As far back as 2009 a Nursing Times survey revealed gaps in continence care training and education. At that time more than one-third of over 1,000 respondents said they had not received any education about caring for incontinent patients in their nurse training, and 53% had had no training after registration.
Our findings were backed up by a research study in 2013 of 84 universities which suggested that undergraduate nursing and other students received between as little as 2-5 hours education on continence care.
None of this would matter if we were confident that continence care was of the highest standards but sadly the Francis report highlighted appalling examples of nurses failing to meet basic toileting needs. Commenting on the Francis report in Nursing Times, Jo Booth, Chair of the Association for Continence Advice Education Committee noted that “of 33 cases of oral evidence presented, 22 (67%) raised significant concerns about continence, including bladder and bowel care. This area of care was singled out for complaint more frequently than any other, indicating just how important dignified continence care is to overall standards”.
Just before the publication of the Francis report in 2013 Jane Cummings, chief nursing officer at NHS England, was questioned about the lack of continence pre- and post-registration education in at a health select committee meeting but was unable to provide answers. Yet continence care is clearly an essential skill for all nurses and failure to provide it has a direct effect on patient dignity and wellbeing. It should be a priority of nurses at whatever level of the NHS.
For years continence advisers and organisations such as the Association for Continence Advice have worked tirelessly to champion the continence needs of patients. However, many services have faced cuts and valuable skills have been lost from the NHS.
So new NHS England guidance Excellence in Continence Care: Practical guidance for commissioners, providers, health and social care staff and information for the public published at the end of last year and summarised this week by Nursing Times is long overdue.
The new guidance provides a framework that enables commissioners to work with providers and others to ensure that safe, dignified and effective continence care is consistently provided.
Cath Williams, business manager, Specialist Services at North Somerset Community Partnership, notes in a comment in Nursing Times that incontinence seldom makes headlines but “with the power of social media to raise its profile, with committed practitioners to educate and enthuse colleagues, with endorsement from professional and patient organisations, this document could well become a powerful tool to improve continence provision for many patients”.
Let’s hope this happens.