Talking to women about urinary incontinence

Amy Hunter, Lecturer Adult Nursing, School of Healthcare, University of Leeds

a.e.hunter1@leeds.ac.uk, @aeh_health

Join our EBN Twitter Chat on Wednesday the 18th of July 2018, 8-9pm UK time, which will focus on urinary incontinence.

Participating in the chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward, you can follow the discussion by searching links to #ebnjc(the EBN chat hash tag) and contribute by sending a tweet (tweets are short text messages), you need to add #ebnjcto your tweet as this allows everyone taking part to view them.

The importance of good communication is fundamental to good nursing care and impressed on nurses from the beginning of their careers, enshrined in professional standards, policies and guidelines (Department of Health and Social Care, 2015, Nursing and Midwifery Council, 2015, NICE, 2012). But when it comes to urinary incontinence how confident do nurses feel when talking to women about symptoms?

Large numbers of women experience urinary incontinence (UI), and as populations age, the number of women experiencing symptoms may increase. Despite the prevalence of UI it is often considered stigmatising which can affect help-seeking behaviours; many women do not seek help from healthcare professionals for their symptoms. This may be compounded by assumptions that UI is normal or natural, and a consequence of ageing or childbirth. Raising the subject of UI can be difficult, and some people may be unaware that help is available, however there is evidence suggesting that these women do engage with health professionals for other conditions and concerns (Shaw et al., 2006).

As some women access healthcare for other conditions, this may provide opportunity for nurses to raise the subject of UI. Whilst theoretically there may be opportunities for pre-help-seeking engagement, the stigmatisation of incontinence has been found to stretch beyond those experiencing symptoms. Continence care is often perceived as ‘dirty work’ and less important than other types of care (Ostaszkiewicz et al., 2016). If continence care is not always prioritised and is subject to cultural influences, it may be unrealistic to expect all nurses to feel confident (or willing) to instigate conversations about continence. Terminology associated with incontinence is sometimes poorly understood by patients, which has the potential to lead to miscommunication.

Women writing blogs use a number of linguistic tools to enable the writers to describe experience of UI, including casual references and jokes to circumnavigate the potential for outright stigmatisation by others. Perhaps consideration of ‘softer’ approaches which acknowledge the difficulties of disclosure, could empower nurses to tackle conversations about continence more confidently.

 1. Should nurses actively discuss continence during other health consultations/ interventions?

 2. What might facilitate more open discussions between nurses and patients about continence issues

 3. Do women have enough opportunities to disclose continence issues?

 4. Do nurses’ attitudes affect conversations about continence care with women?

DEPARTMENT OF HEALTH AND SOCIAL CARE 2015. NHS Constitution for England In:CARE, D. O. H. A. S. (ed.). London, England: Williams Lea.

NICE. 2012. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. Clinical Guideline 138 [CG138] [Online]. England: NICE. Available: https://www.nice.org.uk/guidance/cg138[Accessed 17.05.18.

NURSING AND MIDWIFERY COUNCIL 2015. The Code. Professional standards of practice and behaviour for nurses and midwives. London: Nursing and Midwifery Council.

OSTASZKIEWICZ, J., O’CONNELL, B. & DUNNING, T. 2016. ‘We just do the dirty work’: dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities. Journal of Clinical Nursing,25,2528-2541.

SHAW, C., DAS GUPTA, R., BUSHNELL, D. M., ASSASSA, R. P., ABRAMS, P., WAGG, A., MAYNE, C., HARDWICK, C. & MARTIN, M. 2006. The Extent and Severity of Urinary Incontinence amongst Women in UK GP Waiting Rooms. Family Practice,23,497-506.

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