Continence is an area that requires many community nurses to prescribe from the Nurse Practitioner’s Formulary to promote good patient care and appropriate service delivery. Recently in west Berkshire, with the full support of GPs, the continence advisory service has taken over the non-medical prescribing of all continence products, with the aim of providing a safe, cost-effective and timely service. This initiative is aimed at changing the way continence prescriptions are issued to patients. As well as examining the problems of bladder dysfunction in people with multiple sclerosis (MS), this first article of a two-part series, looks at the background to MS and bladder problems, as well as focusing on treatments such as clean intermittent self-catheterisation (CISC). The second part of the series will feature a case study looking at the management of a patient with MS and bladder dysfunction.
Functional bowel disorders such as faecal incontinence and constipation are relatively common conditions, which have a significant negative impact on patients. This can often affect the social, psychological and financial areas of life, as well as leading patients to become isolated due in part to the social taboo surrounding bowel issues (Lukacz et al, 2011; Holroyd, 2015a). Constipation can affect up to 25% of the population at some point in their lifetimes (Belsey et al, 2010), and it is a condition that crosses all genders, ages and cultures, although it is more prevalent in the very young or older adults (Holroyd, 2015b).
With over a million devices used in the NHS every year, indwelling urinary catheterisation is widely acknowledged as one of the most commonly used invasive healthcare procedures. Despite its widespread use, there is also extensive evidence of the risk of infection, blockage and bypassing associated with indwelling catheters, all of which can adversely affect patients’ health and quality of life, as well as placing a significant burden on the supportive health services that manage the caseloads of catheterised patients in both community and acute settings. This article looks at the reasons for the use of long-term catheters, the complications that can arise and the positive impact the use of a triclosan-based solution can have when instilled into the inflation balloon of the catheter. A selection of case studies highlight the use of Farco-fill® Protect (CliniMed) in complex patients whose only management option for effective bladder drainage is to use an indwelling catheter.
Urinary incontinence is a common problem in the UK, and one often seen by community nurses. While it is often associated with ageing, urinary incontinence can in fact have a number of causes and it is important that the community nurse is aware of the full range of aetiologies and presentations. Community nurses should have a good basic understanding of the causes of incontinence, be able to provide a basic first assessment, become adept at asking the right questions and be able to offer some conventional treatment and problem-solving strategies for immediate relief of symptoms. Most importantly, they should be able to identify when a patient will need referring to a specialist practitioner for more extensive assessment and investigation. This article looks at the assessment of urinary continence in the community, and outlines the common presentations that nurses should look out for.
The Colostomy Association is a national charity that provides support, reassurance and practical advice to anyone in the UK who has, or is about to have, a colostomy. We are here to help and support patients, their families and carers. Our helpline is manned 24 hours a day by volunteers who all have a stoma. Our wide range of leaflets, quarterly magazine Tidings and closed Facebook group offer information and support to anyone affected by life-changing stoma surgery.
Interstitial cystitis or painful bladder syndrome (IC/PBS) is a chronic condition presenting with symptoms including pain, urinary urgency and urinary frequency. IC/PBS is often poorly diagnosed and many patients may have seen multiple healthcare professionals over a period of years and undergone a variety of unsuccessful treatments. The lack of a definitive definition of IC/ PBS and diagnosis of its aetiology, cause and successful treatment contributes to a poor quality of life for many patients. This article looks at the main symptoms, diagnostic techniques and treatments for the IC/PBS. The author outlines how comprehensive history taking, physical examination and appropriate clinical tests all help community nurses to arrive at an appropriate and timely diagnosis, which, when combined with individualised treatment plans, can offer patients effective relief of their symptoms.
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.
