The Mitrofanoff technique uses the appendix to create a continent ‘tunnel’ between the skin’s surface and the bladder, which is then drained using a catheter, which is inserted along the tunnel rather than via the urethra. This is a complex procedure that needs the patient to be motivated and committed to living with such lifechanging surgery. Intense preparation and long-term support from a urinary diversion nurse specialist as well as any involved community nurses is vital. Long term follow-up is vital to ensure continued good health and to anticipate any problems such as infection, stone formation or renal damage. Having access to community healthcare professionals who know about the possible dangers and can offer advice and support is also key to ensure any complications are dealt with swiftly and safely.
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
Constipation is a widespread problem although its subjective nature can mean that diagnosis and treatment can be difficult as there is often a mismatch between patients’ and clinicians’ view of the condition. Constipation is widely believed to include unsatisfactory defecation, infrequent stools and/or difficult stool passage. Thorough patient assessment and promotion of continence issues are imperative to improving services for people with constipation. This article highlights how breaking social taboos around bladder and bowel issues, helping people to acknowledge bowel issues, and referring them to the appropriate specialist nurse-led services will all help to provide a more accurate and timely diagnosis of constipation.
Patients in the community may often have a long-term urinary catheter in place. The management of this usually falls to thecommunity nurse therefore he or she needs to understand the basic procedures involved in urethral and suprapubic catheterisation, as well as being familiar with potential complications and how to troubleshoot. Catheter blockages are the most common problem encountered in long-term catheterisation and it is important that the nurse knows how to address this methodically and identify and treat the cause. This article offers practical and evidence-based advice on some of the common issues that can arise in the management of people who have long-term catheters in place
The number of NHS patients requiring containment products such as pads is increasing year on year due to an ageing population. Patients with long-term conditions are increasingly being cared for at home, and although incontinence is not a disease it is often a symptom associated with other health issues. Community nurses are seeing patients with more complex needs, but incontinence is often not the primary reason for their visit. Containment products can be seen — both by patients and their carers — as the most effective way to manage incontinence and nurses are often put under pressure to prescribe pads, while continence services are being challenged to review the way care is delivered through innovation and the effective use of technology. This article will look at the redesign of a continence service that has involved the development of a community continence team (CCT), along with a summary of the initially encouraging performance indicators. The CCT aims to provide a comprehensive continence assessment with a focus on rehabilitation. The principles underpinning this service redesign could be applied to any community nursing team.
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.
Like many other areas of the NHS, community nursing has suffered from underfunding and a lack of understanding of its true value. However, more recently, there has been a surge in interest in community nursing and a growing appreciation of its potential. Ensuring community nursing is ‘fit for purpose’ is fundamental.
Urinary tract infections (UTIs) are one of the commonest infections seen in primary and secondary care and consequently are often treated with antibiotics. However, recently there has been an increasing amount of evidence highlighting the problem of bacterial resistance to antibiotics commonly used to treat UTI. This makes diagnosis and treatment even more critical. Diagnosis of a UTI can be difficult, especially in elderly patients, and poses many challenges for nurses, including those working in the community, particularly in nursing and residential homes. This article examines the adoption of a chemical indicator dipstick test. This demonstrated good correlation with urine culture results and was seen as a useful additional tool to assist in the diagnosis of UTI, especially in those patients where urine samples may be more difficult to capture.
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.
This article examines the various elements that community nurses need to consider when attempting to provide best practice in urinary catheterisation. The author seeks to challenge what is considered best practice — particularly the requirement for all practice to be evidence based — while encouraging community nurses to think proactively about the care they are providing. The article stresses that the first principle of urinary catheterisation is to avoid the procedure where at all possible — catheterisation is potentially dangerous and can even be life-threatening if performed inappropriately. Overall, the author poses some key questions, including: should there be a difference in the care provided by community and hospital nurses; do community patients have the same needs as those in hospital; and can the manufacturers of drugs/products help to make avoiding urinary tract infections (UTIs) easier?
