Best practice Resources

Bladder and bowel difficulties affect 20% and 10% of the UK population, respectively (Percival et al, 2021). This is most likely not an accurate reflection of the true scale of this often under-reported health issue. Pelvic floor dysfunction can cause symptoms relating to many different systems and its management involves numerous modalities. The management of bladder, bowel and pelvic floor dysfunction should be delivered in the community via general practitioners, pelvic health physiotherapists and bladder and bowel services. An effective multidisciplinary approach using pathways to reduce secondary care involvement unless required should be adopted. Post Covid, community bladder and bowel services are recovering from prolonged redeployment, a backlog of cancelled patients and a rising waiting list. Acute services are the same, with even bigger backlogs for benign lower urinary tract dysfunction and prolapse assessment. Scrutiny of current bladder and bowel services across new clinical commissioning group (CCG) collaborations will undoubtedly uncover the disparity in quality of service provision. 

Hydration is an essential component of life. Fluid balance monitoring in health and social care has been a routine monitoring tool carried out by nursing staff for many decades. The evidence suggests poor compliance and inaccurate data with lack of time or appropriate staff cited as the reasons for this. Several recent high profile cases have attributed fatalities to a lack of adequate hydration of patients in health/social care environments. Managing someone’s input and output can have a signifcant effect on their health and wellbeing. Accurate monitoring can also assist diagnosis and ultimately guide appropriate treatment choices for people with lower urinary tract symptoms. This article looks at the variety in terminology and practice, discusses the importance of maintaining accurate monitoring, and the essential components of a useful monitoing tool. It also identifies some of the challenges faced in maintaining effective monitoring of fluid balance with suggestions for improving practice.

Lipoedema is a challenging condition for patients, health and social care professionals. Lack of understanding about the condition leads to delayed diagnosis and poor support with self-management. This paper draws on key evidence, best practice guidelines for the management of lipoedema, and a patient story, to provide insights into the presentation, diagnosis, impact and management of the condition. It also identifies key points for practice for community nurses.

Urinary catheterisation is one of the most common procedures undertaken in both primary and secondary care. However, the process carries a number of inherent risks, such as the potential for trauma and the introduction of infection. In addition, the inappropriate use of a catheter can cause long-term damage. This article outlines the indications for their use and the type to be used according to patient requirements.

Frank Booth RGN, DN Cert. Freelance Continence Specialist
Melanie Clarkson RGN Dip. He. Clinical Nurse Specialist, Continence Service for Blackpool Teaching Hospitals NHS
Foundation Trust

Article accepted for publication: March 2012

Andrea Surridge & Tanya Spriggs describe the roll out of nurse prescribing in Wales.
Andrea Surridge RGN, BN, NDN, PGCE, CPT is a Lecturer/Practitioner, Bro Morgannwg NHS Trust seconded to University of Wales Swansea
Tanya Spriggs RGN, DN BSc (Hons) is Acting Head of Community Nursing, Bro Morgannwg NHS Trust.
Article accepted for publication: July 2006