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.

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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!

If you want to get involved in our blogs, email us/ message us on Facebook, twitter or Instagram! 

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#hellomynameis Kate

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Kate Granger, the founder of the amazing campaign ‘#hellomynameis’, wonderful doctor and cancer patient, died this week. Throughout her treatment, she spoke up and informed healthcare professionals how they could improve their practice by doing something simple; introducing themselves. A simple introduction, she believed, could go a long way. The patient needs to feel like a person, not just a list of symptoms. This is the exactly what patient-centered care is all about; Kate hit the nail on the head, we need to change our behaviour.

When I first came into contact with this campaign, I thought “gosh how could anybody forget to introduce themselves?” but it happens, and I’ll put my hands up and say there has been a moment when the patient has had to ask me! But it does make all the difference because it is the beginning of a professional-therapeutic relationship, and the patient needs to be able to trust their caregiver. It makes me smile when patients are happy to say “Kate, can I just ask you a question?” Or “Kate can you just do this?”.  It makes the situation a little bit more normal, less formal and that helps people relax.

What we need to learn from Kate’s work is that speaking up is the best way to kickstart change. If you see something, or think that something could work better- do not be afraid to speak up. Even if you just mention it to your mentor, write it in a reflection to show to your academic adviser, maybe even a blog post…. it can do a world of good. It might not turn into a nationwide social media campaign, but the smallest changes can make the biggest difference. For example, Natasha (one of our lovely bloggers) has been using her knowledge, and spreading it amongst the staff in the Sri Lankan hospital where she completed her DILP placement. You can read that blog post here as it’s a good example of what I’m trying to get across.

The #hellomynameis campaign is still going strong, and I don’t think it will be slowing down anytime soon! Kate’s family and supporters are keen to keep her amazing work going, and I for one will happily get more involved. You can get involved on Twitter or just through the website.

Rest in peace Kate, thank-you for inspiring us.

DILP Week 5 – Teaching and Learning in Maternity ft Muetzel

Well the outrageous fact that next week is my FINAL WEEK is madness. Right now I’m sitting pretty at 208 hours (40 to go) but it almost feels like a dream: I’m so full of questions about the culture and the way of working out here so I feel like I’m always engaged in some sort of discussion, which makes each day really rush by.

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Shout out to my amazing Nursing Therapeutics Seminar Lead – you know who you are!!!

After one such discussion with the ward Matron, she said she felt the staff could improve their communication and social skills with patients, creating more of a rapport (this took a while to figure out as she speaks rather broken English). So I briefly explained Muetzel’s model of the therapeutic relationship, which is based around Partnership, Intimacy and Reciprocity. She was so interested I ended up making a couple of posters and giving talks to staff members in little groups over the course of the week. It was a really rewarding experience for me to see these Nurses taking on this academic knowledge and applying it, almost immediately, to practice.

It was also wonderful for me to realize how much I’ve learnt during these last 2 years at UoM. Lots of what I was teaching hasn’t come up in exams and I haven’t been fastidiously revising it, but it was still there in my brain, informing how I interact with patients and being able to pass this on was such a great feeling.

All my questions though did make for a slightly awkward discussion with a consultant this week when I asked why it was the normal procedure in Sri Lanka to give Episiotomies, no matter the size of the baby: “Because Sri Lankan women are far more petite than Western women” Fair enough, I thought (the average height of a Sri Lankan woman is 4ft11) but that wasn’t what he was getting at… Gesturing with his surgical scissors he added; “For example this woman’s vagina is far smaller than yours would be”. THANKS DOCTOR. I almost died of embarrassment.

My questions haven’t all had such uncomfortable endings though. For instance I’ve become fascinated by the many superstitions and traditions deeply woven into everyday Sri Lankan life. One very common belief is that the exact time of a person’s birth is holds great importance over the course of their life.

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Its a bit of a cross between buddhism with a big emphasis on horoscopes, couples are often matched based on Birthdays

It is always noted to the minute and this information is taken to a spiritualist (Tamil or Buddhist astronomer) who produces a big document/graph thing that contains key dates to be wary of and dates of good fortune. These can be days or years. During the times of misfortune the family can offset this bad energy by giving alms, doing charitable work or attending the temple more regularly. Equally there is some level or risk management that is involved. For example if someone is predicted a bad 2016 because they were born at 4.33 instead of 4.34 then even if it made sense with every other facet of their life, big dates such as having a baby or getting married would be delayed until they were back in good favors.

I personally would not respond well to such strict time frames but I was far too curious to know what my prophecies would be. So, luckily, I was able to take a short 20-minute stroll from my apartment to the hospital where I was born, 20 years, 6 months and 5 days ago. After a quick 5 minute trip to the records room a nurse produced a huge leather-bound book, identical to the one I have been writing baby’s birth records in for the last two weeks. Except in this one, “Baby Girl Wragg” made an appearance! Thanks to this hand-written entry I am now armed with my birth time and am setting a meeting to speak to a tamil astrologer to find out how things are going for me! Hopefully 2017 with my dissertation looming, will be a very very lucky year for me or else I’ll just have to find a Buddhist temple somewhere near Stretford.

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Baby Girl Wragg OG Sri Lankan

Supporting Patients with a Learning Difficulty

 

Between 25 and 40% of people with learning disabilities also suffer from mental health problems, with dementia and schizophrenia showing a higher prevalence. Standards of care for those with an identified learning disability have been under the spotlight since appalling levels of care were highlighted in the media relating to a specialist care home – somewhere that should have been a safe haven for those in need of support. Questions were raised about in-patient services for those with a combination of a learning difficulty and a mental illness who presented with behaviours that were challenging and what care options should be provided. It must be highlighted that not everyone presenting with these combination of diagnoses will present with challenging behaviours. Everyone is different but we all deserve the same level of care.

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In placement as a mental health student I have observed patients being brought onto a general mental health acute ward who have a diagnosed learning difficulty. I have seen both good and poor practice observed. I have seen staff gain a real understanding of a patient’s condition and how the patient see’s and understands the world. I have seen other patients on ward stand up for and support a patient with learning difficulties and sadly seen others exacerbate the patients current mental state. Knowing how to support and care for the patient as an individual in this situation is crucial as well as manage the others in your care in the same way.

Learn more about the patient’s condition just as you would a standard mental health patient. Asking the patient directly can also be a great way to gain understanding of they view their situation. Asking a carer or family for advice, again in the same manner you would with other admissions helps to promote equality and improves the care you can provide. Find out if they have any extra physical or communication needs that need support as it can help relieve some stress and anxiety about settling into the new environment.

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Providing an individualised person centred approach to care during an admission is vital. The Royal College of Psychiatrists (2013) recognise the complexities involved in service provision of this kind and confirm the importance that communication between a multi-disciplinary team plays. Some hospitals have a learning disability liaison nurse so it’s worthwhile finding this out too. It maybe that a learning difficulty is undiagnosed in a patient as cognitive impairment is often found in those with schizophrenia; the consultant should be able to provide support on this when made aware. Either way, care provision should be treated with the same respect, care and dignity as it is to all.

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Reference:

The Royal College of Psychiatrists (2013). People with learning disability. London: Royal College of Psychiatrists

 

 

Remembering our Red Cross roots

We’re all familiar with the famous red cross emblazoned across old-fashioned nurses uniforms and  fancy dress costumes, but links to that famous symbol and the nursing profession go waaay back.RedCrossNursen.jpg

Today marks World Red Cross Red Crescent Day, the birthday of founder, Henry Dunant, who set up the International Committee of the Red Cross (ICRC) in Geneva over 150 years ago after witnessing horrific scenes during the Battle of Solferino in Italy, where thousands of soldiers, on both sides, were left to die on the battlefield.

He founded the movement on seven fundamental principles – humanity, impartiality, neutrality, independence, voluntary service, unity and universality  – of which all Red Cross societies around the world still base their work today.

I can’t help but think those principles apply just as much to nursing – in fact, Henry Dunant says that it was the work of Florence Nightingale in the Crimea that inspired him. It’s pretty amazing to think that the heroic efforts and ideas of a nurse inspired the largest humanitarian movement in the world!

During the first World War, thousands of nurses were needed at home and on the front line to care for soldiers wounded in battle. Under the banner of the Red Cross, trained nurses were sent to military hospitals across Europe, while at home, they recruited thousands of volunteers – known as Voluntary Aid Detachments or VADs – to help run all kinds of vital services including new auxiliary hospitals being set up around the country, often in stately homes like Dunham Massey in Cheshire. By 1918, there were over 90,000 Red Cross VADs, both men and women.

These volunteers, many of whom might not have ever thought of nursing, were suddenly thrust into a strange and scary world, learning to treat horrific wounds that had never been seen before, most of which was way beyond their experience or comfort zone. Sound familiar?

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Like now, there was a huge emphasis on training but exam questions were a little different, like: ‘How do you make peptonised beef-tea?’ or ‘How would you prepare a linseed meal poultice, an ice poultice, and a mustard poultice? What are the indications for their use?’ Their version of pharmacology and drug calculations!

Some Red Cross VADs, like Vera Brittain, joined trained nurses in hospitals on the front to care for British and German soldiers alike. Vera Brittain famously wrote about her experiences in her biography A Testament of Youth, published some years after she returned from a military hospital in France, heartbroken having lost her brother and her beloved husband. It’s definitely worth a read – or the film is on Netflix, if you’re looking for a study break!

Red Cross nurses became a familiar sight during World Wars I and II, but they were still needed after war had ended. While the NHS was finding it’s feet, Red Cross nurses and VADs continued to run hospitals around the country – and the link with the NHS still continues today, with Red Cross volunteers offering support to patients when they return form hospital as part of the their support at home services.

Anyway – history lesson over, I promise! I just wanted to take a moment to remember all the Red Cross nurses before us – as the next generation of nurses, we owe so much to their courage and determination.

Was one of your family a VAD? The British Red Cross have an online archive of thousands of VAD record cards, so you can find your own little piece of Red Cross history.

Learning Curve

Your first placement as a student nurse is meant to give a taster of what your career could be. It’s designed to inspire, help you find your feet and learn some of the basic skills. So what happens if that’s not the case?

There is a known fact amongst student nurses/midwives that everybody has a bad placement, whether that means it’s too intense, not what you expected, or not as exciting as you hoped.

For me, it was very much not what I expected. I was placed on an outpatients’ department. It was incredibly diverse in that I worked alongside many different healthcare professionals and was able to observe a wide range of clinics- which all helped my A&P knowledge a lot! But apart from that, I felt a bit shortchanged. Whilst all my colleagues and friends were off being thrown in at the deep end, I was endlessly calling patients in and observing doctors’ clinics. This wasn’t exactly the way I saw my first experience as a student nurse panning out, and I felt completely hopeless. Fellow students and staff would give me a look of sympathy and tell me it gets better when I told them where I was. I would dread going there, because I wasn’t being challenged. I felt that my time wasn’t being spent in the best way possible.

The best thing to do in a situation like this is to make the most of it. It’s hard, I know. You think “what could I possibly get out of this” but you’d be surprised! A placement like this is a great chance to brush up your knowledge, and it’s fabulous for reflective accounts! I have spent countless hours observing every moment in a consultation, thinking about what went well, what could have been better, and how I could improve that when I am put in a similar situation. You’ll also spend a lot of time talking to patients, which can make all the difference to them. A memorable patient for me was a young woman with a rather excitable young child came into the clinic. I played with the child (using only a curtain, which I’m quite proud of) whilst she discussed her medical problem. When she left, she thanked me so graciously that I knew I’d done her a huge favour. Its moments like that I have to remember that nursing isn’t all exciting stuff and clinical skills. Sometimes it’s about those moments when you make someone’s life just a little bit easier.

 

Note: if you ever feel unsure about your placement, no matter what the problem, talk to somebody! Whether that be your mentor, PEF, friend, AA or another member of staff. Someone can help.

5 things I’ve learnt on my first placement 

That’s it – we survived our first placement! One step closer to that blue uniform. I’ve spent the last ten weeks on an elderly rehabilitation ward where the patients are quite poorly, needing help to wash, dress, eat and get to the toilet. I’ve had good days and bad, and it’s been physically and mentally challenging at times. Looking back, I thought I’d share some of the key things I’ve learnt so far:

1. Nursing is messy 256px-research-suggests-women-who-have-a-heart-attack-wait-longer-than-men--221603

…and the bodily fluids are only the half of it! It’s complicated and unpredictable and sometimes it feels impossible to use all the theory we’ve been taught at Uni in practice. There’s no ‘one-size-fits-all’ approach and I’ve had to constantly adjust and adapt to match the needs of each patient, who are all individuals with their own character, ideas and worries. No two days are ever the same, that’s for sure!

2. Healthcare assistants are our best friends

On my first day someone asked me to get a bedpan from the sluice. I literally had no idea what they meant or what I should be looking for – I think I walked round the ward for a good five minutes before I finally plucked up the courage to ask. I had to start from scratch and it was the healthcare assistants on our ward that really helped teach me the core elements of care. I especially loved seeing the way they relate to patients; singing a familiar song to a distressed patient with dementia or taking the time to paint someones nails. They have become invaluable allies and I owe a lot to their patience and encouragement.

3. It’s the little things that count

It’s so easy to get caught up in the long lists of jobs that need to be completed and forget what really matters to the patient. Whether it’s spending time combing someones hair or fetching a fresh jug of cold water, those small acts are what make people feel cared for.

4. Fake it ’til you make it

There have been few nerve-racking moments over the last few weeks; my first bed bath, giving an injection, doing a drug round – but patients can smell fear and I think when I’m anxious, they feel worried and uncomfortable too. Even when I’m nervous and my heart is going 100 miles an hour I now try my best to at least appear calm and in control. Hopefully one day it’ll all be second nature – but for now, I’m just going to have to fake it!

5. It’s down to me to make the most of every placement 

On a busy ward, you can’t spend every minute with your mentor or another nurse but as a result, you sometimes feel like you’re missing out on learning proper ‘nursey’ things. I’ve learnt to ask lots of questions and always have an ear out for anything going on – ‘what’s that? did someone say catheter?’ It can be tempting to watch procedures but one nurse told me not to hesitate and get stuck in – patients are usually understanding that things might take a little longer and can give just as much encouragement.

I hope everyone has enjoyed their first placement and we would love to hear about things you’ve learnt over the past ten weeks – feel free to post on our Facebook page.