Nocturia is a common lower urinary tract symptom that mainly affects older people. Nocturia causes excess urination at night and, because of associated night-time rising, can also result in falls and fractures. Nocturia has a range of presentations, therefore it is vital that nurses understand how to assess the condition accurately to provide appropriate treatment. This article examines the effective assessment of nocturia, as well as detailing the various lifestyle treatment options that can be used, such as a targeted reduction of fluid intake, weight loss and altered medication profiles. Medication and surgical options should only be used following a trial of lifestyle interventions.
Urinary incontinence is a common problem in the UK, and one often seen by community nurses. While it is often associated with ageing, urinary incontinence can in fact have a number of causes and it is important that the community nurse is aware of the full range of aetiologies and presentations. Community nurses should have a good basic understanding of the causes of incontinence, be able to provide a basic first assessment, become adept at asking the right questions and be able to offer some conventional treatment and problem-solving strategies for immediate relief of symptoms. Most importantly, they should be able to identify when a patient will need referring to a specialist practitioner for more extensive assessment and investigation. This article looks at the assessment of urinary continence in the community, and outlines the common presentations that nurses should look out for.
The management of incontinence is often a neglected area of community care, even more so when allied to older people, and it is essential that community nurses consider the effect of the ageing process and its impact on continence. Often, this can involve the specific effects of dementia and the management of urinary incontinence can then become complex due to the range of practical approaches required and the need to adjust these for each patient. A large percentage of the community nurse’s time is spent supporting carers; therefore, it is essential to consider their feelings when suggesting any strategies as they may feel that they are already incorporating them in the patient’s daily activities. It is also important to focus on few key elements of advice around incontinence and to listen empathetically to appreciate the challenges experienced by carers, which will help in identifying suitable strategies.
Urinary incontinence impacts on patients both physically and mentally, restricting employment, educational and leisure opportunities, and leading to social embarrassment and isolation. It is vital that people who are experiencing continence problems are given every opportunity to regain their continence and highquality comprehensive continence services are an essential part identify patients who may be experiencing continence problems, before going on to look at treatments and longer-term care. The author also addresses the issue of when community nurses should look to deal with continence problems themselves, or when they
Incontinence can affect people of all ages and genders and can have devastating psychological, social and financial implications for the individual and his or her family. Many people may fail to seek help with incontinence for years due to embarrassment and stigma, which in turn can lead to social isolation. The prevalence of bladder and bowel incontinence is increasing worldwide, in part due to an ageing population — more people are being looked after in residential and nursing homes than ever before and admissions to acute care due to incontinence-associated conditions have increased. All of these factors increase the burden of care on health and social care staff, potentially leading to a lack of quality services. Dignity is internationally accepted as a fundamental human right, yet a host of public inquiries (such as the Francis Report [2013] in the UK) repeatedly raise the issue of failure to respect patient’s dignity, particularly in relation to continence care. This article explores why continence care causes such complicated issues and how community nurses can help to ensure it is seen as an essential element of care, rather than being dismissed as only requiring basic skills.
Increasing demographic changes in the type and age of patients as well as further government directives requiring more care at home, mean that there is a growing emphasis on primary care-led services. Large caseloads and patients with multiple and chronic health problems are stretching available community nursing resources. Against this background, continence promotion tends not to be a priority and at times it may seem easier and better to prescribe pads for patients with urinary incontinence. This article provides community nurses with guidance on the initial assessment and management options available for patients who present with urinary incontinence. Many patients will subsequently experience improvement in their symptoms (although not always complete resolution), with a corresponding improvement in overall quality of life.
Urinary incontinence affects quality of life in a large number of people of varying ages. For a significant number of patients the problem has to be addressed by catheterisation, a treatment method that can give rise to a host of potentially avoidable complications. Catheter stabilisation is an essential practice in avoiding unnecessary damage to the urethra and accompanying pain. While a number of products are available, there seems to be no preferred device for securing catheters. This article looks at CliniFix® (CliniMed, Buckinghamshire), a universal tube-securing device, which approaches tube fixation in a different way to strap-style-devices.
Julian Spinks, Kent-based GP with a special interest in continence
