1 Continence Care – 6KNIA318 Level: 6 Credits: 15 Module leader: Sue Woodward Tel: 020 7848 3469 Email: [email protected]Module deputy: Carol Fordham-Clarke Tel: 020 7848 3594 Email: [email protected]____________________________________________________________________ This handbook must be read in conjunction with module information provided on KEATS, the King’s E-Learning And Teaching Service. You will be given access to KEATS on enrolment. Important information relating to assessment and related regulations can be found on KEATS and via the Nightingale Student Hub (formerly known as Student Services Centre). This handbook can also be provided in alternative formats (such as large print) upon request to [email protected].
This handbook must be read in conjunction with module information provided on KEATS, the King’s E-Learning And Teaching Service. You will be given access to KEATS on enrolment. Important information relating to assessment and related regulations can be found on KEATS and via the Nightingale Student Hub (formerly known as Student Services Centre). This handbook can also be provided in alternative formats (such as large print) upon request to [email protected].
This module forms part of the BSc Clinical Practice. The module contributes to your programme of study by building on your knowledge of nursing science and clinical practice experience. Many students use this module to inform their choice of dissertation topic.
Module aim
This module is designed to enable practitioners to explore the theory and practice of nursing patients with continence problems. At the end of the module practitioners will have developed knowledge and skills to enable them to conduct continence assessments, promote continence and manage incontinence in clinical practice.
Learning outcomes
At the end of the course you will be able to: 1. Demonstrate a comprehensive understanding of the anatomy and physiology and
neurological control of micturition and defecation 2. Demonstrate an in-depth knowledge of the pathological processes that lead to the
breakdown of continence and the therapeutic approaches that aid in the promotion of continence.
3. Critically evaluate the impact of incontinence on the lives of the people that it affects 4. Plan effective care for people and their families affected by incontinence 5. Implement a variety of evidence-based practices that manage incontinence and promote
continence 6. Critically evaluate care given to develop further strategies where necessary. 7. Use research to promote continence issues and reflect on clinical practice for continuing self-
development as an independent, accountable practitioner 8. Critically analyse ethical issues involved in the practice of continence care
Teaching arrangements The module will be held at a variety of KCL Campus including the Franklin-Wilkins Building and James Clerk Maxwell Building, Waterloo Campus and the Clinical Skills Centre, Guy’s Campus. The course will be taught by a number of specialist lecturers and practitioners. A combination of lectures, group work, student presentations and e-learning will be used.
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Submitting coursework For this module you are assessed by Sue Woodward and Carol Fordham-Clarke.
Assessment criteria All parts of the assessment must be completed and submitted by the date(s) below. Failure to submit assignments or attend examinations will result in a fail grade being awarded.
It is essential that you use your candidate number on all assignments.
Formative assessment
The formative assessment is a group tutorial with the module leader
Prior to this tutorial the student should select a client/patient for the summative assignment.
Some general reading and an initial literature search should be undertaken before the tutorial
The tutorial will be a student led discussion focusing around the guidelines for the summative assignment and students’ individual essay plans
The formative stage will not be graded, but will be considered vital to the success of the overall assignment
Summative assessment Format: A written assignment of 2,500 words
Overview/title: Critical examination of the nursing management of a client with a continence problem.
Guidelines:
The assignment should be structured in essay style: subheadings may be used. It should include an introduction, discussion and conclusion. The essay should be logical with lines of argument developed.
Give a brief description of the client/patient and the care setting.
Outline the holistic nursing continence assessment performed, giving the rationale for the approach you took and detailing the information that was gathered by this approach.
Analyse the assessment process e.g. how the information was gathered, sources of information and the appropriateness of all tools used.
Detail and analyse the nursing interventions given in respect of the continence problem, giving a clear rationale for your care.
Evaluate the effectiveness of the care given (both assessment and interventions) and make recommendations for future nursing practice.
Approximately equal proportions of the essay should be dedicated to the assessment episode and analysis of interventions.
You must demonstrate synthesis and evaluation of knowledge of continence care based on current research and evidence-based practice.
The work should be supported throughout with relevant literature that justifies the assessment and subsequent interventions.
A reference list must be included using the JAN System.
Please note that any issue regarded as unsafe practice will constitute an automatic fail.
Coursework submission are provided on the modules KEATS site. It is essential that you use your candidate number on all assignments/examinations. Your candidate number, which will begin with Z for the academic year 2018/19, will be available via Student Records on the King’s Intranet approximately one month after you enrol. If you are unable to submit your work by the deadline please refer to the information on “mitigating circumstances”. If you require further support in these circumstances, you are advised to contact KCLSU. Submission date for coursework: 17 May 2019; 11.59am Late submissions will be accepted for 24 hours following the submission date. All work submitted late will be marked as normal but will be capped at the pass mark for the module. If your assignment is a hard copy, please ensure you date stamp it and submit it to the submission room G15 James Clerk Maxwell Building. If your assignment is submitted electronically through TurnItIn, information about how to submit late will be provided on KEATS module sites under assessment information. Please label the file with your candidate number and double-check you have submitted the correct file. The external examiner for this module is Lois Seddon. Students are not to make direct contact with external examiners, in particular regarding their individual performance in assessments. The university and its Examination Boards in the ten Faculties (Institutes/Schools, King's Learning Institute and the Association of King's College (AKC), work with over 500 external examiners to ensure the quality and standard of our taught awards. Find the latest report on the External Examiners Report page, navigate to the Faculty section.
Results and resubmissions for coursework Students will receive a provisional (unratified) mark for their coursework 4 weeks following submission. According to the method of submission as detailed on your KEATS site, if your work was submitted online you will be able to download marked coursework from KEATS; alternatively, if you completed a hard copy submission you can collect your coursework and feedback from the Nightingale Student Hub. To collect a hard copy assignment, you must provide your candidate number. Alternatively, you may send a stamped addressed envelope to the Nightingale Student Hub ensuring that this is large enough to accommodate your assignments and that you have applied sufficient postage. Hard copy assignments will be retained for four weeks; if you have not collected your assignment by then, it will be destroyed. Feedback will include the award of a numerical grade which remains provisional until ratified by the examination boards. The dates for the examination boards are available on KEATS. Ratified marks can be viewed via Student Records on the King’s Intranet, the Monday following the relevant examination board. The marking criteria by which your work is judged are provided in full on KEATS. Please also refer to the section on plagiarism and how to avoid it. If you have a query about how to refer to a specific piece of work please ask your module leader, your group leader or a member of library staff for guidance or please use King’s Libguides site.
The feedback you receive on your assignment will guide you towards how to do better next time or how to maintain your existing high standard! If you do not understand your mark or the feedback you receive please contact Sue Woodward. If you are unsuccessful, it is recommended that you contact the module leader before submitting your second attempt. This will enable the module leader to provide you with an appropriate level of support as you prepare to resubmit your work. Submitted work available for download: 10 June 2019 (Exam board 19 June 2019)
Resubmission date: 16 July 2019; 11.59am
Re-submitted work available for download: 13 August 2019 (Exam board 25 September 2019)
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Learning resources
Session 1: Physiology of Micturition & types & causes of Urinary Incontinence
By the end of the session you will be able to:
Discuss the normal neurobiological control of micturition
Define urinary incontinence and its epidemiology
Appraise common types and causes of urinary incontinence
Pre/post-session reading Glynis Collis Pellatt (2007) Anatomy and physiology of urinary elimination. Part 1 British Journal of Nursing 16(7), 406-410.
Brittain K.R., Perry S. & Williams K.S. (2001) Triggers that prompt people with urinary symptoms to seek help. British Journal of Nursing 10(2), 74-86.
Foxley S. (2007) An overview of urinary incontinence. British Journal of Healthcare Assistants 1(1), 35-38.
Rigby D. (2005) Urinary urge incontinence: causes and management strategies. British Journal of Community Nursing 10(4), 172-178.
Session 2: Principles of Assessment in Continence Management
By the end of the session you will be able to:
Evaluate the importance and rationale for assessment in continence care
Critically analyse the appropriate use of trigger questions
Appraise the usefulness of continence assessment tools
Pre/post-session reading Clayman C. et al (2005) Development of a continence assessment of pathway for acute care. Nursing Times 101(18), 46.
Nazarko L. (2008) A guide to continence assessment for community nurses. British Journal of Community Nursing. 13(5), 219-226.
Winder A. (2001) Devising an effective general nursing continence assessment tool. British Journal of Nursing 10(14), 935-947.
Woodward S. (2006) Development of a valid and reliable tool for assessment of urinary incontinence in people with neurological problems. British Journal of Neuroscience Nursing 2(5), 247-255.
Session 3: Behavioural Methods of Treating Urinary Incontinence
By the end of the session you will be able to:
Identify and critically discuss the evidence base for a range of lifestyle modifications, physical therapies and behavioural interventions that are used to treat urinary incontinence including: pelvic floor muscle training, bladder training programmes, electrical stimulation and biofeedback.
Critically appraise the information and support needs required for patients undergoing behavioural interventions for treatment of urinary incontinence
Demonstrate an understanding of relevant NICE guidelines in relation to behavioural interventions for urinary incontinence.
Pre/post-session reading Dumoulin C. & Hay-Smith J. (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub2.
Eustice S., Roe B. & Paterson J. (2000) Prompted voiding for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002113. DOI: 10.1002/14651858.CD002113.
Herderschee R., Hay-Smith E.J.C., Herbison G.P., Roovers J.P. & Heineman M.J. (2011) Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews 2011, Issue 7. Art.No.: D009252. DOI:10.1002/14651858.CD009252.
National Institute for Health and Clinical Excellence (2006) Urinary Incontinence: the management of urinary incontinence in women. NICE, London.
Ostaszkiewicz J., Chestney T. & Roe B. (2010) Habit retraining for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD002801. DOI: 10.1002/14651858.CD002801.pub2.
Ostaszkiewicz J., Johnston L. & Roe B. (2004) Timed voiding for the management of urinary Incontinence in adults. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002802. DOI: 10.1002/14651858.CD002802.pub2.
Swithinbank L., Hashim H. & Abrams P. (2005) The effect of fluid intake on urinary incontinence in women. Journal of Urology 174, 187-189.
Wallace S.A., Roe B., Williams K. & Palmer M. (2004) Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001308. DOI: 10.1002/14651858.CD001308.pub2.
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Session 4: Skin Care & Prevention of Incontinence Associated Dermatitis
By the end of the session you will be able to:
Explain the pathophysiology of incontinence associated dermatitis and differentiate between pressure ulcers and incontinence associated dermatitis
Critically discuss the evidence base for the prevention and treatment of incontinence associated dermatitis
Pre/post-session reading Beeckman D., Schoonhoven L., Fletcher J. et al (2010) Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by nurses. Qual Saf Health Care 19(5), e3 Epub.
Beeckman D., Woodward S., Rajpul K. & Vanderwee K. (2011) Clinical challenges of preventing incontinence-associated dermatitis. British Journal of Nursing. 20(13), 784-790.
Session 5: Intra & Post-partum Bladder Care
By the end of the session you will be able to:
Appraise the importance of maintaining adequate bladder care for women during and after childbirth
Pre/post-session reading Humburg J., Holzgreve W. & Hoesli I. (2007) Prolonged postpartum urinary retention: the importance of asking the right questions at the right time. Gynecol. Obstet. Invest. 64(2). 69-71.
NICE (2007) Intrapartum care: management and delivery of care to women in labour [online] available from: http://guidance.nice.org.uk/CG55 (accessed 09 Oct 2013).
Session 6: Using a Bladder Scanner
By the end of the session you will be able to:
Evaluate indications, contra-indications and precautions for using a portable ultrasound to assess residual urine
Appraise the skills required in order to safely use a portable ultrasound device
Demonstrate practical use of a portable ultrasound device
Pre/post-session reading Addison R. (2000) A guide to bladder ultrasound. Nursing Times 96(40).
Skills for health (2008) CC10 - Assess residual urine by the use of portable ultrasound.
Session 7: Enuresis — Student Presentations
By the end of the session you will be able to:
Evaluate enuresis and identify the nature of the problem
Critically analyse the evidence base underpinning commonly used interventions to treat enuresis
Pre-session reading Links to the Cochrane reviews for interventions for enuresis can be accessed via the KEATS site for this module.
Session 8: Physiology of Defecation & Common Bowel Disorders
By the end of the session you will be able to:
Identify the functions of the gut, especially the colon, rectum and anus
Describe normal physiology of defecation
Critically analyse common bowel disorders and the pathophysiology of constipation and faecal incontinence
Explore the nature of and indications for investigations for bowel disorders
Pre/post-session reading Foxley S. & Vosloo R. (2008) An overview of bowel care: constipation. British Journal of Healthcare Assistants. 2(6), 266-270.
Woodward S. (2012) Assessment and management of constipation in older people. Nursing Older People 24(5), 21-26.
Woodward S. (2012) Management options for faecal incontinence. Nursing and Residential Care 14(5), 224-229.
Session 9: Bowel Continence Nursing
By the end of the session you will be able to:
Critically analyse the aims and nature of biofeedback for faecal incontinence and constipation
Appraise simple nursing interventions to improve faecal incontinence and constipation
Evaluate the evidence base for biofeedback for functional bowel disorders
Pre/post-session reading Chowdhury S. (2006) Exploring the science of laxatives: mechanisms and modes of action. Nurse Prescribing 4(3), 107-112.
Collins B. & Burch J. (2009) Constipation, treatment and biofeedback therapy. British Journal of Community Nursing 14(1), 6-11.
Hosker G., Cody J.D. & Norton C.C. Electrical stimulation for faecal incontinence in adults. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001310. DOI: 10.1002/14651858.CD001310.pub2.
Norton C.C., Cody J.D. & Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD002111. DOI: 10.1002/14651858.CD002111.pub2.
Woodward S. (2012) Assessment and management of constipation in older people. Nursing Older People 24(5), 21-26. Woodward S. (2012) Management options for faecal incontinence. Nursing and Residential Care 14(5), 224-229. Woodward S. (2012) The use of Resolor® (prucalopride) for chronic constipation in women. British Journal of Nursing 21(16), 928-926.
Demonstrate an understanding of the indications and contra-indications for trans-anal irrigation
Discuss the evidence base for and appropriate use of trans-anal irrigation for management of constipation (e.g. Peristeen)
Critically appraise the information and support needs required for patients who are being taught to use trans-anal irrigation for constipation
Pre/post-session reading Christensen P., Bazzocchi G., Coggrave M., Abel R., Hultling C., Krogh K., Media S. & Laurberg S. (2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients. Gastroenterology 131(3), 738-747.
Christensen P. & Krogh K. (2010) Transanal irrigation for disordered defecation: a systematic review. Scandinavian Journal of Gastroenterology. 45, 517-527.
Norton C. & Coggrave M. (2011) Guidelines for the use of trans-anal irrigation: Health Professionals. St Mark’s Hospital Continence Service, London.
Session 11: DRE & MRF
By the end of the session you will be able to:
Explore indications, contra-indications and precautions for digital rectal examination, digital removal of faeces and rectal irrigation
Appraise the skills required to undertake these nursing procedures
Pre/post-session reading National Patient Safety Agenda (2004) Improving the safety of patients with established spinal injuries in hospital. NPSA, London.
Royal College of Nursing (2012) Management of lower bowel dysfunction, including digital rectal examination and manual removal of faeces. RCN, London
Spinal Cord Injuries Centres of the UK and Ireland (2012) Guidelines for the management of neurogenic bowel dysfunction after spinal cord injury. Coloplast Ltd.
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Session 12: Psychosexual Issues in Continence Care
By the end of the session you will be able to:
Evaluate psychosexual issues that may be associated with incontinence or its management
Appraise nursing assessment of sexual health for people with continence problems
Critically analyse practical methods to deal with sexual health problems for people with continence problems.
Pre/post-session reading Aylott J. (2000) Nurses must not ignore clients’ sexual health. British Journal of Nursing. 9(10), 609.
Cooper E. & Guillebaud J. (1999) Sexuality and Disability. Radcliffe.
Levy L. (1999) Taking a patient’s sexual history. Practice Nursing 10(2).
Session 13: Catheter Maintenance Solutions
By the end of the session you will be able to:
Evaluate the indications for and appropriate use of catheter maintenance solutions
Critically analyse the evidence base underpinning use of catheter maintenance solutions
Pre/post-session reading Getliffe K. (2002) Managing recurrent urinary catheter encrustation. British Journal of Community Nursing 7(11), 574-580.
Rew M. (2005) Caring for catheterized patients: urinary catheter maintenance. British Journal of Nursing 14(2), 87-92.
Rigby D. (2004) pH testing in catheter maintenance: the clinical debate. British Journal of Community Nursing 9(5), 189-194.
Critically appraise the range of products available to promote continence and management of incontinence
Select appropriate products for treatment of different types of continence problem
Critically analyse the need for both clinical and cost-effective product selection.
Pre/post-session reading Ashurst A. & Bennet M. (2008) Managing incontinence products effectively. Nursing & Residential Care 10(2), 82-84.
Dingwall L. (2008) Promoting social continence using incontinence management products. British Journal of Nursing 17(9 Suppl), S12-S19.
Doherty W. (2001) Urinary sheaths: assessment, prescription and evaluation. British Journal of Community Nursing 6(2), 80-85.
Hampton S. (2005) Importance of the appropriate selection and use of continence pads. British Journal of Nursing 14(5), 265-269.
Pomfret I. (2005) Managing urinary incontinence with penile sheaths. Nursing & Residential Care 7(9), 403-405.
Rogers J. (2004) The supply of continence aids and products: navigating the choices. Nurse Prescribing 2(1), 31-36.
Wells M. (2008) Managing urinary incontinence with BioDerm® external continence device. British Journal of Nursing 17(9 Suppl), S24-S29.
Woodward S. (2007) The BioDerm external continence device: Evidence and assessment for use. British Journal of Neuroscience Nursing 3(12), 580-584 (Dec 2007).
Module evaluation As part of the university’s Student Voice Strategy, King’s uses an electronic module evaluation system known as EvaSys. This provides an opportunity for you to feedback on different aspects of the module through a series of pre-set questions and qualitative comments. At the end of the module you will receive an automated invitation via your KCL email account to complete your evaluation online.
Please take the time to complete as your feedback is important. It informs ongoing developments to individual modules to ensure that the learning needs and expectations of the Faculty’s student community are met to a high standard.
To strengthen the feedback cycle, a report summarizing the quantitative results for the module as a whole and the module lead’s reflections on your feedback will be sent to you after the online evaluation survey has closed.
Action from previous evaluations Like the use of external speakers: this will be continued for the current module.
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Timetable
Date Session Title Time Facilitator Location
15 Feb 2019
Introduction to the course 11.00-11.30
Sue Woodward
FWB B5 Physiology of Micturition and types and causes of urinary incontinence
11.30-13.00
Principles of assessment in continence management – group work
14.00-15.00 WBW 3/7
Behavioural methods of treating urinary incontinence (PFMT, bladder training, Stim)
15.00-16.00 E-learning
22 Feb 2019
Intra and post-partum bladder care 11.00-12.00 Angie Rantell
FWB 1.16 Skin Care and prevention of incontinence associated dermatitis 12.00-13.00 Sue Woodward
Using a bladder scanner 14.00-15.00 Lena (KCH)
Enuresis: student presentations 15.00-16.00 Sue Woodward
1 March 2019
E-learning: Pharmacological management of urinary incontinence
11.00-13.00 E-learning
E-learning: Surgical interventions for urinary incontinence 14.00-16.00
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8tMarch 2019
Physiology of defecation and common bowel disorders.
Bowel continence nursing, laxatives and behavioural methods for bowel control
11.00-13.00 Sue Woodward
G4 New Hunts House, Guys Campus
Lunch Lorraine - Coloplast
Trans-anal irrigation 14.00-15.00 Sue Woodward
G8 CSC, Guy’s Campus
Digital rectal examination, manual removal of faeces 15.00-16.00
15 March 2019 E-learning: Catheterisation 11.00-13.00
E-Learning 14.00-16.00
10 May 2019
Psychosexual issues in continence care 10.30-11.30 Sue Woodward WBW G/552
