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Guest Editorial: We Are All Continence Nurses!
To many healthcare professionals, continence nurse signifies a nurse specializing in advanced continence care — ie, urodynamic testing, biofeedback therapy, and electrical stimulation. As a result, most clinicians believe (and say) they are not involved in “continence care.”
Yet clinicians in all care settings manage the care of patients with urinary and fecal incontinence, using toileting programs, absorptive products, and containment devices such as indwelling or external catheters and fecal containment devices. In addition, WOC(ET) nurses are frequently consulted regarding skin care for incontinent individuals, whether preventive care or management of perineal dermatitis. These interventions and activities certainly represent continence care. An effective plan for skin protection and containment of stool and urine is just as appropriate (and important) for the patient with intractable incontinence as a bladder retraining program for the patient with overactive bladder and urge pattern incontinence.
Practitioners in the past1 and current WOCN President Laurie McNichol2 support broadening the continence care perspective to embrace both continence restoration nursing and incontinence management. This viewpoint underscores the fact that clinicians in all care settings contribute to continence care. The goal is to provide state-of-the-science care within our area of expertise and care setting and to recognize and refer patients who could benefit from care beyond the scope of our abilities.
For example, clinicians in acute care settings rarely have the opportunity to develop or expand their skills in continence restoration because the focus in acute care is on resolution of the problem that resulted in hospitalization. However, clinicians in acute care can develop protocols that 1) ensure that indwelling catheters are used and managed appropriately and discontinued as quickly as possible, 2) encourage toileting of elders who can cooperate as opposed to routine use of absorptive products for anyone who looks “old”, 3) promote appropriate use of absorptive products along with skin care to prevent perineal dermatitis, and 4) manage fecal incontinence safely via fecal containment devices or routine use of suppositories to regulate bowel elimination.3,4 In addition, clinicians in acute care can serve as casefinders and refer patients with chronic incontinence to outpatient continence centers.
Home health clinicians also have the opportunity to serve as casefinders, as well as 1) to teach patients and caregivers simple strategies for bowel and bladder management, 2) to teach appropriate skin care and containment or absorptive product use when indicated, 3) to provide appropriate catheter management and to evaluate patients for possible catheter removal, and 4) to either initiate more advanced therapies for continence restoration or to refer patients to a center where such care is provided.
Clinicians in long-term care settings deal with continence issues on a daily basis because their patients are at high risk for urinary and fecal incontinence and urinary retention and fecal impaction. Elimination management must be a high priority for clinicians in this setting. They need to be skilled in assessing bladder and bowel function and in establishing simple programs for bowel and bladder management (eg, toileting programs for patients able to cooperate and protocols for use of bulking agents, fluid, and mild stimulants that promote regular defecation). In addition, clinicians need to be skilled in catheter management, use of absorptive products and containment devices, and perineal skin care. Finally, they should be able to initiate bladder retraining programs and other continence restoration therapies for patients who could benefit or feel comfortable referring patients to centers or providers of such care.
This issue of Ostomy/Wound Management focuses on strategies that clinicians in all care settings can use to improve bladder and bowel function for their patients. Your challenge is to assess current practices and implement the changes necessary to demonstrate your expertise and commitment to providing the best possible continence care and incontinence management.
1. WOCN Society. Position Statement: Role of WOC(ET) Nurses in Continence Management. Laguna Beach, Calif.: WOCN Society;1996.
2. McNichol L. Do you do it? (Continence care nursing, that is). Journal of Wound Ostomy Continence Nursing. 2002;29(2):61–62.
3. Jensen L. Assessment and management of patients with bowel dysfunction or fecal incontinence. In: Doughty D (ed). Urinary and Fecal Incontinence: Nursing Management, 2nd ed. St. Louis, Mo.: Mosby; 2000.
4. Grogan T, Kramer D. The rectal trumpet: use of a nasopharyngeal airway to contain fecal incontinence in critically ill patients. Journal of Wound Ostomy Continence Nursing. 2002;29(4):193–201.
