continence summer 2007 - Invest for CONTINENCE

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continence summer 2007 - Invest for CONTINENCE


RCN Continence Care Forum

Summer 2007

Further information

    Contributions for the next issue should reach the editor by 2 October 2007

Sue Thomas


Letter from the Chair

A frightfully exciting conference

Katherine Wilkinson is inspired by the latest plans for this year‟s forum conference.

    I am writing this letter on my journey home from London following an RCN Continence Care Forum Committee meeting. It was a most enjoyable meeting; as a committee, we worked well together in finalising the plans for our forum conference, titled: „Continence care in action: demonstrating quality‟, to be held 31 October and 1 November, 2007 at

    York Racecourse.

    The conference programme is packed with a variety of excellent speakers and masterclasses, offering nurses at all levels of practice the opportunity to gain new knowledge and skills and, in the large exhibition, to learn about the products available for clients.

    Last year‟s conference was a huge success, and was well attended by delegates and companies. Because of this, we have been able to reduce the cost of registration this year to an extremely competitive price of just ?159 for RCN members who register before 18 September.

    I am aware of the pressures on many specialist nurses at present, and the difficulties that many of you are experiencing in taking study leave and receiving funding for attendance

    at conferences. I hope that you can manage to persuade your employer that the RCN Continence Care Forum Conference offers an excellent programme and exceptional value for money. I look forward to seeing you there!





    Do you think the RCN should proceed to a formal ballot on industrial action over this year‟s pay award? This is the question we will be asking members employed by the NHS who, this year, are looking at a pay award of just 1.9 per cent.

    The Government in Westminster chose to ignore the recommendation of the independent pay review body that NHS nurses should receive an increase of 2.5 per cent and wants to stage the award instead, reducing its real-terms value to 1.9 per cent and saving ?60m in the process even though the NHS in England ended the last financial year with a surplus of ?500m.

    The Scottish Executive has agreed to raise NHS nurses‟ pay by 2.5 per cent in full from the start of April and RCN Scotland has chosen to accept the award on that basis. But in England, Northern Ireland and Wales, ordinary, hard-working nurses stand to lose hundreds of pounds, at a time when the cost of living is high.

    Consequently, the RCN is balloting all its members employed by the NHS in England, Wales and Northern Ireland.

    This ballot is also an opportunity to check we have correct information about your employer and workplace this is vital in order to comply with legal requirements should we go ahead with a second ballot on industrial action. You can check your details on your ballot form, or, alternatively, update them online at , or telephone RCN Direct on: 0845 772 6100.

    Your ballot paper will be sent out to you in mid-July and forms must be returned by noon on Monday, 6 August 2007 make sure you vote!

For further information, visit

RCN Congress fringe event

Developing best practice in the management of children with constipation and soiling

    June Rogers MBE provides an overview.

    Constipation and soiling in childhood is a common condition that is often under diagnosed and under treated. This fringe session gave a summary of constipation and soiling, the causes, prevalence and impact on the child and family as well as an overview of the nurses‟ role in supporting such children and their families, in what is often a

    distressing condition.

Initial review results

    A review of paediatric continence promotion services carried out in 2003 in conjunction with the NHS Modernisation Agency found that, overall, the standard of service provision for children with continence problems was poor, with little evidence of a child-centred approach or integrated working (DH, 2003). This was then followed by the recommendation within the Children‟s National Service Framework for primary care trusts to develop integrated paediatric continence promotion services.

    The development of care pathways and locally agreed guidelines to help facilitate an evidence-based integrated approach to paediatric continence promotion, which is standardised across all disciplines, was recommended. The fringe session gave an opportunity to discuss evidence-based treatment options that can be initiated in primary care and the role of care pathways such as the IMPACT bowel care pathway.

Putting it into practice

    Evidence-based practice is seen as an important force in health care today and the use of developed practice guidelines and protocols is fast replacing the phrase „That‟s the way I‟ve always done it‟ (Munro 2004). Evidence-based practice integrates clinical

    experience and patient values with the best available research information (Craig et al., 2001). Developed clinical practice guidelines and protocols have been shown to improve the quality of care by reducing inappropriate variations, producing optimal outcomes,

    minimising harm and promoting cost-effective practices (American Academy of Pediatrics, 2004).

    Nurses also need to play an advocate role for the child and if they are aware of acknowledged or evidence-based treatment options that reduce the risk of adverse events, then that should be considered as the first treatment of choice. For example, traditional practice for a child with constipation who required dissimpaction was to use enemas or suppositories. This method is very distressing for the child and is also costly in terms of nursing time.

    There is now considerable emerging evidence, for example, regarding the use of oral therapy for dissimpaction that is effective, safe to use and not at all distressing for the child. It was stressed that nurses must take responsibility of keeping up to date and incorporating any new evidence, as it becomes available, into the pathways and developed guidelines.


    The fringe session was very interactive and provided the opportunity for nurses from different areas to discuss their local practice. Due to clashes with other paediatric events, the numbers who attended were small, but the feedback was very positive, with the majority reporting they were going back to see how they could now improve practice locally.

Changes ahead for home deliveries?

    Forum members respond to consultation document regarding proposed arrangements for the remuneration of services relating to appliances within Part IX of the Drug Tariff Arrangements for the reimbursement pricing of stoma and incontinence appliances under Part IX of the Drug Tariff.

    The RCN responded to this consultation document earlier this year, undertaking a survey of its Continence Care Forum members as part of the consultation process. Over 300 continence nurse specialists made individual comments. One of the main issues raised was that of home delivery services and appliance services.

    Having to obtain continence products over the counter at a chemist can be embarrassing as well as an inconvenience for transportation. For these reasons, many service users may

    prefer the discretion that a home delivery service offers. Access to a wide range of incontinence products, including some of the more unusual bespoke products, can make a huge difference to quality of life. The specialist nursing services provided by some companies are essential to ensure that the fitting of incontinence appliances is correctly undertaken and the forum indicated it would not wish this to be eroded.

One of the aims of this consultation is to “maintain and, where applicable, improve the

    current quality of care to patients and provide a consistent level of care”. The RCN stated it was unable to visualise how the current proposals will improve the service for patients, or even maintain the level of service currently available. The RCN hopes that the Department of Health will reconsider the proposed arrangements.


    American Academy of Pediatrics Steering Committee on Quality Improvement and Management (2004) Classifying recommendations for clinical practice guidelines, Pediatrics, Vol.114 (3), pp.874877.

    Craig J C, Irwig L M, Stockler M R (2001) Evidence-based medicine: useful tools for decision making, Medical Journal of Australia, Vol.174 (5), pp.2145.

    Munro N (2004) Evidence-based assessment: no more pride or prejudice, A A Clinical Nursing, Vol.15 (4), pp.5015.

NHS Modernisation Agency (2003) Good practice in paediatric continence services

    benchmarking in action, London: Department of Health.

Continence Care National Occupational Standards

    An update on continence competences, by Martin Christie, Skills for Health/RCN Technical Consultant.


    Skills for Health (SfH) was established in April 2002 with support from the four UK health departments, the independent and voluntary health sectors and staff organisations

    to become the Sector Skills Council for Health. Sector Skills Councils have a variety of responsibilities, one of which is to develop and maintain National Occupational Standards (NOS).

    NOS describe good practice in the workplace in terms of what an individual needs to be able to do, as well as what they need to know and understand. They may be used for competence-based approaches to training, development and assessment. They are developed to be applicable across the four countries, and must adhere to criteria laid down by the accrediting bodies.

    The RCN mission is to represent nurses and nursing, promote excellence in practice and shape health policies. The RCN is actively involved in the development of competence-based approaches for its members and others involved in delivering patient-centred care.

    This project is a joint piece of work between RCN and SfH to identify NOS for individuals working in the area of continence care. The project is being jointly managed between RCN and SfH, with lead responsibility resting with RCN. The project is being funded (by an unconditional education grant) from Coloplast Ltd.

Overall project timetable

    The project is running from June to November 2007. It includes a development phase involving workshops and consultation with experts from the sector, and a field testing phase. In addition, throughout the project, draft NOS will be made available for evaluation and feedback. In this way, there will be plenty of opportunities for experts and stakeholders to comment on the content.

Workshops (JulySeptember 2007)

    RCN and SfH are staging a series of workshops to obtain feedback on the draft Continence Care NOS. The workshops will be used to review the draft NOS and find out how they can be improved. They will take place on the following dates:

9 July, RCN Belfast

11 July, RCN Glasgow

23 July, RCN Birmingham

25 July, RCN Cardiff

18 September, RCN London.

Further details will be provided nearer the time.

Field test (SeptemberOctober 2007)

    The field test will involve a number of field test sites working with and using the draft NOS for purposes, such as:

job design



training and development


service development.

    Each field test site will have a lead person in place to manage the field test at a local level. Field test sites will also be supported by the project team. The arrangements for field testing will be designed to suit what can be achieved at individual sites. In other words, the time commitment will largely depend on how the field test sites want to use the NOS. This usually varies from site to site and can take from as little as two hours‟ to two days‟ work overall.

    It is also hoped that the field testing exercise for this project will generate a number of case studies to support the implementation of the NOS.

Keeping up to date

    This is the first of a number of project briefs that will be produced at key stages in the work process to keep individuals up to date with developments. Interested parties can also visit the SfH website, where draft materials and supporting information is available, at:

Get involved!

    If you would like to contribute to the development and testing of the NOS, please contact Natalie May (Project Administrator), on email: , or telephone: 020 7647 3740.

Assessing the risk of constipation

    Constipation is a common and unpleasant condition. All too often, it is only when a patient becomes constipated that treatment is initiated. The Norgine Risk Assessment Tool for Constipation aims to predict a patient‟s risk of becoming constipated by identifying and recording the number of risk factors present. The more risk factors identified, the higher the risk of the patient becoming constipated. A patient who scores highly on the risk assessment tool may not necessarily develop constipation, but will need monitoring because of the risk. Once a patient‟s score has been calculated, the Norgine

    Risk Assessment Tool gives advice on how to assess and prevent the development of constipation.

    This tool hopes to encourage health care workers in both primary and secondary care to adopt a proactive and preventative approach to the management of constipation and can be used routinely as part of all adult patients‟ assessment and reassessment processes.

    The tool is very simple to use, and contains a number of questions with tick box answers that can be quickly completed by taking the patient‟s history and checking their medical records. The higher the number of ticks, the greater the patient‟s risk of developing constipation. Anyone who scores four ticks or more is at risk of suffering from constipation and there is advice on the back of the sheet on how to effectively manage the patient.

    The risk assessment tool was developed by Gaye Kyle, Senior Lecturer, Thames Valley University; Terri Dunbar, Advanced Nurse Practitioner; and Phil Prynn, Continence Services Manager, Berkshire West PCT. It was supported by an unrestricted educational grant from Norgine Pharmaceuticals Limited.

    For a free copy of the Norgine Risk Assessment Tool for Constipation, please send your name and address

    with postcode to email:

Continence care in care homes

    Joanne Mangnall, Continence Advisor, Rotherham PCT, discusses the development of a new framework.

    In 2005, an RCN continence care in care homes audit identified a number of key issues relating to the delivery of continence care within care homes. Evidence of assessment and planned continence care was often difficult to find and often did not reflect the true nature of care being delivered.

A new framework developed

    In partnership with representatives from care homes across England, a continence care framework has been developed. The framework is intended to guide staff in gathering appropriate clinical information in order to develop a continence care plan. The framework lists a number of key questions to ask or suggests what information to gather if a resident has a bladder or bowel problem. The list is not exhaustive, but will guide the assessment process. The format used allows all information to be recorded in a standardised way and stored together for easy access.

Where to find it

    Hard copies of the framework can be ordered from RCN Direct, quoting publication code: 003 139. The framework is also available in PDF format. This can be accessed by RCN members via the RCN website, at: . The framework can be found in the Learning Zone section of the site, under the clinical skills section, and is included in the newly developed continence resource.

    The continence resource is intended to be used as a tool to promote reflection. Individuals using the resource are invited to watch short patient stories and then, after completing a number of self-assessment exercises, reflect how they deliver continence care within their workplace. Feedback from pilot sites has indicated this resource may be particularly useful for staff studying for a NVQ. The continence resource will be updated on a regular basis. Sections on continence care for clients with Parkinson‟s disease, arthritis or dementia will be added in the near future.

    If you would like to see a specific item included in the resource, please contact me at email: to discuss further.

Skills for Health FAQs

What is a competence?

    National Workforce Competences/National Occupational Standards (NOS) are statements of competence describing good practice and are written to measure performance outcomes. They are competences that describe what needs to happen in the workplace not what people are like. They are tools to enable a range of people

    individuals, employers, education and training providers to:

meet the demands of employment

develop good practice in employment

develop the coverage and focus of services

    develop the structure and content of education and training and related qualifications

develop appraisal targets

meet continuing professional development needs.

Where can I find the competences?

    All the competences developed to date are available on the Skills for Health (SfH) website, at: . These competences can be grouped together into suites competences that are specifically relevant to a particular condition, or into other applications such as a qualification or a role. The wide range of competences available can be grouped together as necessary.

    Competences can be printed off in hard copy form, both in paper and CD formats. For more details of these, and to request copies, please contact the SfH Bristol office on telephone: 0117 925 1155, or email:

What do competences cover?

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