Continence Resources

Incontinence is associated with other medical conditions and has a variety of social and physiological consequences — from the person who has had a stroke and who needs to urgently empty their bladder; to someone with dementia who has lost the ’skills’ of continence. Community nurses who are able to manage people’s continence needs can help to restore patient’s dignity and improve quality of life, as well as preventing wastage and saving limited NHS resources (All Party Parliamentary Group for Continence Care [APPG], 2011). Knowing what constitutes ‘good’ continence services will also help patients and carers understand the services on offer, as well as making it easier for nurses to deliver standard outcomes. This article looks at recent guidelines that outline measurable continence services for adults, children and young people (APPG, 2011).

The management of incontinence is often a neglected area of community care, even more so when allied to older people, and it is essential that community nurses consider the effect of the ageing process and its impact on continence. Often, this can involve the specific effects of dementia and the management of urinary incontinence can then become complex due to the range of practical approaches required and the need to adjust these for each patient. A large percentage of the community nurse’s time is spent supporting carers; therefore, it is essential to consider their feelings when suggesting any strategies as they may feel that they are already incorporating them in the patient’s daily activities. It is also important to focus on few key elements of advice around incontinence and to listen empathetically to appreciate the challenges experienced by carers, which will help in identifying suitable strategies.

It is widely recognised that the NHS is facing unprecedented challenges in trying to improve the quality of services provided, while managing the most severe and protracted period of resource constraint in its history (NHS Confederation, 2014; Today’s NHS, 2015). The hour-a-day project was specifically designed by the author’s trust as an efficiency initiative, with the aim of saving an hour a day for each team member, releasing half that time as cashable savings, with the other half retained for the benefit of patient care. Saving time across 4,175 trust employees offered considerable scope for achieving efficiencies and reducing costs. 

In addition to achieving savings where possible, many services report that they now make better and smarter use of their time and resources (Berkshire Healthcare NHS Foundation Trust, 2015). The hour-a-day initiative was in place from autumn 2013 and drew to a close at the end of February 2015. A total of 92 services completed the process and delivered a combined saving of £1.9 million. Berkshire Healthcare NHS Foundation Trust (2015) demonstrated that the project was not overly complicated and simply offered an opportunity for busy staff members to take a reflective but introspective look at the way they work. For the majority, the hour-a-day initiative acted as a springboard for staff and managers alike to address and solve problems together. 

The Mitrofanoff technique uses the appendix to create a continent ‘tunnel’ between the skin’s surface and the bladder, which is then drained using a catheter, which is inserted along the tunnel rather than via the urethra. This is a complex procedure that needs the patient to be motivated and committed to living with such lifechanging surgery. Intense preparation and long-term support from a urinary diversion nurse specialist as well as any involved community nurses is vital. Long term follow-up is vital to ensure continued good health and to anticipate any problems such as infection, stone formation or renal damage. Having access to community healthcare professionals who know about the possible dangers and can offer advice and support is also key to ensure any complications are dealt with swiftly and safely.

Urinary incontinence impacts on patients both physically and mentally, restricting employment, educational and leisure opportunities, and leading to social embarrassment and isolation. It is vital that people who are experiencing continence problems are given every opportunity to regain their continence and highquality comprehensive continence services are an essential part identify patients who may be experiencing continence problems, before going on to look at treatments and longer-term care. The author also addresses the issue of when community nurses should look to deal with continence problems themselves, or when they

Constipation is a widespread problem although its subjective nature can mean that diagnosis and treatment can be difficult as there is often a mismatch between patients’ and clinicians’ view of the condition. Constipation is widely believed to include unsatisfactory defecation, infrequent stools and/or difficult stool passage. Thorough patient assessment and promotion of continence issues are imperative to improving services for people with constipation. This article highlights how breaking social taboos around bladder and bowel issues, helping people to acknowledge bowel issues, and referring them to the appropriate specialist nurse-led services will all help to provide a more accurate and timely diagnosis of constipation.

Patients in the community may often have a long-term urinary catheter in place. The management of this usually falls to thecommunity nurse therefore he or she needs to understand the basic procedures involved in urethral and suprapubic catheterisation, as well as being familiar with potential complications and how to troubleshoot. Catheter blockages are the most common problem encountered in long-term catheterisation and it is important that the nurse knows how to address this methodically and identify and treat the cause. This article offers practical and evidence-based advice on some of the common issues that can arise in the management of people who have long-term catheters in place

The number of NHS patients requiring containment products such as pads is increasing year on year due to an ageing population. Patients with long-term conditions are increasingly being cared for at home, and although incontinence is not a disease it is often a symptom associated with other health issues. Community nurses are seeing patients with more complex needs, but incontinence is often not the primary reason for their visit. Containment products can be seen — both by patients and their carers — as the most effective way to manage incontinence and nurses are often put under pressure to prescribe pads, while continence services are being challenged to review the way care is delivered through innovation and the effective use of technology. This article will look at the redesign of a continence service that has involved the development of a community continence team (CCT), along with a summary of the initially encouraging performance indicators. The CCT aims to provide a comprehensive continence assessment with a focus on rehabilitation. The principles underpinning this service redesign could be applied to any community nursing team.

Incontinence can affect people of all ages and genders and can have devastating psychological, social and financial implications for the individual and his or her family. Many people may fail to seek help with incontinence for years due to embarrassment and stigma, which in turn can lead to social isolation. The prevalence of bladder and bowel incontinence is increasing worldwide, in part due to an ageing population — more people are being looked after in residential and nursing homes than ever before and admissions to acute care due to incontinence-associated conditions have increased. All of these factors increase the burden of care on health and social care staff, potentially leading to a lack of quality services. Dignity is internationally accepted as a fundamental human right, yet a host of public inquiries (such as the Francis Report [2013] in the UK) repeatedly raise the issue of failure to respect patient’s dignity, particularly in relation to continence care. This article explores why continence care causes such complicated issues and how community nurses can help to ensure it is seen as an essential element of care, rather than being dismissed as only requiring basic skills.

Urinary tract infections (UTIs) are one of the commonest infections seen in primary and secondary care and consequently are often treated with antibiotics. However, recently there has been an increasing amount of evidence highlighting the problem of bacterial resistance to antibiotics commonly used to treat UTI. This makes diagnosis and treatment even more critical. Diagnosis of a UTI can be difficult, especially in elderly patients, and poses many challenges for nurses, including those working in the community, particularly in nursing and residential homes. This article examines the adoption of a chemical indicator dipstick test. This demonstrated good correlation with urine culture results and was seen as a useful additional tool to assist in the diagnosis of UTI, especially in those patients where urine samples may be more difficult to capture.