There are many elderly clients quietly enduring continence issues, believing that frequency, urgency, and incontinence is an inevitable part of aging. Advanced practice nurses can play a significant role in discovering continence problems (Lea R.et.al.2007).Urinary incontinence is defined as the complaint of any involuntary leakage of urine(International Continence Society,1997). A thorough physical assessment and evaluation is necessary to identify the problem at the early stage and to ensure its necessary management. In my placement area I found many residents either with urinary catheter or using incontinence pads. That is suffering from this problem. Thus I selected this as one of my learning outcome. I choose Gibbs Reflective cycle 1988 to write this reflective essay on assessment and management of urinary incontinence. This model of reflection allows me to evaluate and analyse my own experiences to bring out new learning and changes.
When I started my clinical practice I identified there are lot of elderly people with the complaint of urinary incontinence. It is important that incontinence be treated since it impacts not only the physiological, but also the psychological realms of a person’s life. Depression and decreed quality of life have been found to co-occur in the person struggling with incontinence (Barbara Ann,2003). The most important effect of incontinence reported in men was “being out of control” while most women considered “feeling impelled to take several precautions” to be the most important consequence of UI (Doreth et al,2006). In my placement area I noticed that most of the patients with parkinson’s disease also suffer from the problem of urinary incontinence. When I searched in the literature ,a study by Dr.Vaughan points out that those with Parkinson’s disease usually experience urgency and incontinence as a common problem. When I started my placement , Mrs . X who was suffering from Parkinsonism since 5 years and dementia since 2 years was on Indwelling urinary catheter for the management of urinary incontinence. Adhering to the results from the literature review I planned for initiating several steps to control incontinence in Mrs.x. My mentor was always with me with full support and guidelines. Fluid management was the first step started. An input output chart was kept and well maintained. Then steps wre also taken to manage constipation. Exercises were the last method practiced and the final result was really appreciable as she got a great reduction in the incontinence rate.
After the experience I felt so glad and proud to myself as it was a great success towards its end. In the beginning, during the time of planning I thought it may be bit difficult for a patient with parkinsonism and dementia to make follow our instructions and continue till the end of this practice. But when we started the programme her response was so nice that she found very cooperative and understanding. This made me more happy and I tried my level best to make every interaction to bring out something positive. I always tried to keep good inter personal relationship with the patient by using the different techniques of communication.
Even though I felt some difficulties during the beginning, as a whole I could feel a progressive response in my patient. My mentor was there with me when I felt some problems and helped me a lot to overcome all those. She gave me more resources to manage difficult situations and it was really beneficial. I realised proper delegation of duties is necessary for a better implementation and also learned about the factors to be considered while delegating the duties and responsibilities.
Actually the experience was beneficial to me in different ways. First and foremost I could upgrade my level of knowledge. I read different journal articles and each one was a big store of new knowledge for me. I learned about the different techniques of management of urinary incontinence. I could also understand the importance of behavioural intervention in the management of incontinence. I could understand some of my weak points and my mentor helped me to improve them.
Urinary incontinence is a disease condition which not only affects the physiology of a patient but also affects his psychological status and needs a continuous assessment and evaluation. It is very clear that practice can make a difficult problem more easy and manageable.
Maintain proper fluid balance
Assess and find out the symptoms of constipation at an early stage and manage it effectively Maintain a regular assessment of urinary incontinence and record each incidence if possible Understand the importance of communication and the positive effects of it. Keep a therapeutic relationship with the patient.
Utilise the resources like man, money and material in the best effective manner Plan with the patient to ensure his cooperation and win his confidence Support and encourage the co-workers as and when required
Evaluate and record each days progress so as to have best result at the end.