Incontinence Associated Dermatitis in Residential Aged Care: An exploratory study of staff perspectives

Author: Petya Zhelezarova

Zhelezarova, Petya, 2022 Incontinence Associated Dermatitis in Residential Aged Care: An exploratory study of staff perspectives , Flinders University, College of Nursing and Health Sciences

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Background: Incontinence Associated Dermatitis is characterised by inflammation of the perineal skin, which is usually caused by incontinence of urine, stool, or both. The condition is prevalent among the elderly population, including people living at home and in residential aged care facilities.

Incontinence Associated Dermatitis is a relatively new and growing topic of interest. The lack of research evidence around the condition in nursing homes in Australia has determined the need for deeper understanding to improve the quality of life of the affected population.

Objectives: To explore the existing knowledge and experience of RACF staff regarding Incontinence Associated Dermatitis; to describe the barriers and enablers to providing best practice care and assessments; and to explore further educational needs.

Method: Interpretive Description methodology was chosen for this qualitative study. Ten nurses and one carer practicing in the aged care sector in Australia were recruited and interviewed. Data was coded using a constant comparative approach to identify patterns which were consistent, yet distinct. Identified patterns were used to develop a conceptual structure to present thematic ideas.

Results: The analysis resulted in four main themes, ‘Awareness of the condition’, ‘Current good practices’, ‘Major challenges’, and ‘Areas for improvement’.

The participants had good awareness of the essence of Incontinence Associated Dermatitis. They were aware of risk factors associated with higher risk of IAD, such as obesity, and lengthy exposure of the skin to acid, chemical substances, and heat after an incontinence episode. Furthermore, participants acknowledged that reduced mobility and cognitive deficit are also contributors.

Incontinence Associated Dermatitis was considered an easily preventable condition. Good practices were mainly about prevention rather than treatment. Timely toileting, good hygiene, and use of skincare products were identified as best prevention strategies. Education and training of staff was also important for proper management.

Two major challenges were identified. Shortage of staff represented as a low staff-to-resident ratio means lack of enough staff to provide residents with timely and adequate incontinence care. Another major challenge was the difficulty in differentiating between Incontinence Associated Dermatitis and pressure injury as they can look quite similar.

Addressing staff shortages and promoting staff awareness to better distinguish between Incontinence Associated Dermatitis and pressure injuries were identified as important areas for improvement.

Conclusions: This study is the first to research the perspectives of nurses and carers regarding the assessment and management of Incontinence Associated Dermatitis in nursing homes in Australia. The study results suggest appropriate use of recognised strategies for prevention; however, two major problems emerged, staff shortages, and difficulties in distinguishing between Incontinence Associated Dermatitis and pressure ulcers. The derived insights can help identify what is needed to inform, improve, and advance nursing home clinical practice regarding Incontinence Associated Dermatitis.

Keywords: Incontinence Associated Dermatitis, Residential Aged Care, Carers, Nurses

Subject: Nursing thesis

Thesis type: Masters
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Anita De Bellis