Comment - Continence care must respect patients' dignity

The winner of the Nursing Times Continence Award was announced on 6 November at an awards ceremony in London. The awards celebrated the achievements of all of the finalists from around the country and highlighted the enthusiasm that continence teams have in raising awareness and improving the care of patients with continence problems.

The winner of the Nursing Times Continence Award was announced on 6 November at an awards ceremony in London. The awards celebrated the achievements of all of the finalists from around the country and highlighted the enthusiasm that continence teams have in raising awareness and improving the care of patients with continence problems.

Continence problems are a symptom of an underlying condition rather than a diagnosis, and management of patients with these problems is essential nursing care.

Despite the work of multiprofessional teams across the country that has focused on improving the management of functional incontinence, it is evident that this message is not getting across to health professionals (see Update, p40).

Many nurses admit that more can be done to promote continence, yet it is easy for a patient to be labelled as incontinent. Take for example the management of Mr Green, who was admitted to hospital with reduced mobility due to arthritis and oedematous legs. He arrived in hospital without his walking frame and could not get to the toilet on his own. The nurse forgot to give him a call bell and, as he was unable to attract the attention of staff, he passed urine on the floor. He had also previously asked for a urinal but no one had got back to him. The nurse reported in Mr Green's notes that he appeared to be occasionally incontinent and suggested that he should wear a pad just in case.

A campaign, 'Dignity Behind Closed Doors', organised by the British Geriatric Society, challenges health and social care professionals to look at how they provide bowel and bladder care. It asks them to consider whether they take this essential work seriously and treat patients with the privacy and dignity they deserve.

Taking someone to the toilet may appear to be a fairly simple task, yet patients who are unable to get there unassisted because of acute or chronic health problems need careful assessment.

Nurses need to ask some basic questions. Is the toilet in your unit large enough to accommodate a wheelchair and a carer with the door shut? Does your patient have to use a commode by the bedside or can the patient be wheeled to the toilet? Is your patient wearing a body-worn absorbent pad because hoisting them onto a commode takes too long? Are there alternatives such as urinals for women or perhaps urinary sheaths for men?

The challenge is to look at your patients and ask if their toilet needs have been adequately assessed and appropriately met.

Incontinence is often described as a hidden problem and, unfortunately, its mismanagement can also be hidden. If you are struggling to resolve a toileting problem, contact your continence advisory team for advice.