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Nurses lack sufficient training in continence management

  • 7 Comments

Nurses are not being given sufficient training in assessing and caring for patients with continence problems, suggest findings from a Nursing Times survey.

According to the survey results, 95% of more than 1,000 respondents considered management of continence problems to be a nurse’s responsibility.

But only 64% said they had received any education in caring for patients with such problems in their pre-registration training. Of those who had received some training in bowel and bladder dysfunction, 52% said it was insufficient to carry out a baseline assessment of patients with continence problems.

Additionally, 54% said that they had not received any post-registration education on care for people with continence problems.

One nurse said: ‘My training was over thirty years ago and I have had no updates other than the reading I do myself.’

Another said that ‘sadly due to reorganisation and lack of funding’ post-registration training in working with patients with continence problems had been discontinued.

This gaps in training exist despite ‘continence, bladder and bowel care’ being one of the initial nine Essence of Care benchmarks for nursing care set out by the Department of Health in 2001.

In addition, poor management of continence has often been described in Healthcare Commission reports on nursing care, including Maidstone and Tunbridge Wells NHS Trust and Mid Staffordshire NHS foundation NHS Trust.

Sharon Eustice, chair of the Association of Continence Advice, said there was a need for more training at both pre- and post-registration for nurses on continence. ‘Lots of university courses on this have been culled over the past year but there definitely needs to be more training,’ she said.

Cath Williams, continence service manager at North Somerset PCT, agreed there needed to be more training but said she was concerned that training courses that were organised were often cancelled due to lack of attendance.

‘We need to make sure training is more flexible and that we are innovative so that nurses can attend,’ she said.

Ms Williams added that ‘attitudes’ towards patients with continence problems among newly qualified nurses needed to become more focused on prevention.

‘The attitude of new nurses is to clean up people with incontinence. If you can get a nurse to think about why that person is incontinent and try and solve the issues they will be more motivated. We need to offer continence promotion services,’ she said.

  • 7 Comments

Readers' comments (7)

  • Is it possible to see the full results from the survey - this would be very useful

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  • Absolutely agree with respondents Sharon and Cath. I was Head of Continence Services for many years and although we tried very hard to maintain continence education for NHS staff, one of the biggest problems my Team found was also apathy or unwillingness to let staff attend or similarly on the part of staff. We offered training for free. We were very imaginative in how re ran things even taking a coach full to ACA Conference both in London and the Midlands to try to stir emotions. Our biggest supporters came from the Independent Sector - they were marvellous and appreciative.
    The survey results will be interesting but will it make a difference? Are we still at risk of no interest in the incontinent? Has all the time energy and money spent on Good Practice in Continence Services, local and RCP Audits, Essence of Care to name just a few. Those still in the field must stand firm and fight to maintain a position or the last 20 years work is wasted.

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  • eileen shepherd

    The full results of the survey will be published in the Nursing Times Continence Journal on 2nd June.

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  • I agree! I am a clinical leader on a Stroke Unit and have an interest in continence. I have been unable to find a course which would provide me with the knowledge to carry out continence assessments effectively. Does anyone know of any courses in the North West?

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  • Linda, your initial port of call should be your Continence Service either in Secondary or Primary Care. It's pointless to re-invent the wheel and basic, intermediate and advanced levels of continence assessment models must abound in Trusts. If not in yours then in next doors Trusts and simply adapt.

    If you cannot go further. contact Eileen Shepherd at Nursing Times by email and she will give you my personal email address - don't let this one get away from you - future stroke studies are likely to have a link to continence as does the RCP various audits so stroke and continence will not go away and I promise that you really can make a difference especially if as a leader you are feeling empowered by your Trust. Continence Assessment does not always lead to a magical cure but it always does give the patient and family a chance of improving their quality of life and sometimes, even the most persistent of incontinence is curable/ it can always be managed better with knowledge but this I'm sure that you aready know. Good luck.

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  • I work on acute stroke unit, we are trying to find a flip flow regime, so we can remove catheters effectively without retention or incontinence returning. At present as soon as someone is catheterized we commence 4 hourly flip flow.Post stroke catheterized for retention or skin integrity only. Do you know of any regimes in issue, significantly for stroke group?. Thank you

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  • Just one initial note; flip flo(w) is a brand of product. I understand what you are saying but just a point to be aware of. Flip-flo(w) is as good a regime as any and manufactured by a respected company.

    There are a few others and you will find that we either like or loathe brand (a)or brand (x) for a varieties of reasons.

    The evidence that I have seen is like many in this area both contentious and difficult to agree on.

    The principles still stand that there are few reasons to catheterise post stroke, retention is one but incontinence per sae is not. You seem to have that right and this is fantastic.

    Having said that the person is catheterised so getting the catheter out a.s.a.p. is good. Time does not seem as critical as may be suspected as some suggest, others will advise that simply it takes many weeks before problems with e.g. bladder tone etc. arise.

    So 2 issues;
    New stroke, new catheter, just take the catheter out, preferably within a few days and within a day or two or even an hour or two things return to normal urologically, just watch mobility and ability.

    Stroke where catheter has been in for say a few weeks, try the above or a valve starting with 1- 2 hour closure, and upping the time gaps to say 4 hours.

    You just need to ensure whatever you agree at unit level everyone does and is clear about it.

    You might like to see if your local continence service/urology service can help you, no point in re-inventing the wheel.

    I have spoken to quite a few colleagues on Stroke Units/Wards and all have the same problem and it is difficult to get anyone to agree a way forward so it's possible an agreed and established policy will be few and far between - hope you can get one - I haven't seen one though.

    If you have to invent then justify WHY in case your policy is drawn into question.

    You might find BAUN, Rcn or ACA are good sources of knowledge.

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