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Increasing demographic changes in the type and age of patients as well as further government directives requiring more care at home, mean that there is a growing emphasis on primary care-led services. Large caseloads and patients with multiple and chronic health problems are stretching available community nursing resources. Against this background, continence promotion tends not to be a priority and at times it may seem easier and better to prescribe pads for patients with urinary incontinence. This article provides community nurses with guidance on the initial assessment and management options available for patients who present with urinary incontinence. Many patients will subsequently experience improvement in their symptoms (although not always complete resolution), with a corresponding improvement in overall quality of life.
This article examines the various elements that community nurses need to consider when attempting to provide best practice in urinary catheterisation. The author seeks to challenge what is considered best practice — particularly the requirement for all practice to be evidence based — while encouraging community nurses to think proactively about the care they are providing. The article stresses that the first principle of urinary catheterisation is to avoid the procedure where at all possible — catheterisation is potentially dangerous and can even be life-threatening if performed inappropriately. Overall, the author poses some key questions, including: should there be a difference in the care provided by community and hospital nurses; do community patients have the same needs as those in hospital; and can the manufacturers of drugs/products help to make avoiding urinary tract infections (UTIs) easier?
Continence problems in children can be very disabling for both the child and their families/carers. The need to have an indwelling catheter can be inconvenient and, even, traumatising for the child. There is also a social stigma associated with incontinence, continence care and catheters, which should not be underestimated. This article discusses how healthcare professionals can help children and families and thereby reduce the burden, both emotional and physical, of living with a catheter and then introduces a new range of leg bags that have been designed specifically with children in mind.
This article looks at a telephone triage assessment clinic that was set up to improve the bowel, bladder and pelvic floor service in the authors’ locality. A pelvic floor triage questionnaire was developed to identify patients’ faecal, urinary and prolapse symptoms then, between April and December 2013, patients were referred to the colorectal pelvic floor clinic via telephone triage assessment. Investigations could also be requested directly from the telephone triage assessment clinic. The need for any investigations and patient responses to the telephone triage assessment clinic questionnaires were reviewed in the pelvic floor multidisciplinary meeting. Previously, the wait for a new pelvic floor appointment was four months and this has been reduced to two weeks (or five weeks for a new consultant appointment). The telephone triage assessment clinic has led to a reduction in waiting times, an improvement in patient experience and more efficient referral. It is also more cost effective as
it can replace a new consultant appointment.
Urinary tract infection (UTI) is caused by the presence and multiplication of bacteria in the urinary tract, with associated tissue invasion. It is most common in women but can be more complicated in male and catheterised patients. This article highlights the importance of the correct diagnosis of UTI, which will identify ‘red flags’ to aid community nurses’ choice of management options and avoid the unnecessary prescription of antibiotics. In addition, the author makes recommendations for reducing catheter-associated UTIs (CAUTIs) in the community.
Caring for patients with indwelling catheters is common in nursing practice in all settings (Foxley, 2011), despite being the last resort for patients with long-term bladder control problems. Community nurses in particular will regularly encounter patients with indwelling catheters, ranging from those with nerve damage such as spina bifida, multiple sclerosis (MS), stroke or spinal injury; those with debilitating or terminal illness with loss of mobility; to those who may lack the cognitive ability or sufficient awareness to use the toilet. Catheterisation carries a high risk of infection, resulting in an increased burden of care and cost to healthcare providers. It can also negatively impact on patient wellbeing. Providing for these patients 'around the clock' can be a particular problem in the community, with carers and patients requiring education in how to manage both the catheters themselves, as well as the accompanying equipment at night. This article provides a background to long-term catheterisation, before looking at ways of preventing infection as well as the techniques and equipment that can better enable 24-hour care.
It has been estimated that around 4% of patients on community caseloads have long-term indwelling catheters (Pomfret, 2000). Healthcare professionals have a responsibility to be aware of the different closed drainage systems available, so that they can offer patients choices to suit their lifestyle and preferences. Leg bags are one option, which can be customised to maximise patient comfort and dignity. This paper discusses the impact that urinary incontinence can have on patient quality of life, and one range of leg bags that has been developed to meet patients’ specific needs.
Constipation is one of the most common gastrointestinal problems experienced by the general population, with an estimated UK prevalence of 52 per cent. Despite this, constipation is often both misdiagnosed and under-treated both in children and adults. This paper will look at the issues and suggest specific management strategies for addressing constipation in both the general adult population and these apparently vulnerable groups.
June Rogers MBE, RN, RSCN, BA(Hons), MSc, ENB 216, ENB N01, ENB 978. PromoCon Team Director, Disabled Living Manchester.
Article accepted for publication: January 2013
Irritable bowel syndrome (IBS) is associated with a significant impairment of quality of life. Due to the nature of its symptoms, the role of the nurse is central to the care of patients who may have IBS. The often embarrassing symptom profile means that patients may rely on nurses to provide psychological and physical support in helping them to improve their symptoms. In this article, the author discusses the management of patients with irritable IBS, including the optimal delivery of care for patients and the role of community nurses in dealing with this chronic condition.
Isobel Mason, Nurse Consultant, Gastroenterology, Royal Free London NHS Foundation Trust, London
Why does incontinence continue to lag behind many other key healthcare conditions, despite being a massive public health issue? There is a vast literature base that informs us that incontinence can affect men, women and children at any age, and that even slight incontinence can have a severe impact on quality of life for individuals and carers.
Sharon Eustice is a Nurse Consultant at the Bladder and Bowel Specialist Service, Truro, Cornwall