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?