title: Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.
abstract: OBJECTIVE
  Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care.
  
  
  METHODS
  Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures.
  
  
  RESULTS
  Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use.
  
  
  CONCLUSIONS
  There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities.
authors.affiliation: Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Ostaszkiewicz
authors.affiliation: Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Beverly
authors.initials: B
authors.lastname: O'Connell
authors.affiliation: Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
authors.forename: Trisha
authors.initials: T
authors.lastname: Dunning
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D001315:Australia; D019985:Benchmarking; D005239:Fear; D005242:Fecal Incontinence / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D033161:Government Regulation; D066296:Grounded Theory; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D016496:Incontinence Pads; D007407:Interviews as Topic; D009735:Nursing Homes / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards; D011050:Policy Making; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards; D011361:Professional Competence; D019984:Quality Indicators, Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000191:economics / Q000628:therapy*
keywords: incontinence; quality of health care; regulation; residential aged-care facility