Best Practice Statement
Continence: adults with urinary dysfunction - November 2005 (PDF, 366K, 1.44 mins)
About this Best Practice Statement
This best practice statement was originally produced by the Nursing and Midwifery Practice Development Unit to offer guidance to nurses, midwives and health visitors on best practice relating to the assessment of urinary dysfunction in the care of adults in primary and secondary care settings. A multidisciplinary working group was set up with professional representation from across Scotland. (Appendix 2 ). The statement was reviewed and updated in 2005. In addition to the review process, an audit tool has been developed to support practitioners/organisations wishing to audit their continence care.
Continence issues can affect people of all ages who come into contact with health services in both primary and secondary care settings. It is estimated that between 5 and 9% of the adult population in Scotland have significant problems with urinary continence (SIGN guideline 79). The Continence Foundation estimates that incontinence costs the NHS across the UK 423 million. Causes and contributing factors are many and varied. Incontinence can have a profound effect on an individual s quality of life. There may also be an impact on wider health issues, eg urge incontinence in older women has been associated with an increased risk of falls and fractures (Brown JS et al 2000). This best practice statement aims to provide practitioners with a framework which can be used when making decisions about the management of continence. A thorough and accurate assessment of individual continence status is essential in order to determine appropriate treatment.
The statement covers all care settings. It is recognised that where a patient does not have a holistic assessment undertaken (eg minor injuries unit) then the nurse should use clinical judgement concerning the relevance of urinary dysfunction.
A key element of the statement is that all patients should have access to appropriate toilet facilities. Concerns were raised about people in outpatient or GP clinics who would require assistance to access the toilet, although there were no comments about the consequences for the patients if they were denied access to toilets. The statement tries to reflect staff concerns without accepting the conclusion that patients who can not go to the toilet independently have two choices: to either avoid outpatient/GP appointments or to accept the potential humiliation of an incontinent episode.
The original consultation indicated that some areas would prefer to categorise patients at the outset as those who would benefit from continence promotion and those assigned to incontinence containment. The original working group considered that in all cases the initial aim should be the restoration of continence. This was confirmed by the subsequent review of the statement. It was accepted that, following comprehensive assessment, this goal may need to be revised. In all cases, however, a continence care plan should be implemented and evaluated.