Comment: Providing coping mechanisms is an essential aspect of care
Despite new surgical interventions and pharmacological options that give hope when bladder and bowel control problems have not been overcome by more basic interventions, incontinence care is still often seen as a Cinderella service
Even though technology plays a greater role in many nursing therapies, and cure rather than care is increasingly an objective, some nurses, whether because of a lack of confidence, interest, knowledge or time, continue to see pad provision as the only feasible solution.
As incontinence continues to be a taboo subject, those with the condition may put off asking for continence advice, especially when the onset has been gradual and the symptoms have been almost creeping up on them. Less likely to seek help immediately than those who have experienced a sudden onset, they often struggle on alone, feeling isolated, cutting down their drinks, purchasing pads or even becoming reclusive. If these individuals do summon up the courage to seek assistance but are seen by a nurse who – for whatever reason – treats their incontinence by palliative means only, their negativity continues, as they feel that nothing positive can be done.
To be realistic, sometimes not even the most diligent patient, under the guidance of a nurse who is expert in continence promotion, can regain full continence. This is probably why some nurses feel reluctant to invest time and effort in acquiring and making use of appropriate skills.
Although it is necessary to maintain a positive attitude and encourage the patient to do likewise, it is equally important to acknowledge that achieving the pinnacle of complete continence might be unrealistic. However, the upside of this acknowledgement is that even if this pinnacle is not reached, the physical and psychosocial benefits of positive adjustment to living with incontinence can provide a successful outcome. Nurses can help those for whom the achievement of faecal continence is no longer an option climb from the depths of their problems – if not to the pinnacle – to the higher ground of positive coping.
Initially, this may involve helping patients to choose the most appropriate continence product – which is not always a pad. Knowledge of aids such as male urinary containment devices, intermittent catheters or anal plugs for faecal incontinence may be necessary to manage incontinence as adequately as possible.
Awareness of Radar key access to unisex toilets with wash and change facilities – assisted if necessary by a partner – and cards requesting the urgent use of a toilet where there are no publicly designated facilities, further enable nurses to encourage their patients to reclaim a quality of life that may have been severely compromised.
Mary Wilson, PhD, MA, BSc, RGN, is nurse specialist in bladder and bowel health, Specialist Services for Bladder and Bowel Health, Westwood Hospital, East Yorkshire.