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There are many specialities within the field of nursing, in both primary and secondary care, I would like to share with you my thoughts as the chair of the Royal College of Nursing Bladder and Bowel Forum on bladder and bowel services and the mixed provision of care in the current pandemic.
One person in seven at sometime will have a bladder and/or bowel problem in their lifetime and it can be one of the many areas of nursing that is fundamental to the individual patient, everyone passes urine and has their bowel open, and sometimes in our care a patient or carer may need to discuss this with us.
There are many variants in bladder and bowel services, currently provided nationally, dependent on commissioning or historical provision, with a mixture of clinical skills, knowledge and types of healthcare professionals within a team. So what happens in a pandemic?
There is a variation in the way services have been affected by the pandemic, from services completely being stopped and staff deployed on to wards, test centres, a skeleton crew to support urgent referral, transfer to telephone and video appointments, and a reduction in face to face urgent clinical support.
Within some services, nursing support colleagues and healthcare support workers are being redeployed to wards or community teams, but other bladder and bowel services have been lucky to be able to keep staff to support the new way of working, as they are a valuable asset to the service.
NHS England and NHS Improvement set out in the Covid-19 Prioritisation Within Community Health Services document that some specialities should continue with some parts of the service provided being reduced, such as annual reviews and group education sessions.
The definition of essential services in the pandemic is a challenge for us all as nurses, and we have had to review caseloads, practice and challenge what we do and why we do it. We have had to ask how much our patients are prepared or able to manage their own health.
One of my colleague’s patients wanted an assessment in their garage, so that this would protect the person he was living with from any risk of infection.
“Failure to manage bowel and bladder care could add pressure onto the nursing workforce”
We are innovators, but this pandemic has provided an opportunity to stop and think about what services we provide and how we do it. We are now providing virtual training for patients, carers and staff. Some services are offering group education sessions on the internet. A wealth of patient information is being produced for wound care and diabetes. Will healthcare ever be the same again?
What is the risk of stopping a bladder and bowel services? Could this increase the risk of hospital or care home admissions and add pressure on current areas such as social care?
Failure to manage bowel and bladder care could add pressure onto the nursing workforce, for example in the community, an incontinent patient could end up with moisture associated skin damage; or a person might stop drinking in an attempt to control their symptoms of incontinence leading to urine infection, constipation, confusion, or a fall.
This increases pressure on other services, so our work as continence nurses needs to continue so that we can help to reduce pressure on acute care.
How can we support the patients to adapt to changes of lockdown? Continence care becomes a problem – for example we spoke to one lady who was too embarrassed to ask someone shopping for her to purchase some incontinence products, a mother with two sons who were not able to attend school are now at home all day.
For our continence specialists who have been redeployed, remember that this gives you an an opportunity to network, share knowledge about the specialism, observe how continence assessment is carried out and what gaps there are in learning.
Alison Wileman is chair, Royal College of Nurisng Bladder and Bowel Forum