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'Continence training is under the microscope as Mid Staffs inquiry starts'


“My father messed himself in his bed; he had to sit in that for a long time before he was cleaned up. That was the last thing that broke his spirit actually.”

The public inquiry into Stafford Hospital has commenced and will continue for at least six months.

The chair of the inquiry, Robert Francis QC, said he wanted to know why no government organisation charged with regulating the NHS had been made aware that serious problems existed at the hospital. Relatives affected by the appalling conditions are rightly angry and bitter and want answers as to what went wrong. They also want to make sure that the same poor quality of care does not happen in any other institution or to anyone else’s loved ones.

The independent inquiry published earlier, also chaired by Robert Francis, reported that of the 33 cases from which oral evidence was heard, 22 included significant concerns in the continence, bladder and bowel category. The report stated that requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long. They were also often left in sheets soiled with urine and faeces for considerable periods of time. Suffering, distress, embarrassment and loss of dignity were caused to patients - often in the final days of their lives.

The report also says there were accounts suggesting that the attitude of some nursing staff to these problems left much to be desired, with a small number appearing uncaring. However, more often there were inadequate numbers of staff on duty and it was suggested that there was also a lack of training in continence care. The findings of the recently published national audit on continence suggest it is not just at Mid Staffordshire that there is a lack of training of healthcare professionals in continence care. It is prolific within the NHS.

Basic continence care is a fundamental right of every patient, but unless there is an identifiable lead in continence within each care setting, no-one takes responsibility for implementation of good integrated continence services or for adequate training of staff at all levels.

Continence care, I would suggest, is not rocket science, it can, however, be time consuming and labour intensive. Attitudes, at all levels, need to change within many care settings. Clinicians must realise that incontinence is not an inevitable consequence of ageing. Often there are strategies that help regain or maintain continence, but education and translation into practice must take place. Proper assessment is fundamental and patients and their carers need to be included in the care plan. The maintenance of privacy and dignity are crucial to basic continence care.

The Nursing, Midwifery and Allied Health Professions Research Unit at Glasgow University, in conjunction with the Association for Continence Advice, is presently undertaking a survey of UK continence education in undergraduate health education, as well as seeking the views of recently qualified staff as to its effectiveness. The results of the former will be published in the spring and will hopefully identify if undergraduate continence education is adequate. Moreover, because there is no centrally held registry of post-registration courses, we do not know where validated and appropriate courses are being run, but we do know that as a consequence of the pressures within the NHS, staff are often unable to attend due to decreased funding and availability of study time.

Doreen McClurg, PhD MCSP, NMAHP, Research Unit, Glasgow Caledonian University

Share your views

Is continence training up to scratch? What are your experiences? Post your comments below.


Readers' comments (5)

  • What continence training?

    Staffs is certainly NOT the only hospital that needs to address this matter.

    I've seen relatives cleaning up their loved one's after finding they have been left in truly appalling conditions.

    As a professional this makes me cringe. As a daughter of a father left in such a mess that I found him crying with shame, I feel the pain of everyone who has experienced this. My father was left not only in his urine and faeces but on one visit I found him lying in what looked very large pool of blood! Only to discover this was the tomato soup that had been left plonked on his chest whilst lying down and when it had spilt the staff had taken the spoon and bowl and left him in the sodden bedding. I visited him at 1930, so you can guess how long he had been lying there.

    Continence care is almost non existent in most trusts with a far stretched continence advise nurse to cover the entire hospital. Disgusting.

    Hopefully this inquiry will achieve a positive outcome whereby everyone from HCA upwards receives continence training.

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  • I am a senior continence nurse specialist working in the community. My colleagues and I are continually frustrated by having to cancel training sessions due to lack of participants. This is by no means due to a lack of interest, but with overstretched staff, and full workloads, staff are not able to comit to study leave, or even not allowed to attend any training other than mandatory training.

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  • Good heavens! whatever do nurses need continence training for. Don't they learn basic care during their training and possess the innate commonsense of how to keep their patients comfortable. I really wonder how some people manage to become nurses in the first place, especially those who do not seem to possess any common sense and those who cannot cope with the basic needs of their patients and leave them in soiled beds should be removed from the register on the grounds of negligence. Have these nurses never read their code of professional conduct published by the NMC. This should be statutory reading before qualifying.

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  • Compassion, caring, empathy - I could go on. The issue is not necessarily training but having the right people in the job in the first place. I think the nursing profession atracts too many people who don't have the basic qualities to become a good Nurse!!

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  • True continence care is part of the fundemental principles of nursing. What we need to achieve is good quality training in continence assessment as incontinence can be retractable. However nurses feel they are neither competent or confident to undertake such assessment. There is also a lack of intergrated services accross many areas.

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