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Blog: Why we need to spread the continence know-how

'You and your team have to accept that you cannot and should not see everyone'

If you are a clinical nurse specialist you have the knowledge to care for people with continence problems. But what about everyone else? Do they have the knowledge and, if not, how do they get it?

If, as we believe, no less than 1 in 20 and possibly as high as 1 in 10 of the population will at some time get some type and level of incontinence, then we have a huge job ahead of us.

We know that as we get older the incidence of incontinence rises and with an ageing population we are facing the reality of many more people presenting for help with bowel and bladder dysfunction. The problem is that as a CNS you and your team have to accept that you cannot and should not see everyone.

Most primary and secondary care staff will deal with more incontinence than the specialist, and this makes sense as many will not need specialist interventions.

Typically, women are more likely to be incontinent than men and stress urinary incontinence (SUI) is the most common type of female incontinence.

A women with stress urinary incontinence following childbirth should be managed by a practice nurse with appropriate training in assessment and is able to teach pelvic floor exercises. How do they get this knowledge?

Sadly, most general nurses have not benefited from additional or specialist training to care for people with continence problems. Historically we have seen that the older lady who leaks when she coughs is told she should expect it at her age and wear a pad - when in fact her problem could be solved. The man with post-micturition dribble again might be told it’s a common problem and just one of those things, to 'just live with it'.

Is this really acceptable? I don’t think so.

Student nurses do not get adequate training on the management of continence problems to deliver continence care. The education they receive is not built on during training and when they qualify that basic knowledge is often missing. The result is that few have insight into the enormous physical, social, emotional and psychological effect that incontinence has on people.

It is the responsibility of the clinical nurse specialist to prepare and develop higher levels of knowledge for all staff. It is you who must be prepared to stand up and be counted, ensuring that wherever and whatever your area of responsibility is, you must use your teaching skills to help others develop and manage care effectively.

Before anyone can develop enhanced and specialist skills they must have a basic understanding and knowledge of the subject. It is up to continence specialist to educate general nurses to screen for, assess, manage and appropriately refer patients with continence problems.

Education is about developing better quality care, the care that everyone has a right to expect. If you are a continence specialist, do you teach? Do you seek out teaching opportunities? Do you ensure that people know about your role as a continence specialist? Do they know where to ask for help?


Readers' comments (3)

  • While I agree with Mr Booths comments, with all the will in the world it is sometimes impossible for nurses to be released from clinical areas for training. How can sharing knowledge take place if staff can't access it? Has anyone got any ideas?

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  • I do so agree you with Anon from Nottingham. It doesn't matter how many opportunities you provide, if staff are not allowed to attend (or are not interested) we are being set up to fail. However, our consciences cannot allow us to give in. One thing I have learned over many years is that Continence specialists just don't 'give up', it's just not what we do. Very frustrating as no one seems to listen to us do they?

    Just a minute! Did I read it correctly? (NT 24/6/2008 Vol 104 No.25 page 3) Ann Keen, Junior Health Minister has given her support to the NT campaign to protect time and funds for nurse training. Well done. maybe just a lone voice but if she is willing to take a strong bite at Trusts who will not play so that it hurts then training will be taken seriously as it should be. Please Ministers, Junior, Senior or 'Prime' PLEASE LISTEN AND DO SOMETHING TO HELP ANN.

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  • Just a footnote to what I said earlier. If staff genuinely 'can't' attend due to work commitments, how about accepting this and simply target one ward/area/directorate and then through evidence based practice we can show what a difference has been made. Perhaps then training on the ward could come back as it did in my time as a student nurse. Ward based training can be every bit as effective as classroom work. Most CNS's are adaptable and can deliver all types. If you are ward based, it costs nothing to ask your CNS for training they are likely to jump at the opportunity, Primary Care staff leaders, do the same. CNS's get ready to be bombarded. Generally 20% of a CNS's time should be dedicated to education.

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