Women's narratives of long-term urinary incontinence

PURPOSE: The purpose of this study was to use narrative analysis as a method for examining the lived experience and meaning of long-term, female urinary incontinence (UI). METHOD: Cognitive anthropology and critical medical anthropology provided the overall framework for this study. Theoretical saturation (Strauss, 1987) was achieved after 17 community-dwelling women with long-term (greater than 5 year's duration) UI were interviewed. Informants participated in two face-to-face, audiotaped, interviews and a semi-structured, topical outline for each interview was used. A field journal was used to supplement and validate other data. Informant's narratives were analyzed to emphasize the overall plot type of their stories. FINDINGS: In this study, three dominant plot types emerged from women's narratives: the UI Quest Narrative, UI Restitution and Redemption Narratives, and the UI Victim Narrative. These plot types provide a beginning understanding of the lived experience and meaning of long-term female UI. CONCLUSIONS: Study findings suggest (a) long-term female UI is primarily conceptualized as a condition integrated into a larger life story, (b) women with long-term UI relate stories that follow a narrative format, and (c) long-term, female UI is heterogeneous. Findings go beyond existing literature by suggesting that women's UI narratives serve an important function in understanding the lived experience and the meaning of UI.     

Fear of humiliation inhibits women's care-seeking behaviour for long-term urinary incontinence

Most women with urinary incontinence (UI) do not seek professional help. Women's experiences of their behaviour when seeking care for incontinence are important to improve understanding by nurses and encourage as well as enable women to seek help. The aim of this study was to illuminate the meaning of women's lived experiences of their behaviour when seeking care for long-term UI. Thirteen women were interviewed (range 37-52 years) who had not sought professional help for incontinence. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Three themes evolved from data: being in an affected situation, having personal beliefs about seeking care and having desired expectations about care. Being in an affected situation, means that the women were negatively affected by their long-term incontinence. Living with shame, altered sexual relationships and a need for distancing have negatively influenced their care-seeking behaviour (CSB). Having personal beliefs about seeking care means that the women had their own beliefs regarding morally acceptable behaviour for seeking care because of incontinence. This led to a toning down of their problem and a minimization of the problem associated with incontinence as it was considered to be a normal consequence of pregnancy and childbirth. Having desired expectations about care means that the women had opinions relevant to the care and felt being asked about incontinence and an understanding atmosphere should be included. The conclusion is that fear of humiliation inhibited women from seeking care for long-term UI. The findings suggest that nurses should be precise when asking about women's experiences of UI because otherwise they do not bring it up. Additionally, CSB can help nurses to explain the experience and enable women to seek help for this manageable condition.     

The meaning of women's experience of living with long-term urinary incontinence is powerlessness

Aim. The aim was to illuminate the meaning of women's experiences of living with urinary incontinence (UI). Background. Living with long‐term UI means a variety of consequences for everyday life. Women's narratives about their lived experiences are important in enabling nurses to better understand and to help women achieve symptom control. No previous study could be found that has focused on the meaning of women's experience of living with UI from a symptom management perspective. Method. Fourteen women with UI (range: 34–52 years) who had sought professional help were interviewed. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Findings. The women's experiences of living with UI are presented in terms of two interlaced themes of being in a vulnerable situation and striving for adjustment. Being in a vulnerable situation means that the women had no control over UI and experienced powerlessness. The sub‐themes in this case were living with an uncontrolled body, living with incontinence as taboo and experiencing a less satisfying encounter. Striving for adjustment means that the women tried to handle their incontinence in different ways to regain power and continue to live as normal. The sub‐themes here were living in readiness, making urine leakage comprehensible, accepting living with UI and being familiar with the situation. Conclusion. The meaning of women's experience of living with UI is powerlessness. Relevance to clinical practice. Nurses should supervise women in pelvic floor muscle training to achieve control over incontinence, thereby helping them regain power. Additionally, Integrated Approach to Symptom Management can help nurses enhance women's self‐care abilities.     

Incontinence in women: effect of expectancy to regain control and severity of symptoms on treatment outcomes

Urinary incontinence (UI) is a common problem for women of all ages. Associated with poor self-reported health, UI may have a negative effect on women's lifestyle and quality of life. Because UI is not commonly discussed between women or between women and their care providers, the extent of its impact on their lives is not fully understood. This study provides insight into how a woman's perceived or subjective opinion of the severity of UI and her belief in the ability to regain control of UI influence the effectiveness of treatment.     

重庆城市社区卫生服务中心托老科入住老人生活体验的质性研究

目的 深入分析重庆城市社区卫生服务中心内设的托老科入住老人的真实生活体验,为新型养老模式的建立与推广提供参考依据.方法 2015年11月至2016年1月,采用目的抽样法,选取重庆市主城区3所已开办托老科的社区卫生服务中心的18名入住老人为研究对象,采用现象学研究方法对其进行深度访谈,运用Colaizzi的7步分析法进行资料分析,提炼主题.结果 重庆城市社区卫生服务中心托老科入住老人的生活体验可归纳为6个主题,即安全与信任、满足与欣慰、同情与理解、独立与适应、抱怨与无奈、担心与忧虑.结论 托老科老人在医疗保障、亲情慰藉方面得到较大满足,在社区卫生服务中心内设置托老科的养老模式发展前景良好,但环境限制、社会心理服务缺失等方面的不足应引起管理者的重视.     

Primary Health Care of Elderly Women

Traditional health care of the expanding elderly population has focused on illness diagnosis and management. However, because more individuals, women especially, are living longer and living better, the emphasis should be shifted and modified to include primary health care for elderly people. Primary health care includes active health promotion and health maintenance, prevention of illness or disability, and attention to the quality as much as to the quantity of life. Unfortunately, the health concerns of elderly women, especially the oldest-old groups who live more or less independently, have been addressed inadequately in medical and nursing literature. Routine approaches to health care for women aged 70 and older must consider women's apparent hardiness, potential social isolation, and unique worries about safety and independence. Nurse practitioners in adult health, family practice, and gerontology must expand their repertoire of health promotion and health maintenance strategies to meet the needs of this special population. This article outlines the role of the nurse practitioner in the care of the well elderly woman.     

Women's experiences of bulimia nervosa

AIM: This paper reports a study to interpret and understand bulimia nervosa as women experience it. BACKGROUND: Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care. METHOD: The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18-36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires. FINDINGS: Participants' narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self-induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self-induced vomiting. CONCLUSIONS: Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives.     

Social and cultural construction of urinary incontinence among Korean American elderly women

The purpose of this article is to describe the social and cultural constructions that influence help-seeking for urinary incontinence (UI) among Korean American elderly women. Many Korean American elder women do not perceive UI as a problem worthy of attention. The reason may lie in its social and cultural construction. The social construction is rooted in the collectivist nature of Korean culture, which makes UI a family, rather than an individual, problem. The cultural construction is related to Confucianism, which directs conceptions about ageism, shame, and fatalism. This article will help the gerontological nurse to better understand Korean American elderly women's sociocultural background related to UI care and could lead to appropriate family centered interventions to manage or treat UI in this population.     

Discovering older women's experience of urinary incontinence

Grounded theory was used to acquire an understanding of older women's experience of urinary incontinence (UI). Women explained that accidents or other problems related to the UI were threats to their self-esteem. These threats provided strong incentives to develop an effective continence care system which would help to protect their self-esteem. If they were successful in developing an effective system, it was possible that they could accept the UI and lead "normal" lives. Examination of the data using the constant comparative method revealed the self-care system that the women in this study produced to manage the UI, but not how they developed or sustained it. Further investigation into how women with UI develop and sustain continence care routines is needed, so that nurses can provide better assessments and nursing care.     

Seeking care: women's narratives concerning long-term urinary incontinence

INTRODUCTION: As part of a recent study (parent study), women's narratives of long-term urinary incontinence (UI) were compiled and analyzed. In this article, findings are presented from a secondary analysis of parent study data. PURPOSE: Primary aims of this study were to 1) examine care-seeking behaviors for women experiencing UI, and 2) describe individual experiences with UI affecting sexuality and intimacy. METHODS: Seventeen community-dwelling women (mean age, 65; 35% African American) participated in semi-structured interviews. Thirteen (76%) had sought treatment from either their primary care provider or a continence specialist. Demographic, general health, continence, and interview data were analyzed using QSR NUD*ist (Non-numerical Unstructured Data by Indexing, Searching, and Theorizing) 6.0 software and by hand, using line-by-line coding. RESULTS: Findings suggest that women who seek care for UI are more likely than those who do not seek care to 1) tell a story, 2) describe UI as having a negative impact on sense of self, and 3) be older, Caucasian, in "good" or "excellent" general health, and suffer from UI for a longer period of time than those who choose not to seek care. An additional finding is that some women relate UI to sexuality, intercourse, and intimacy. CONCLUSIONS: This study expands current knowledge of the characteristics of women with UI and possible relationships between UI and sexuality. Further research is needed to examine how or if these factors relate to whether or not women choose to seek professional care for UI.     

Women''s Health and the Practice of Public Health Nurses in Northern British Columbia

This study explored women's health and the practice of public health nurses in northern British Columbia using a phenomenological methodology. Ten public health nurses in northern British Columbia were interviewed to determine their perspectives on their practice in the area of women's health. Findings reveal three central themes: women's health, public health nursing practice, and rural context. Several subthemes elaborate on the central themes. Women's health is described in terms of women's health needs, how women stay healthy in northern communities, and conditions that affect women's health. Public health nursing practice is described in terms of activities, strengths, conditions, and ways to strengthen practice. Definitions of rural context are provided and some of the benefits and challenges of living and working in northern communities are presented. Health promotion and illness and injury prevention needs of women are clearly evident in the findings. Public health nurses are well placed in the North to help women meet their health care needs. However, further attention to women's health needs and the expansion of public health nursing services would facilitate improved health for women who live in isolated northern settings. In addition, further research is needed to explicate women's health and public health nursing practice in isolated northern settings in Canada.     

Improving Care for Women With Urinary Incontinence in Primary Care

Urinary incontinence (UI) is highly prevalent in primary care, disproportionately impacts women, and is associated with poor quality of life related to significant psychological, physical, social, and financial burdens. UI places significant economic burden on the United States health care system. Cost-effective, first-line UI treatments improve continence and can be successfully offered in primary care. Unfortunately, UI is largely untreated, in part because health care providers fail to inquire about involuntary urine leakage and are uncomfortable with UI diagnosis and treatment. The aim of this article is to familiarize clinicians with UI risk factors and effective nonpharmacologic management strategies for primary care.     

Falling short of the mark: tales of life after hospital discharge

The purpose of this qualitative study was to explore the everyday issues, challenges, struggles, and needs of elderly, community-dwelling women in the first weeks posthospital discharge. Fourteen elderly women were interviewed in their homes 6 to 8 weeksfollowing hospitalization. In addition, using a process based on photo novella or photovoice, 4 of the women took photographs of their everyday lives. The photos were used as triggers during the interviews. The interviews were analyzed to identify the themes of the women's experiences. The overarching theme was that hospital discharge plans "fall short of the mark" because theyfailed to reflect the complexity of the posthospitalization experience by focusing primarily on very basic physical and medically related needs rather than on the reality of the women's recovery. These findings are alarming given the aging population. The implications for hospital discharge planners, home care service providers, and policy decision makers are discussed.     

The experience of women with advanced chronic obstructive pulmonary disease of repeatedly relapsing to smoking

Living with chronic obstructive pulmonary disease (COPD) a smoking-related disease and repeatedly relapsing to smoking is a complicated health problem, particularly for people expected to be at the peak of their productivity in life. As the prevalence of COPD among women is on the rise devoted attentiveness must be given to women's smoking. The purpose of this study is to illuminate the experience of women with COPD of repeatedly relapsing to smoking. The study draws on interpretive phenomenology. Seven women, aged 47-65 years, selected out of convenience, were interviewed twice, shortly after being hospitalized for an exacerbation of the disease. Data were analysed into themes emphasizing commonalities and differences in the lived experience. Results illustrate the intricacies between the lung disease, which controls life of participants on a very fundamental level and smoking cigarettes, which only augments the disease. Six not mutually exclusive themes emerged with one, being caught in a spider web, overarching. Other themes were: circumstances of the relapses, shame, the excuse, ambivalence and incomplete attempts to quit. The capacity of the women participating in this study to refrain from smoking was limited and they vacillated between wanting and not wanting to stop. This suggests that for women in similar situations an exhaustive and long-term nursing care is necessary for them to be able to come to terms with what they really aspire to and to stay with that decision.     

Women's experiences of 'being diagnosed' with a long-term illness

AIMS: In this paper we share women's storied accounts of 'being diagnosed' with a long-term illness. The purpose of the paper is to raise awareness of health professionals that receiving a medical diagnosis is a potentially calamitous event, challenging self-identity. BACKGROUND: The three authors were involved in three separate inquiries which explored women's experiences of living with illness. The authors realized that 'being diagnosed' was a common memorable event for the women across the inquiries. The literature around receiving a diagnosis was scarce. DESIGN: This paper is the result of secondary analysis of data from three different projects where we researched women living with long-term illness. In this paper, we focus on the experience of 'being diagnosed' as we share and show women's perceptions of receiving a medical diagnosis. FINDINGS: Receiving a medical diagnosis of a long-term illness was a memorable event in the women's lives. Many women felt alone with their illness, often without adequate information to find meaning in the relationship between their familiar self and their new identity as a woman living with illness. They felt vulnerable and lost as they tried to understand the meanings and consequences that the diagnosis held for their present and their future. Informational needs may be specific and individual. For many, receipt of a diagnostic label was momentous and should not be underestimated, despite the initial feeling of chaos, many women felt validated. CONCLUSION: Receiving a medical diagnosis is one event where health care professionals could be on standby. It is important to take the woman's articulation of the event seriously. Open, genuine communication, with willingness on behalf of the health professional to listen would be affirming for women who are coming to terms with the diagnosis of a chronic illness.     

Impact of caregiving: listening to the voice of informal caregivers

Long-term care of the elderly and the disabled rests on a vast network of informal caregivers. This qualitative study examined the effects of caregiving on the health and wellbeing of a small, non-representative sample of urban women caregivers. These 11 informants participated in two interviews. Health was conceptualized in a holistic manner, consistent with the view of the World Health Organization and Health Canada. The caregiving experience, as described in this study, was life changing and consuming. Analysis revealed that the domain of caregiving could be captured by three dominant themes: loss and grieving; adapting and coping; and the short- and long-term impact. The consistency in the findings and policy recommendations of studies of informal caregiving begs the question: when will caregivers finally be heard?     

Incontinence in a manufacturing setting: women's perceptions and responses

The true prevalence of urinary incontinence (UI) and its impact on the quality of life in working women are not well established. Many women do not report UI to a health care provider because they mistakenly believe UI is a natural part of aging. This situation exists despite the dissemination of a national guideline for UI in adults. The aims of this study were to (1) explore what incontinent women in a manufacturing setting name or identify as the proposed cause of urinary leakage (2) analyze an association between identifying a UI cause and reporting it to a health care provider and (3) determine how many women were aware of the AHCPR Guideline. The results indicate that the majority of incontinent women (62%) have not reported this to a health care provider. Most women attributed urinary leakage to parity and waiting too long to empty the bladder. There was no relationship between identifying a UI cause and reporting it to a health care provider. Only 2 of the women out of 78 had heard of the AHCPR Guideline but the majority of women wanted more information about UI (85%). Mechanisms are suggested for querying women with UI and disseminating the AHCPR Guideline.     

Breast cancer patients' experiences of lymphoedema

The aim of this study was to explore employed women's experiences of light or moderate arm lymphoedema following breast cancer treatment in order to gain a deeper understanding of this phenomenon. Twelve women took part in a semistructured interview. A qualitative method with a phenomenological approach was applied to analyse data. In order to integrate the experiences in the everyday life of the women, a critical incident method was used. The findings indicate that there are many different practical and psychosocial problems related to arm lymphoedema. Three main themes were common to all the women. These themes were: (i) Attitudes from people in their surroundings, including reactions to the problem from other people and reactions from the women on the attitudes of other people. (ii) Discovery and understanding of oedema as a chronic disease and its treatment. (iii) Coping, including both problem-focused and emotion-focused strategies. The problems integrated in daily life were of low frequency but of considerable importance to the women. In conclusion, it is of great importance that health care professionals should be aware of and have knowledge about these problems. The women's needs for expressing their experiences of arm lymphoedema may be encouraged at the time of discovery and then regularly as long as the women seek care. Efforts may be made to strengthen the women's coping skills, eventually in a multidisciplinary approach. The interaction skills of health care professionals are probably of great importance in strengthening the resources of the women leading to a positive outcome.     

Talking circles: Northern Plains tribes American Indian women's views of cancer as a health issue

OBJECTIVE: The purpose of this research was to understand the cultural meanings of cancer among American Indian women from Northern Plains tribes living in western South Dakota and their experiential view of breast and cervical cancer screening. DESIGN AND SAMPLE: Using an exploratory design, a purposive sample of 28 women, 35-75 years of age, were recruited into three Talking Circles. MEASUREMENT: Talking Circle and focus group methodology, combined with Affonso's Focus Groups Analytic Schema, were used to generate contextual data sets including thematic findings. RESULTS: Ten themes emerged indicating interrelationships between cultural traditions and health structures of care. The themes provided a unique perspective for conceptualizing women's experiences with breast and cervical cancer screening. CONCLUSIONS: Incorporating women's cultural experiences into screening services is necessary to address clinical and policy challenges for reducing breast and cervical cancer mortality among American Indian women. Findings from this research will be used to guide a future study investigating breast-screening patterns related to mammography adherence and development of interventions specific to American Indian women.