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Amanda Cheesley: why continence should be the seventh ‘C’

Continence care is a fundamental nursing skill and should be a compulsory element of pre-registration training, says RCN professional advisor Amanda Cheesley. 

Continence care is a fundamental nursing skill and should be a compulsory element of pre-registration training, says RCN professional advisor Amanda Cheesley 


Continence care is not just for specialist nurses – it is a fundamental nursing skill. Picture: iStock

Why are people who experience incontinence finding it hard to discuss their problems? And why are nurses reluctant to have a constructive and helpful conversation with their patients? 

The main reason is the paucity of good quality information for the general public, and a lack of education for nurses and other practitioners. 

Continence management is not on the Nursing and Midwifery Council curriculum requirements for pre-registration training, meaning it is not given the importance it deserves. But worrying about having an ‘accident’ can prevent someone from leaving the house or inviting people to see them for fear they may be wet, dirty or smell. 

Fundamental skill 

Continence care is a fundamental nursing skill, it is not the province of a specialist nurse. Continence services are specialist services to support people with complex needs, and referral to this service is not the first option. 

Pads are not the solution, but many people buy these because they have not been able to discuss their concerns with a knowledgeable, approachable and supportive nurse. Catheters should be a last resort, not a quick fix. 

Incontinence is hugely varied, and is not the sole domain of the elderly. Many young people experience temporary or permanent bladder and bowel problems as a result of illness, injury, surgery or inadequate or non-existent assessment to establish the cause. 

It is the responsibility of all of us to do everything we can to support people who are experiencing continence problems. The RCN continence forum has developed an online learning resource that discusses the essentials of continence care and the environmental, physiological or other factors that can contribute to someone not being able to maintain adequate bladder or bowel control. 

Available resource

The resource, which is available to anyone who would like to know more about how to discuss this issue with patients, includes first line management, tools and techniques as well as more complex interventions. 

We are planning to update RCN guidelines on catheter care and bowel management, and will continue to ask that continence is a compulsory element of all pre-registration training.

This is the start of making continence the seventh ‘C’. If you are incontinent and nobody cares, then the other six C’s are not being met.


Amanda Cheesley is RCN professional lead for long-term conditions and end of life care

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