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Let's bring continence out into the open

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VOL: 97, ISSUE: 30, PAGE NO: 51

Susan Denton, BSc, RN, is senior clinical nurse specialist continence adviser, Derriford Hospital, Plymouth

Change takes place every day - and we often resist it - but, if planned and implemented well, it can have a positive effect on all those involved. Following the demise of the NHS internal market and trusts splitting into primary and secondary care and the subsequent formation of primary care trusts and emphasis on local service development means that continence has now been brought squarely on to the change agenda.

Change takes place every day - and we often resist it - but, if planned and implemented well, it can have a positive effect on all those involved. Following the demise of the NHS internal market and trusts splitting into primary and secondary care and the subsequent formation of primary care trusts and emphasis on local service development means that continence has now been brought squarely on to the change agenda.

Documents such as Good Practice in Continence Services (Department of Health, 2000), Modern Standards and Service Models for Older People (DoH, 2001) and Essence of Care (DoH, 2001) mean that services cannot and should not stand still - change is inevitable.

It is worrying, however, that services that have been disrupted, disjointed and alienated from each other may now be expected to link, perhaps even amalgamate. This poses some complex questions, such as where does the service sit and where should clinics be run? These issues cannot be resolved overnight, because the change needs to be constructive and well managed.

The concern is that as we try to implement changes, such as bringing services together too quickly, patients may fall into a gap between primary and secondary levels of care. We could try asking patients themselves what they think about the way services should run. However, continence is still not a breakfast-time subject. Getting patients involved can be difficult if we want to get as wide a range of views as possible on this taboo topic.

If as health professionals we cannot talk openly about continence, how can we expect the general public to accept it as an issue that does cross that breakfast barrier? The secret here has to be training to raise the awareness and profile of continence not just to the public, but to the health fraternity as a whole. With training comes knowledge and that brings untold benefits for patients, so that accessing continence services is seen as accepted practice. Why should a bladder or bowel problem be any different to a heart condition?

Patients are often surprised that and simple treatments such as pelvic floor exercises, changes in fluid intake and a reduction in caffeine consumption can make a difference. Change and training must go hand in hand with service development that allows all patients full access to services.

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