Evidence-based practice implications for nursing research and implementation

Covidien Pad Research

There are a number of major concerns when it comes to the residents of rehabilitation centers, nursing homes or any other similar facilities that house people of higher age and/or that otherwise have toileting issues. While the management, supervisors and nurses (among others) of those facilities take great care to ensure that residents are using the toilet as they need to and assisting them with the same as needed, staffing and other limitations preclude there from being any assertion that the need for Depends, Covidien Wings or other similar undergarments are not or should not be needed. Indeed, there are situations where a resident is asleep, is generally incontinent or has lost the mental acuity to be mindful and aware of themselves and/or others. A common example would be someone with severe dementia who does not realize that they should alert the nurse if they need accompanying to the toilet. Given this reality, this research proposal will speak to some research on such undergarments that are from one of the brands mentioned previously in this section, that being Covidien. While there are other brands and types of garments or other solutions out there, this proposal will deign to answer the question as to whether the Wings quilted formulary comfort undergarments as created, marketed and sold by Covidien offer a proper and full solution to the common nursing home/rehabilitation center situation mentioned above.

Background & Review of Literature

So as to inform and justify the reason for this research, the author of this proposal would be prudent to review and cover why precisely this research could be helpful. One reason why focusing on toileting-related undergarments is important is that the alternate solutions to dealing with this subject are simply not as effective and all-encompassing as what is otherwise possible and practical. Just as one example, the very idea that qualified nurses, LPN's and other nursing professionals can be provided in what is anywhere close to a 1:1 ratio is folly. While that would be lovely, the system is not built in a way that allows for it, the financials necessary to fulfill that desire would never work and no state government in their right mind would have such a requirement, even if some scholars and professionals suggest the states need to change their standards immediately (Harrington, Schnelle, Mcgregor & Simmons, 2016). Second, it was noted before that not all patients in nursing homes and rehabilitation centers have the ability or mental acuity to notify the nurses that they need to make it to the toilet. Quite often, it is too late and there are some patients who are barely aware of themselves, let alone the nurses, family or other people that surround them at any given time (Forbat, 2004). Lastly, the other methods besides staffing and undergarments that present themselves in terms of preventing toileting within an undergarment have some significant tradeoffs. Just as one example, there are many that suggest that nurses or other nursing professionals should, as part of their normal rounds, wake up a patient that is sound asleep so as to find out if they need to use the bathroom. While this may be at least somewhat efficient in terms of avoiding toileting mishaps, it does not prevent all such mishaps and jarring a patient out of sleep for toileting reasons alone is seen as disturbing and unnecessary in the eyes of many nursing professionals, leaders and scholars (Oulsander, Ai-Samarrai & Schnelle, 2001).

With that in mind, the general approach that is being taken by many, and this would include the author of this report, is to focus on dealing with eventuality that the use and acceptance of toileting undergarments needs to happen, not unlike what is done with children and their diapers. Rather than overly focusing on prevention, there is indeed a shift and focus on what to do when such an event happens and what products and methods are best when it comes to addressing the same. As noted throughout this proposal, the focus in this particular report and the research to come is what product is best and why it stands apart from other offerings. There are indeed other brands and products out there when it comes to what some people consider diapering. However, some products are better than others and there are a few names and models that stand out. Covidien is among those names and their Wings Underpad product will be the focus of this proposal and the research to come, as noted before (Twersky et al., 2012; Ishrak & Lee, 2014).

It should be noted that the company that has commonly been referred to as Covidien is now legally known as Medtronic Minimally Invasive Therapies. Per the company's new website, their revised and renewed mission is to "to diagnose earlier, intervene earlier, treat better and help patients recover faster" (Medtronic, 2016). Something else that is stated within the Medtronic/Covidien literature is a focus on comfort, functionality and utility as part of their products and what makes them work. The main focus in terms of functionality and purpose that shall be given particular attention is the function of the product to absorb urine and pull away from the skin so as to prevent or at least minimize discomfort (Twersky et al., 2012; Ishrak & Lee, 2014).

Aim & Purpose

Now that the general premise behind the research has been established, it would now be important to pose the questions that are to be answered as part of the research proposal that is being put forth. Those questions are as follows:

• Does the Covidien/Medtronic Wings Underpad product serve as an effective means to pull voided urine away from the skin and maximize comfort?

• Would a design different from that of the Wings product serve the patients that need them better?

• Are there brands/solutions that would be better than Wings that Covidien/Medtronic does not currently offer?

Methodology & Design

So as to ensure that the conclusions drawn from this proposal and the ensuing study are valid, reliable and scholarly, the author of this report would offer the following:

• While a focus on quantitative figures and hard numbers will be pressed for and favored when possible, so much of this proposal is going to come down to customer (patient) satisfaction and the perception of the quality of the product. As such, there will surely be a blend of quantitative and qualitative data. Beyond that, there will be every effort to draw conclusions and outcomes that make heavy use of both.

• Rather than conduct a primary study, the author of this study will instead use scholarly studies and other reports that assess the quality of the Covidien/Medtronic Wings and similar products in a way that is not biased or bought and paid for.

• The participants, third party as they may be, would be a collection of different residents that were studied with their consent and/or from their appropriate guardians. Of course, any study that contains personally identifiable information will be discarded. Even so, important general demographics such as age, medical condition(s), gender, race and other such details will be important to consider, presuming that the sources used have not already done so.

• The totality of all of the above will be considered through the lens of the implications they all have on nursing practice and on the patients that they serve

Implications for Nursing Practice

As was suggested and established at the end of the previous section, a big reason why this research is of particular importance is because of the implications it has on nursing practice. After all, there are a number of important considerations when it comes to care in nursing and rehabilitation centers. Those considerations would include financial solvency, quality of care, ensuring the right amount of staffing and ensuring the highest level of comfort possible and practical when it comes to patients. Of course, the use of Covidien/Medtronic Wings and similar products would fall into the latter category. Indeed, keeping patients as comfortable as possible is something that should be sought out and maximized for all patients. As has been noted within this proposal, there will always be limitations to the amount of comfort that can be provided due to the reality of staffing/patient ratios and this is true even when compliance with the law is assured. Beyond that, nurses cannot be with all patients all of the time and some patients have acuity issues that can really only be managed rather than done away with, like the aforementioned dementia patients. Regardless, whatever reasonable measures and actions that can be taken to assure the highest level of comfort for patients should be the order of the day even if the patient is not immediately aware of themselves or those around them.

Conclusion

As one might expect, there are people that disagree about what methods are best and why. This will always be the case in some respects, of this there is no doubt. Even so, whatever can be settled and put into the sphere of evidence-based practice should be done and that is indeed one of the high-level aims of this proposed study and many others like it. Some people have their biases and politics and ideology are not always good things when it comes to subjects like this. However, that does not mean that the scholarly community should not try its best.

References

Forbat, L. (2004). Listening to caregivers talking about the subjects of continence and toileting. Nursing Times, 100(2), 46-49.

Harrington, C., Schnelle, J. F., Mcgregor, M., & Simmons, S. F. (2016). The need for higher minimum staffing standards in U.S. nursing homes. Health Services Insights, 913-19.

doi:10.4137/HSI.S38994

Ishrak, O., & Lee, J. (2014). Medtronic CEO: Covidien deal will accelerate med tech investment in the U.S. Modern Healthcare, 44(31), 28-29.

Medtronic. (2016). Medtronic Minimally Invasive Therapies. Medtronic.com. Retrieved 29

October 2016, from http://www.medtronic.com/covidien

Ouslander, J. G., Ai-Samarrai, N., & Schnelle, J. F. (2001). Prompted voiding for nighttime incontinence in nursing homes: is it effective?. Journal of The American Geriatrics

Society, 49(6), 706-709.

Twersky, J., Montgomery, T., Sloane, R., Weiner, M., Doyle, S., Mathur, K., & Schmader, K.

(2012). A randomized, controlled study to assess the effect of silk-like textiles and high-

absorbency adult incontinence briefs on pressure ulcer prevention. Ostomy/Wound

Management, 58(12), 18-24.