (AIMS care plan) for the assessing incontinence and skin (A), identifying and managing risk (I), managing incontinence (M), and skin care (S) was modified based on the recommendations of the guidelines. The intervention group adopted the modified AIMS care plan, while the control group adopted a structured skin care plan, with continuous intervention for at least 14 days. The skin was inspected every shift and international standards were used to determine the occurrence of IAD and changes. The primary outcome indicator was the incidence of IAD in both groups of patients, and the secondary outcome indicators were the healing rate and healing time of IAD. The relevant clinical data of the two groups before and after intervention was collected and compared. Results The general data of the both groups of patients showed no statistically significant differences, which included gender, age, types of incontinence, frequency of incontinence, chronic comorbidities, serum albumin, hemoglobin, blood glucose, pulse oxygen concentration, and Braden scores (P>0.05). The incidence of IAD in 60 elderly COVID-19 patients with incontinence was 33.3% (20/60), of which the incidence of IAD was 43.3% (13/30) in the control group and 23.3% (7/30) in the intervention group; There was no statistically significant difference in the incidence of IAD between the two groups of patients (P>0.05). There was no statistically significant difference in the grading, and healing rate of IAD between the two subgroups of patients (P>0.05). Patients in the intervention subgroup had a delayed time to IAD occurrence (t=3.225, P=0.005), shorter time to IAD healing (t=2.644, P=0.020), and shorter hospitalization time (t=4.364, P<0.001) than those in the control subgroup. Conclusion Both incontinence care plans based on guidelines can effectively prevent IAD and promote healing in elderly incontinent patients. However, the modified AIMS care plan is more effective and can be referred to and used in clinical care.
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