Journal of Community Nursing

16 JCN 2020,Vol 34, No 4 assessment of someone’s pelvic floor muscle contractibility involves:  P ower — healthcare professionals feeling the power of the muscle to grade its strength  E ndurance — evaluating the patient’s muscle endurance, i.e. the time the person can contract the muscle in seconds  R epetition — assessing the number of times the patient can repeat that contraction with a two-second relaxation time between each contraction  F ast — ascertaining the number of quick contractions followed by immediate relaxation which the patient can do  E levation — assessing the lift of the posterior vaginal wall  C o-contraction — seeing if the ancillary muscles also contract during the pelvic floor contraction, i.e. the abdominal wall, gluteal or quadricep muscles  T iming — noting if the pelvic floor contracts on coughing and if there is vaginal descent or urinary leakage  R elax — assessing the patient’s ability to relax the pelvic floor between contractions. The Newcastle-upon-Tyne continence service has attempted to teach this intervention via the telephone to enable patients to start treatment programmes for their SUI until a face-to-face visit can be achieved. Thus, all patients are reviewed by telephone and the intention is to see all patients once the Covid-19 restrictions are lifted. To help patients with this self-assessment, the continence service has used the Educator ® (a vaginal probe). When inserted into the vagina, this responds to the C urrent Covid restrictions have forced many healthcare professionals to embrace technology and work in very different ways. Indeed, the traditional telephone has allowed the Newcastle continence service to provide a service to patients referred with all types of urinary incontinence. But, is it even possible to assess someone’s continence and devise a treatment plan over the telephone? One of the most difficult challenges to the continence service has been for those women who present with stress urinary incontinence (SUI). The World Health Organization (WHO) estimates that 6–10% of women will have symptoms of SUI (Milsom, 2018), which can be more prevalent in younger women as overactive bladder (OAB) symptoms tend to increase with age (Milsom et al, 2016). During the Covid-19 pandemic, patients have continued to be referred to the Newcastle-upon-Tyne continence service. Normally, these patients would receive a face-to- face assessment as a gold standard recommendation (National Institute for Health and Care Excellence [NICE], 2019), involving holistic health assessment including a vaginal examination of the patient’s pelvic floor. The pelvic floor examination, both external and internal, enables clinicians to tailor an individual pelvic floor rehabilitation programme for that patient. As this vital part of assessment cannot be conducted over the telephone, due to Covid-19 restrictions the author’s service has had to adapt its procedure for some patients who present with SUI. First, a comprehensive history is taken via telephone contact with the patient, including a record of their fluid intake and bladder charts. This information can be emailed by the patient or taken over the telephone and transcribed onto a new chart, i.e. trust endorsed bladder output and fluid intake charts. Questions specific to SUI, vaginal atrophy, menopause, signs of vaginal prolapse, pregnancies, etc are then asked and, if the woman consents, she is guided through a peroneal self-assessment. Using a mirror to identify potential vaginal prolapse, i.e. where the pelvic organs protrude into the vagina, the cough test is carried out to identify urinary leakage. At this point, if any potential abnormality is detected, a home visit following all Public Health England’s personal protective equipment (PPE) guidelines (2020) would be carried out. Carrying out a complete PERFECTR assessment (Haslam and Laycock, 2010) cannot be undertaken via the telephone. This Assessing continence issues during the Covid-19 pandemic Viewpoints Alyson Laws, nurse specialist continence (community lead), Newcastle upon Tyne Hospitals NHS Foundation Trust ‘... is it even possible to assess someone’s continence and devise a treatment plan over the phone?’