A day in the life of a remote continence nurse

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Anita Erlansen, who was last year awarded a clinical placement in Melbourne as part of her National Conference on Incontinence scholarship, describes a typical working day in a remote New South Wales health service – a post to mark World Continence Week

Thanks Anita for a fascinating glimpse of your truly valuable daily work. We’d love to carry more Day in the Life stories from nurses and midwives – contact us here if you’re interested in telling your story [first name only is fine.]

I work at Dareton Primary Health in the far west of NSW. There is no doctor on site and the service is made up of specialist nurses, Aboriginal health workers and other allied health professionals. We are on the NSW-Victoria border, about 1000 kilometres from Sydney and 550 kilometres from Melbourne. The nearest major hospital is in Mildura.

When I first started at Dareton, there was no continence service and the one that existed over the border (which sometimes seemed impenetrable despite it being just a river) only saw people with a Victorian address. My role was in women’s health, which seemed the closest thing to continence.

By my second year, I knew I had to do some more formal learning, so I completed the Continence Nurse Advisor Certificate through Flinders University and Tasmania University’s Pelvic Assessment for Continence Training course to improve my assessment skills.

Since then the clinic has grown and continues to be busy, with referrals coming from other nurses and health workers within the organisation, as well as from nursing homes, school counsellors, urology specialists and hospitals.

A typical day:

First up is a follow-up phone call to a client in Broken Hill, about three hours away, who I had seen the day before for help with intermittent self-catheterisation after his prostate surgery. I had earlier sent him a CD and some catheter samples and he’d done a great job; all he needed was someone to give him the confidence to do the first one.  All was well.

Next I meet with primary school staff, parents, a school counsellor and a young child with faecal incontinence. He loves school, but has some learning and development issues. We spend time working out a plan so he can continue going to school without his incontinence negatively impacting on his education. By the end of the meeting we have a plan: an abdominal scan to rule out (or in) conditions such as chronic constipation and encopresis and strategies in place for the practical side of things,  such as timed toileting, responsibility for changing him and responding to cues that he needs to go. We leave with a written plan and will follow up his progress in the coming weeks.

Next is a home visit to a 90-year-old woman who had recent bladder surgery and required catheterisation in the emergency department a few days after coming home. The catheterisation procedure was traumatic and painful and her Melbourne-based urologist asked me to do an at-home void trial. The catheter is removed without any problems and, after explaining what to expect and when to worry, I hand her my mobile phone number and head off.

I then head to a Fit and Strong session, a gentle exercise program for older women. Several of the nurses, including myself, are qualified community exercise leaders and I lead a pelvic floor exercise session.

We have a few regulars who attend the clinic for management of their supra-pubic catheters (SPC) and two of them come in this afternoon. The first is a gentleman in his seventies who has had his SPC for about 12 months. He manages it well, but a few months ago it became dislodged, so now we do a balloon check every few weeks. The timing today was good because I notice his urine has an unusual odour and he tells me the catheter is more uncomfortable than usual. Sure enough, his GP later confirms a bladder infection.

Our other regular is a paraplegic woman who requires regular bladder wash-outs to avoid hospitalisation. Like many of our clients, she has a difficult home situation and, as well as keeping her bladder working, these visits to the clinic provide her with an opportunity to interact with the female staff. She is a regular fixture in the centre now and we take pride in managing to keep her out of hospital for bladder-related problems.

The afternoon is spent preparing for a trip later in the week to Balranald, a two-hour drive from Dareton and part of our catchment. I have several referrals from the local multipurpose service for continence assessments for clients before discharge in the Balranald Hospital sub-acute ward and in respite.

I make a follow-up phone call to my 90-year old client I saw earlier in the day and, to use her words, she is “weeing beautifully”.  I let her urologist know and attend to her notes.

Finally we have our clinical handover and a Primary Health meeting. Nurses and Aboriginal health workers attend the handover and we discuss clients we are all involved with. Today’s new clients include a palliative patient who will require end-of-life continence care and an elderly person with dementia who will be cared for by his wife and will need access to continence products.

At our Primary Health meeting, it is my turn to provide an education session to my colleagues. I give them an overview of the National Conference in Melbourne I recently attended and, having spent time at the Royal Melbourne Hospital, get to tell them what a fully staffed and resourced continence clinic looks like.

Thanks Anita for a fascinating glimpse of your truly valuable daily work. We’d love to carry more Day in the Life stories from nurses and midwives – contact us here if you’re interested in telling your story [first name only is fine.]

Thanks also to the Continence Foundation of Australia. This article first appeared in their consumer magazine Bridge, Autumn 2016.

Professional resources can be found at the Australian Continence Exchange.

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