Debbie Ohl, RN, M.Msc., PhD - HCMarketplace.com

CHAPTER 2
Reinstating or improving continence for the cognitively impaired can be accomplished via habit
training, scheduled toileting, or prompted voiding. The only question is which to use when.
Of course, the ability to cooperate is essential for all three of these programs. If there is resident
resistance, the first challenge is to determine whether the resistance has been staff
induced. An evaluation of cognitive loss and communication status can help determine the
answer.
•• Review the MDS coding for frequently or always incontinent residents. Residents
coded as frequently incontinent may be able to improve this status. Determine
when the resident is continent (regardless of who toileted him or her) and build the
care plan from there.
•• Be realistic about factors that can be addressed.
Urinary incontinence is the inability to control urination in a socially appropriate manner.
Consider:
•• Bladder•retraining. The resident is the primary player. Retraining demands that
the resident has the ability to consciously delay urinating or resist the urgency to
void.
•• Scheduled•toileting. The staff is the primary player. A staff member takes the resident
to the bathroom, hands him or her a urinal, or reminds him or her to go to
the toilet. This includes habit training and prompted voiding.
Bladder continence refers to the ability to control bladder function. Influencing factors for
bladder continence are:
•• A bladder that can store and expel urine
•• A urethra that can open and close appropriately
•• Fluid balance, integrity of spinal cord, integrity of peripheral nerves
•• Timely toilet access with or without assistance
•• Dexterity to adjust clothing
•• Cognitive and social awareness
•• Individual motivation
22 MDS 3.0 Care Plans Made Easy
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