Date of Award

January 2026

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Carissa Tufano

Abstract

Urinary incontinence (UI) affects up to 90% of persons living with dementia (PLWD),impacting quality of life, caregiver (CG) burden, and early nursing home admission. Yet, there is a lack of standardized tools guiding the assessment and management of UI in dementia. This DNP project addressed this by developing and implementing a tool focused on the assessment of UI and the optimization of nonpharmacological UI management to enhance PLWD quality of life and reduce caregiver stress. After expert panel consultation, providers and staff were educated on its use. The tool was integrated into the workflow at an outpatient clinic over a 12- week period. Overall, 24 PLWD and caregiver dyads were included in the data analysis. Following the use of paired t-test, UI episodes had lower mean scores during the follow-up visit but was not statistically significant, (t(23) = -1.04, p = .307). Conversely, the CG stress mean scores were higher and was statistically significant (t(23) = -3.84, p < .001) during the follow-up visit. Furthermore, results indicated that providers found the tool feasible and acceptable in clinical practice. Additional tasks potentially increased CG stress burden while a marked increase in CG efficacy likely indicated improved confidence in UI management of caregivers. The development of the tool may establish a precedent in informing the gap in UI management in PLWD. Moreover, the results of this quality improvement project have implications for practice by highlighting the importance of addressing the negative effects of UI on PLWD and the significance of CG stress.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 10/06/2027

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