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'Continence should not be a special nursing topic'


Nursing Times blogger Gaye Kyle comments on the National Audit of Continence Care report

The results of the National Audit of Continence Care were released on 14 September. To read that incontinence is causing a “life sentence” of suffering for one in five people, especially on those who are frail older people and younger people with learning disabilities, is a terrible indictment of nursing care in the UK. Especially as a key finding from the audit refers to the continence training of healthcare professionals as being inadequate.

But it came as little surprise to me. I have recently retired as a full time lecturer in pre- and post-registration nursing. My clinical background is in specialist palliative care and continence. I taught continence for the pre registration programme. I was allocated just three hours for continence education.

In that time I was expected to teach female urethral catheterisation procedure and cover male catheterisation. There was absolutely no time to cover any type of bowel dysfunction. Student nurses consequently never had neither time nor knowledge to develop good standards for continence care (assessment, diagnosis, treatment evaluation of care).

Nurses need to be competent and confident to ask about any continence issues the patient may have because all too often patients find the topic of incontinence too embarrassing to mention.

Sadly, this lack of competency was reflected in many of the nurses who undertook the post registration (CPPD) module in the promotion of continence I facilitated. Often nurses misguidedly referred to treatment in terms of the containment products used. Few could identify a basic continence assessment.

My constant comment from my module reports is ‘The students appear to have little understanding of continence issues’. Of course, not all students lacked this fundamental knowledge, but my experience seems echo the findings of the National Audit.

It is my belief that there is a fundamental problem with our nursing education. When poor nursing care is reported by the media you do not have to look far to find a continence issue, soiled bed linen left unchanged, slow response to call bells when patients require assistance with toileting, dirty toilets, verbal abuse because a patient has had an incontinent episode. These are but a few but all relate to continence and more importantly all relate to the real ethos of nursing, which is about protecting and providing for the patient.

Do I have an answer? Better education has to be the way forward, all healthcare professionals, care assistants and social service workers need to understand that continence is treatable. There are national evidence based guidelines to support our practice. Those who specialise in continence have a true passion for their speciality.

However, I am not convinced that continence should be a special topic in nurse education. Continence care is a very basic subject and as such it should be seen to be taught throughout a pre registration programme. Once a basic understanding of continence care is established perhaps more nurses will find this topic a rewarding and fascinating aspect of care.


Readers' comments (3)

  • I agree, it is certainly worthy of inclusion in Nurse training (which is often woefully poor anyway), but certainly not worthy of a whole special topic, an entire module on it's own say.

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  • Yes incontience is in all aspects of patient care, but as a specialist nurse I find that because nurses feel it is "simple" to treat, which it can be in many cases, it does require the ability to analyse and problem solve. Many more complex and sometimes life threatening issues can be discovered from a specialised in depth continence assessment perfromed by an expert in the field.

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  • I am sad to read that Mike is unhappy with nurse training as I found my IBL Diploma quite adequate as I embraced my role as a life long learner. I did find qualified nurses unsporting and uninformed which did impact on my learning experience especially in relation to continence assessment on the wards. Because of this I undertook my final 8,000 word project discussing the nurses role in continence assessment of adult females. My conclusion was that most nurses other than the 'specialist' have any idea of the impact of continence assessment and provision of care. There are generally two categories of either continent or incontinent. In the main if incontinent then no encouragement to return to continence is made. Sad I feel but I found that although unjustifiable - time played a major part in this shortfall as a comprehensive assessment is lengthy and detailed.

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