An Evolutionary Concept Analysis of Urinary Incontinence

Nicole Zhang


Urol Nurs. 2018;38(6):289-295. 

In This Article

Proposed Definition of UI and Concept Map

Having examined the essence of UI, the proposed definition is as follows: involuntary loss of urine to a place that is socially unacceptable that results in significant impacts on activities of daily living, QoL, and physiological and psychological aspects of culturally situated notions of health. This definition was developed to include all attributes of UI and holistically understand the condition. It is important for nurses to holistically consider UI because caring for patients with UI involves holistic care and the facilitation of health.

A formalized diagnosis of UI should come as a part of an interactive assessment between the patient and his or her healthcare provider. Healthcare professionals often label a patient has having UI based on responses to a series of diagnostic questions. Planning and management should also occur as a collaborative experience between all parties involved in the care of the individual with UI, with education and open discussion being important. Consideration of all facets of the concept of UI are important.

In addition to the proposed definition of UI, a concept map was developed to depict the nature of UI. This is displayed in Figure 1. The concept map incorporates components of the definition of UI, as well as the dynamic and iterative nature of the condition. UI is situated in the cultural and environmental context. General societal perceptions, as well staff beliefs and the environmental situation, have been demonstrated in impact of UI. Therefore, UI is situated in the environmental and cultural context. Various factors predispose an individual to develop UI, including physiological factors, behaviors (intake and voiding practices), and innate risk factors. Factors combine, and if the individual develops UI, there are outcomes. These outcomes are economic, physical, psychological, and overall impact on QoL, and these interact with precipitating factors.

Considering these attributes, antecedents, and consequences, a model is proposed to guide the way UI is conceptualized. The model, a concept map, is shown in Figure 1. UI can be perceived of as a cycle or feedback loop. There are precipitating and predisposing factors that lead to the development or perpetuation of UI. These factors are health promotion mediators, health promotion inhibitors, the disease state, and health risk factors. Health promotion mediators include communication, education, self-efficacy, self-care, resources, and disease prevention. Health inhibitors can be thought of as the absence of health mediators described above. The disease state is the current health condition, including but not limited to UI. Many ailments impact UI. A helpful mnemonic developed for assessment and treatment of modifiable causes of UI is DIAPPERS, which is an acronym that stands for Delirium, Infection, Atrophic urethritis or vaginitis, Pharmaceuticals, Psychological disorders, Excessive urine output, Restricted mobility, and Stool impaction (Dowling-Castronovo, 1985). These conditions may be treated and positively impact UI if addressed appropriately. There are the major risk factors for the development UI in older adults. Each precipitating and predisposing factor can interact and influence one another.

These precipitating and predisposing factors can be considered similar to a systems model, with factors feeding into UI as an input and producing outputs. These outputs influence health management and outcomes, QoL outcomes, and economic implications. Health outcomes are effects of the development of UI (as a result of predisposing and precipitating factors) and implications of health outcomes and management. These vary from person to person. For example, if a patient has little education about UI, he or she may believe that UI is a normal part of aging. Therefore, the patient may be complacent about episodes of UI. As a result, a UTI develops from sitting in soiled absorbent products and linens.

QoL has been researched extensively in the realm of UI. The condition can be embarrassing and affect relationships, friendships, and self-perception. These outcomes then produce the feedback to impact predisposing factors. This whole model must be thought of as a being situated within the environment and social contexts of the individual with UI.