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Night-time continence care in Australian residential aged care facilities: findings from a grounded theory study

Background: Continence care commonly disrupts sleep in residential aged care facilities, however, little is known about what staff do when providing continence care, and the factors that inform their practice. Aims: To describe nurses' and personal careworkers' beliefs and experiences of providing continence care at night in residential aged care facilities. Methods/design: Eighteen nurses and personal careworkers were interviewed about continence care, and 24 hours of observations were conducted at night in two facilities. Results/Findings: Most residents were checked overnight. This practice was underpinned by staffs' concern that residents were intractably incontinent and at risk of pressure injuries. Staff believed pads protected and dignified residents. Decisions were also influenced by beliefs about limited staff-to-resident ratios. Conclusion: Night-time continence care should be audited to ensure decisions are based on residents' preferences, skin health, sleep/wake status, ability to move in bed, and the frequency, severity and type of residents' actual incontinence.