Incontinence 101

Having spent 3 years in various wards, community areas, clinics etc., there has always been one problem which many of my patients have been affected by; incontinence!

Incontinence can be urinary, faecal or both. Incontinence is not a disease, rather a sign of a lifestyle problem, or a symptom of a medical condition. It affects between 3 and 6 million people (!!!!), and many do not seek help until much later. This needs to change!

Types of incontinence

Stress incontinence -not actually related to stress! It means that there is pressure on the bladder due to pregnancy, being overweight, sneezing, lifting heavy objects and some medical conditions (such as prostate cancer). It happens because the pelvic floor and urinary sphincter are weakened.

Overactive bladder- this is when you feel a strong urge to urinate, as your bladder is not relaxed. This means your bladder doesn’t like any amount of urine, so is constantly telling you to get rid of it! This can be caused by the type of fluids you drink, like caffeine or alcohol. It may be due to dehydration, as small concentrated amounts of urine in the bladder will irritate it. A urinary tract infection (UTI) can also cause an overactive bladder, but this is easily ruled out through a urine dip.

Functional incontinence- This means that the incontinence is occurring as they are unable to reach the toilet on time, often due to immobility but also caused by Dementia or other physical/mental illnesses.

Mixed incontinence- As the name suggests, this is when there are two causes of incontinence. For example, a mix of stress and overactive bladder. Very common in women!

Total incontinence- This is the most severe, as there is no control over the bladder so there is constant leakage. This can be due to bladder abnormalities, spinal cord damage or bladder fistulas.

Faecal incontinence

Faecal incontinence can be harmless or serious, so it’s important to know all the details! Diarrhoea and constipation are the most common causes. Chronic constipation can lead to a weakening of rectal and intestinal muscles, causing faecal leakage. This is common in people with Parkinson’s.

How can you prevent incontinence?

• Avoid/cut down on “bladder unfriendly” things such as caffeine, alcohol and spicy/acidic foods
• Regular exercise (the answer to everything!)
• Regular pelvic floor exercises
• Treat any constipation and diahorrea quickly
• Don’t strain during bowel movements, as this can weaken the muscles which control your bowel movements and only allow small amounts of faeces to pass

Treatments

There are so many options, and it depends upon the persons health and mental capacity, as well as the type of incontinence they have.

Pelvic floor exercises– These strengthen the pelvic floor muscles, which is the most effective treatment for stress or childbirth related incontinence. They are undertaken for 12 weeks, and must be completed 3 times a day (8 contractions each time).

Bladder training- This is a method I’ve been doing accidentally in all my years as a waitress/student nurse (2 professions where emptying you bladder needs to be precisely scheduled with your many other tasks). It involves delaying the passing of urine for 5-10 minutes, in order to force the bladder to wait. Techniques to achieve this include crossing you legs, standing on your toes, distracting yourself or applying pressure to your perineum.

Medicinal- I won’t go too far into detail, as I’m not an expert just a keen observer. Medicinal treatment of incontinence only works for overactive or mixed incontinence, and it is not the first-line of treatment (in nurse-led services). Drugs such as Oxybutynin, Tolterodine, Darifenacin and Festoterodine. These drugs are either immediate or extended release, with extended release causing less side effects but interacting with more drugs. They work by inhibiting the parasympathetic nerve impulses, relaxing your bladder. However, it is highly important to educate your patients about the possibility of urinary retention with these drugs, and a bladder scan is required 4 weeks after starting these treatments.

So that’s your one stop blog about continence! I can highly recommend spoking with your local continence service, whether in hospital or community, as you learn so much!

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The 3rd Year Survival Guide

After 3 long years, the September 2015 cohort is finally done! Portfolios have been verified, dissertations are completed and PARE is locked. It’s unbelievable that just 3 years ago, we were starting our student nursing journey. Time has flown! Many of us began this journey with little to no care experience, either coming from school or college, or previous degrees or access courses. It just shows that Nursing is not a career where you need experience, or very strict qualifications. It can be for anyone!

As a goodbye present to the younger years, I asked the ‘15 cohort to impart some wisdom about surviving 3rd year…

Dissertation/deadlines

You’ll be given a little suggested timeline for your dissertation. Try to keep to it as it really helps with structuring everything.

Plan ahead, and try not to leave things till the last minute (unless that is what works for you!)

Remember that your dissertation is YOURS, it should be enjoyable too!

I found keeping a dissertation diary (noting down time/date of session and what you did) is hugely helpful, as it can be easy to forget what you did when there’s so much to do!

Make sure you act on the constructive feedback from your supervisor. If you aren’t getting it- ask for it! 

Placement

You will have to complete your medicines management mini exam at some point in 3rd year. The earlier you do it, the better! It’s a weight off your shoulders, and task ticked off!

Be honest about your academic workload and life commitments to mentors. They should be sympathetic and ensure your off duty works with life.

You will feel like a lot is expected of you as a 3rd year, and that might make you a it terrified. It’s okay! Keep going. Make your own goals, talk to your mentor about it and set your own pace!

Trust me, you will feel SO ready to qualify in your last few weeks!!

Portfolio

Plan how you will meet your exposure to other fields as early as possible, otherwise you’ll have a mad rush at the end of the year!

Don’t leave it till the end of the year. Make you life easy, even if it means spending a weekend or doing it in bits over the year. It will allow you to enjoy your last moments of being a student nurse. 

Advice for student parents

Keep to your deadlines, and try and submit early if possible. Including your portfolio!  Leaves less room for unfortunate occurrences like a sick child.

Make sure your mentor knows that you are a parent,hopefully they will be sympathetic and flexible.

The most important pieces of advice

Talk to your family, family, anyone you trust if you feel you are struggling. You will feel better. Share the burden!!!

Peer support is what will get you through the madness that is 3rd year.  Ensuring that you attend seminars and lectures is a great way of doing this. Don’t lose motivation! 

Having a twitter account (personal, just nursing or both!) is an excellent way of getting advice, learning and networking. You can start by following us

Practice self-care in your own way everyday. Whether its a relaxing bath, a run, playing computer games or walking the dog, you are the most important person to look after. No matter how busy you feel, it can’t come before you!!

So there you have it! The baton has been handed to September 16, and will be yours before you know it September 17!!

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The not-so-clinical skills

Placement allocation. A daunting prospect for all! There are, as always, disappointments. Many of these are for valid reasons, such as very similar/the same as another placement, too far away or you’ve experienced it as a service user/you worked there.

But I’ve noticed that many people (including myself previously!!!) get disappointed with placements if they aren’t “hands on” enough. But why?

We all enter into nursing for different reasons, and many of us will prefer “more clinical environments” than others. But does this mean that we should expect these placements throughout our studies? No! Because that wouldn’t reflect what nursing is!

Even with the nursing role changing, the non-clinical skills such as communication, leadership, delegation and teamwork will always be at the forefront of nursing. These skills may seem “soft”, but they are the bread and butter of our practice and are transferable across all jobs!

I’ll use an example of my own.  My first ever placement was on outpatients, and I was gutted! Most of my nursing friends were off living the dream on wards, whilst I was falling asleep in doctor’s consultations. The staff were lovely, but I wanted more! I was convinced that my time in outpatients was a write off, completely pointless to my nursing education. Surprise surprise, I was wrong! My listening skills improved greatly, and, since I spent so much time noting down words I did not understand, I learnt a lot about pathology. Whilst at the same trust later on in my degree, I was able to reassure patients and relatives about the outpatient clinic process. When I held someone’s hand during a painful procedure, I learnt how even the smallest of actions can make a difference. And I still fondly remember when I was present whilst someone was being told they were cancer free, and I cried with the patient and their mother. These experiences and lessons have stayed with me throughout my training, and I am so grateful for that!

Clinical skills can be taught at any time in your career, whether you are in your first year of training or you have been practising for 30 years. But the non-clinical skills, those are harder to teach. They require time, experience and reflection. And remember; your degree is the start of your learning, not the end!! 

Spoke with Learning Disability nurses, in the community!

As the end approaches for me, I been thinking more and more about what experiences I want to have before I become a qualified nurse. The beauty of being a student is the range of places you can go, especially when its an area you might not otherwise experience!

When I signed up to do my spoke with the community learning disability nurses, I was excited. I’ve had quite a few personal experiences with caring for people with learning disabilities, but very little exposure during my training. My aim of the spoke was to understand the role of an LD nurse better, as well as gain a better understanding in how I can support patients I will have in the future.

I’ll start by saying that the team who looked after me for the day were fantastic. They were super welcoming, made me laugh a LOT and were all happy to teach me. The day started (after cups of tea, obviously) with a meeting, which included looking at one patient in detail and discussing the best plan.

In the afternoon, myself and one of the nurses visited a patient who had been discharged but was up for review. We met with the patient, the manager of the home he lived in and went through the original nursing assessment, ensuring that any changes were updated. As the waiting list is very long for this team, these reviews aim to keep the patient in their own care and give advice to those caring for them.

My spoke allowed me to understand that learning disability nurses have a very holistic role, and are often at the centre of someone’s care. Referrals for the service can range from talking to young people about sex, relationships and consent to helping a home co-ordinate different services. I had never considered the breadth of their role, but I will now!

Many students can be worried about caring for a patient with learning disabilities, as it is often “unknown territory” and often requires different methods of communication. Everyone who had a learning disability should have a hospital passport, which should include the necessary information to help care for your patient. The link nurse for learning disabilities and of course (if the patient has one) the community learning disability nurse can also help with any questions.

I can 100% recommend getting a spoke with a Learning Disability nurse, whether its in community or in the hospital!

 

If you’ve had an interesting spoke/exposure and want to blog about it, please contact us via email/Facebook/Twitter/Instagram!

 

“The Student”

Being addressed as “the student” is not my favourite thing in the world. I’ve never spoken up about it, but I feel it makes you into a commodity as opposed to a human being who is there to learn. My usual response is to introduce myself, and keep introducing myself until people understand that I have a name. It sounds daft I know, but it tends to work.

But sometimes introductions are not enough.. I was working a Saturday shift, in order to see my mentor, and it was my 3rd day of placement that week. During handover, I noticed that my mentor wasn’t there and none of the nurses were regular members of staff; but agency staff who I had seen once or twice. I was really disheartened that my mentor didn’t turn up. And then, after handover, they allocated the Trainee Nursing Associate with a nurse, and left me standing there like a proper lemon.

I was hurt. I’d spent the past 2 days working really hard on placement, during the snow and short-staffing. I thought I was finally somewhat integrated in the team.  The tiredness, shock and hurt built up, and I had to retreat to the staff room to try and calm myself down. I just kept thinking, I’m third year! I shouldn’t be doing this! Why am I upset!

I knew why. I’m a confident person, happy to talk to anyone and everyone. But when you’re in a room of people and nobody acknowledges your existence, confidence can be hard to come by.  After some kind and supportive words from my boyfriend (an endlessly calming presence even via text), I knew it was my responsibility to make something of this situation. So I spoke to the nurse in charge and (after being passed between 3 different nurses), one finally agreed to take me.

I ended up having an okay day, and the nurse I was working with let me be mostly autonomous, and still made time to teach me about NG tubes and giving medication down them. At the end of the shift, she apologised for not wanting to take me on initially. She felt that, with the time pressures and being an agency nurse, it wouldn’t be fair to me. I explained that as a third year, and having been on the ward for a few weeks now, I was quite happy being somewhat autonomous and would ask if I needed anything/wanted to learn about something.

This experience threw me, and I need to raise it with someone so it doesn’t happen again. But it did teach me how important it is to communicate your needs to whoever you’re working with, and make yourself known. It’s not easy, and it can be daunting, but it needs to be done!

If you’ve had a similar experience, feel free to comment and share your story.

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Finding your feet in third year: a lesson from A&E

*Disclaimer: this post includes description of a traumatic situation which some may find distressing* 

When I started 3rd year, I was excited! I had a fantastic end to second year, and I truly felt ready to enter my final year of my degree. But with that excitement came the endless worrying about jobs, dissertation, and work for other modules. When placement began, I realised I felt like a complete novice again! Despite only having two months off over summer, I felt like I couldn’t remember how to do anything on placement (clinically speaking). I was even putting on blood pressure cuffs the wrong way. Everyone asked me what year I was in, and saying “I’m in third year, but I don’t know what I’m doing” every time was ruining my confidence.

It wasn’t until my 5th shift when I finally started to feel less on edge. I was working in resus (for the most critically ill patients in a&e), and we had an man with chest pain and fluctuating consciousness. Since he was in a bad way, a few anaesthesiologists from ICU came to set up mechanical ventilation for the patient. It was really fantastic to see everyone working together almost seamlessly, and including me in their decision making. I was given little jobs such as getting supplies or checking the observations but it was all I could really help with at the time. After a very long trip to CT, it was clear our patient was deteriorating. As soon as he was back in resus, our patient went into cardiac arrest. The nurse I was working with asked if I had done CPR before, and if I wanted to get involved. To my own surprise, I agreed. I have been learning CPR for well over 5 years now, so I knew that I could help in some way. Each person did 2 minutes of CPR, whilst keeping an eye on the defib heart monitor. Due to the patient being on a hospital bed, we all had to stand on a stool in order to reach, which I found really bizarre!

I wish I could accurately describe the feeling of trying to save someone’s life, but I can’t. There was so much adrenaline rushing around me, but all I kept thinking about was how I was currently involved in the worst day of someone’s life.

During CPR, the doctors confirmed (through an echo-cardiogram) that there was nothing left we could do. Myself and the nurse went to work on ensuring our patient was at peace, and ready to be seen by his family. They were in shock and declined, which I understand. And our day went on. I had a debrief with the nurse, and a HCA who had also performed CPR for the first time, which was lovely. We spoke about how CPR is so different from how it is often portrayed. I had never thought about the fact that you won’t be able to reach a patient without standing on a stool, or how someone must time each session of CPR.

Despite being a high-pressure and sad situation, it helped me a lot. I did something I had never done, but had extensively prepared for. If you feel like you are back at square one, despite being a third year, I challenge you to think about what you do on placement. I think there is a tendency to see progression as acquiring new skills, but sometimes its about putting our current skills to use in a new situation.

 

 

Never ‘just’ a student

“I’m sorry, I’m just a student.”

Sound familiar? How many times have you said this while out on placement? Maybe it’s just me, but I’m ashamed to say it’s more often than I can count, especially in the first two years of my training. It possibly stems from a lack of confidence or uncertainty, perhaps a fear that I’d do or say something wrong – something we’re all bound to experience at some point during our training.

But is this lack of confidence a wider issue among qualified nurses, as well as students? Do we sometimes have a tendency, as a profession, to devalue our work and contribution? Do we see ourselves as less important or influential than other health professionals?

Conference programme

I recently attended the 2017 Nursing and Midwifery Conference held by the newly formed Manchester Foundation Trust at Manchester Royal Infirmary. The keynote speech was given by Dr Eden Charles, a leadership coach and consultant who has been successfully supporting individuals to create cultural change in their organisations, including the NHS, for more than 30 years. He recognised that as nurses and midwives it is in our nature to give, to put others first and to sometimes put our own needs on the back burner. But, he said, with that sometimes comes a tendency to lack confidence in our huge strength and contribution as a profession. He said he often hears nurses refer to themselves as ‘just’ the nurse and is always baffled because of how important the role really is from the perspective of patients.

As student nurses or midwives, we are on the cusp of joining the largest professional body in the health service who are in a unique and privileged role as both care givers and advocates for patients. Although not yet registered, we are still an integral part of the nursing profession and make a difference in many ways to care in the NHS. The more confidently we value our contribution, the better we can speak out for our patients and give a voice to those who otherwise might not be heard.

In his speech, Dr Charles said: “Never say ‘I am just a nurse’. Change that story to ‘I am a professional nurse’. Put yourself into the world boldly and confidently as people who deserve to have a voice.” He challenged us to be ‘nursing rebels’ or ‘rebels for compassion’; to acknowledge our strength and abilities in order to gain greater influence and make changes to practice that really matter. He reminded us that leadership can be found at all levels, not just at the top; we all have a responsibility to bring about the changes we want to see. It’s not always easy or straightforward, but as students we can make positive changes by living the values that brought us to nursing or midwifery in the first place.

So I’m making a promise to myself and I hope you will too; I will never be ‘just the student’ or ‘just a nurse’ ever again.