Continence Care - 6KNIA318 - King's College London
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Continence Care – 6KNIA318
Level: 6
Credits: 15
Module leader: Sue Woodward
Tel: 020 7848 3469
Email: sue.woodward@kcl.ac.uk
Module deputy: Carol Fordham-Clarke
Tel: 020 7848 3594
Email: carol.fordham-clarke@kcl.ac.uk
____________________________________________________________________
This handbook must be read in conjunction with module information provided on KEATS, the
King’s E-Learning And Teaching Service. You will be given access to KEATS on enrolment.
Important information relating to assessment and related regulations can be found in the
Undergraduate Programme Handbook, available on KEATS and via the Student Services Centre.
This handbook can also be provided in alternative formats (such as large print) upon request to
asc@kcl.ac.uk.
1Contents
Module overview .......................................................................................................... 3
Module aim ............................................................................................................... 3
Learning outcomes ................................................................................................... 3
Teaching arrangements ............................................................................................ 3
Submitting coursework ............................................................................................ 4
Assessment criteria................................................................................................... 4
Formative assessment .............................................................................................. 4
Summative assessment............................................................................................. 4
Results and resubmissions for coursework .............................................................. 5
Learning resources ....................................................................................................... 7
Session 1: Physiology of Micturition and types and causes of
Urinary Incontinence ............................................................................................... 7
Session 2: Principles of Assessment in Continence Management ........................... 7
Session 3: Behavioural Methods of Treating Urinary Incontinence ........................ 8
Session 4: Skin Care and Prevention of Incontinence Associated Dermatitis ......... 9
Session 5: Intra and Post-partum Bladder Care....................................................... 9
Session 6: Using a Bladder Scanner ......................................................................... 9
Session 7: Enuresis — Student Presentations .......................................................... 10
Session 8: Physiology of Defecation and Common Bowel Disorders....................... 10
Session 9: Bowel Continence Nursing ...................................................................... 11
Session 10: Trans-anal Irrigation ............................................................................. 12
Session 11: DRE and MRF ........................................................................................ 12
Session 12: Psychosexual Issues in Continence Care ............................................... 13
Session 13: Catheter Maintenance Solutions ........................................................... 13
Session 14: Containment – Aids and Appliances ..................................................... 14
Module evaluation........................................................................................................ 15
Action from previous evaluations............................................................................. 15
Timetable...................................................................................................................... 16
2Module overview
This module forms part of the BSc Clinical Practice. The module contributes to your programme
of study by building on your knowledge of nursing science and clinical practice experience. Many
students use this module to inform their choice of dissertation topic.
Module aim
This module is designed to enable practitioners to explore the theory and practice of nursing
patients with continence problems. At the end of the module practitioners will have developed
knowledge and skills to enable them to conduct continence assessments, promote continence and
manage incontinence in clinical practice.
Learning outcomes
At the end of the course you will be able to:
1. Demonstrate a comprehensive understanding of the anatomy and physiology and
neurological control of micturition and defecation
2. Demonstrate an in-depth knowledge of the pathological processes that lead to the
breakdown of continence and the therapeutic approaches that aid in the promotion of
continence.
3. Critically evaluate the impact of incontinence on the lives of the people that it affects
4. Plan effective care for people and their families affected by incontinence
5. Implement a variety of evidence based practices that manage incontinence and promote
continence
6. Critically evaluate care given to develop further strategies where necessary.
7. Use research to promote continence issues and reflect on clinical practice for continuing self-
development as an independent, accountable practitioner
8. Critically analyse ethical issues involved in the practice of continence care
Teaching arrangements
The module will be held at a variety of KCL Campus including the Franklin Wilkins Building and
James Clerk Maxwell Building, Waterloo Campus and the Clinical Skills Centre, Guys Campus. The
course will be taught by a number of specialist lecturers and practitioners. A combination of
lectures, group work, student presentations and e-learning will be used.
3Submitting coursework
For this module you are assessed by Sue Woodward and Carol Fordham-Clarke.
Assessment criteria
All parts of the assessment must be completed and submitted by the date(s) below. Failure to submit
assignments or attend examinations will result in a fail grade being awarded.
It is essential that you use your candidate number on all assignments.
Formative assessment
• The formative assessment is a group tutorial with the module leader
• Prior to this tutorial the student should select a client/patient for the summative assignment.
• Some general reading and an initial literature search should be undertaken before the
tutorial
• The tutorial will be a student led discussion focusing around the guidelines for the
summative assignment and students’ individual essay plans
• The formative stage will not be graded, but will be considered vital to the success of the
overall assignment
Summative assessment
Format: A written assignment of 2,500 words
Overview/title: Critical examination of the nursing management of a client with a continence
problem.
Guidelines:
• The assignment should be structured in essay style: subheadings may be used. It should
include an introduction, discussion and conclusion. The essay should be logical with lines of
argument developed.
• Give a brief description of the client/patient and the care setting.
• Outline the holistic nursing continence assessment performed, giving the rationale for the
approach you took and detailing the information that was gathered by this approach.
• Analyse the assessment process e.g. how the information was gathered, sources of
information and the appropriateness of all tools used.
• Detail and analyse the nursing interventions given in respect of the continence problem,
giving a clear rationale for your care.
• Evaluate the effectiveness of the care given (both assessment and interventions) and make
recommendations for future nursing practice.
• Approximately equal proportions of the essay should be dedicated to the assessment episode
and analysis of interventions.
• You must demonstrate synthesis and evaluation of knowledge of continence care based on
current research and evidence based practice.
• The work should be supported throughout with relevant literature that justifies the
assessment and subsequent interventions.
• A reference list must be included using the JAN System.
Please note that any issue regarded as unsafe practice will constitute an automatic fail.
4Coursework submission are provided on the modules KEATS site. It is essential that you use your
candidate number on all assignments/examinations. Your candidate number, which will begin with
X for the academic year 2016/17, will be available via Student Records on the King’s Intranet
approximately one month after you enrol.
If you are unable to submit your work by the deadline please refer to the information in your
programme handbook on “mitigating circumstances”. If you require further support in these
circumstances you are advised to contact KCLSU.
Submission date for coursework: 16 May 2017
Late submissions will be accepted for 24 hours following the submission date. All work submitted
late will be marked as normal but will be capped at the pass mark for the module. If your assignment
is a hard copy please ensure you date stamp it and submit it to the submission room G15 James
Clerk Maxwell Building. If your assignment is submitted electronically through TurnItIn,
information about how to submit late will be provided on KEATS module sites under assessment
information. Please label the file with your candidate number and double-check you have submitted
the correct file.
The external examiner for this module is Lois Seddon. Students are not to make direct contact
with external examiners, in particular regarding their individual performance in assessments.
The College and its Examination Boards in the ten Faculties (Institutes/Schools, King's Learning
Institute and the Association of King's College (AKC), work with over 500 external examiners to
ensure the quality and standard of our taught awards. Find the latest report on the External
Examiners Report page, navigate to the Faculty of Nursing and Midwifery section.
Results and resubmissions for coursework
Students will receive a provisional (unratified) mark for their coursework 4 weeks following
submission. According to the method of submission as detailed on your KEATS site, if your work
was submitted online you will be able to download marked coursework from KEATS; alternatively, if
you completed a hard copy submission you can collect your coursework and feedback from the
Student Services Centre.
To collect a hard copy assignment, you must provide your candidate number. Alternatively, you may
send a stamped addressed envelope to the Student Services Centre ensuring that this is large enough
to accommodate your assignments and that you have applied sufficient postage. Hard copy
assignments will be retained for four weeks; if you have not collected your assignment by then, it
will be destroyed.
Feedback will include the award of a numerical grade which remains provisional until ratified by the
examination boards. The dates for the examination boards are available on KEATS. Ratified marks
can be viewed via Student Records on the King’s Intranet, the Monday following the relevant
examination board.
The marking criteria by which your work is judged are provided in full in your programme
handbook. Please also refer to the section in your programme handbook on plagiarism and how to
avoid it. If you have a query about how to refer to a specific piece of work please ask your module
leader, your group leader or a member of library staff for guidance or please use King’s Libguides
site.
5The feedback you receive on your assignment will guide you towards how to do better next time or
how to maintain your existing high standard!
If you do not understand your mark or the feedback you receive please contact Sue Woodward.
If you are unsuccessful, it is recommended that you contact the module leader before submitting
your second attempt. This will enable the module leader to provide you with an appropriate level of
support as you prepare to resubmit your work.
Submitted work available for download: 14 June 2017 (Exam board 27 June 2017)
Resubmission date: 7 August 2017
Re-submitted work available for download: 5 September 2017 (Exam board 12
September 2017)
6Learning resources
Session 1: Physiology of Micturition and types and causes of Urinary Incontinence
By the end of the session you will be able to:
• Discuss the normal neurobiological control of micturition
• Define urinary incontinence and its epidemiology
• Appraise common types and causes of urinary incontinence
Pre/post-session reading
Glynis Collis Pellatt (2007) Anatomy and physiology of urinary elimination. Part 1 British Journal of
Nursing 16(7), 406-410.
Brittain K.R., Perry S. & Williams K.S. (2001) Triggers that prompt people with urinary symptoms to
seek help. British Journal of Nursing 10(2), 74-86.
Foxley S. (2007) An overview of urinary incontinence. British Journal of Healthcare Assistants 1(1),
35-38.
Rigby D. (2005) Urinary urge incontinence: causes and management strategies. British Journal of
Community Nursing 10(4), 172-178.
Session 2: Principles of Assessment in Continence Management
By the end of the session you will be able to:
• Evaluate the importance and rationale for assessment in continence care
• Critically analyse the appropriate use of trigger questions
• Appraise the usefulness of continence assessment tools
Pre/post-session reading
Clayman C. et al (2005) Development of a continence assessment of pathway for acute care. Nursing
Times 101(18), 46.
Nazarko L. (2008) A guide to continence assessment for community nurses. British Journal of
Community Nursing. 13(5), 219-226.
Winder A. (2001) Devising an effective general nursing continence assessment tool. British Journal
of Nursing 10(14), 935-947.
Woodward S. (2006) Development of a valid and reliable tool for assessment of urinary
incontinence in people with neurological problems. British Journal of Neuroscience Nursing 2(5),
247-255.
7Session 3: Behavioural Methods of Treating Urinary Incontinence
By the end of the session you will be able to:
• Identify and critically discuss the evidence base for a range of lifestyle modifications,
physical therapies and behavioural interventions that are used to treat urinary incontinence
including: pelvic floor muscle training, bladder training programmes, electrical stimulation
and biofeedback.
• Critically appraise the information and support needs required for patients undergoing
behavioural interventions for treatment of urinary incontinence
• Demonstrate an understanding of relevant NICE guidelines in relation to behavioural
interventions for urinary incontinence.
Pre/post-session reading
Dumoulin C. & Hay-Smith J. (2010). Pelvic floor muscle training versus no treatment, or inactive
control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews
2010, Issue 1. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub2.
Eustice S., Roe B. & Paterson J. Prompted voiding for the management of urinary incontinence in
adults. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002113. DOI:
10.1002/14651858.CD002113.
Herderschee R., Hay-Smith E.J.C., Herbison G.P., Roovers J.P. & Heineman M.J. (2011) Feedback
or biofeedback to augment pelvic floor muscle training for urinary incontinence in women.
Cochrane Database of Systematic Reviews 2011, Issue 7. Art.No.: D009252.
DOI:10.1002/14651858.CD009252.
National Institute for Health and Clinical Excellence (2006) Urinary Incontinence: the management
of urinary incontinence in women. NICE, London.
Ostaszkiewicz J., Chestney T. & Roe B. (2010) Habit retraining for the management of urinary
incontinence in adults. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD002801.
DOI: 10.1002/14651858.CD002801.pub2.
Ostaszkiewicz J., Johnston L. & Roe B. Timed voiding for the management of urinary Incontinence
in adults. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002802. DOI:
10.1002/14651858.CD002802.pub2.
Swithinbank L., Hashim H. & Abrams P. (2005) The effect of fluid intake on urinary incontinence in
women. Journal of Urology 174, 187-189.
Wallace S.A., Roe B., Williams K. & Palmer M. (2004) Bladder training for urinary incontinence in
adults. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001308. DOI:
10.1002/14651858.CD001308.pub2.
8Session 4: Skin Care and Prevention of Incontinence Associated Dermatitis
By the end of the session you will be able to:
• Explain the pathophysiology of incontinence associated dermatitis and differentiate between
pressure ulcers and incontinence associated dermatitis
• Critically discuss the evidence base for the prevention and treatment of incontinence
associated dermatitis
Pre/post-session reading
Beeckman D., Schoonhoven L., Fletcher J. et al (2010) Pressure ulcers and incontinence-associated
dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by
nurses. Qual Saf Health Care 19(5), e3 Epub.
Beeckman D., Woodward S., Rajpul K. & Vanderwee K. (2011) Clinical challenges of preventing
incontinence-associated dermatitis. British Journal of Nursing. 20(13), 784-790.
Session 5: Intra and Post-partum Bladder Care
By the end of the session you will be able to:
• Appraise the importance of maintaining adequate bladder care for women during and after
childbirth
Pre/post-session reading
Humburg J., Holzgreve W. & Hoesli I. (2007) Prolonged postpartum urinary retention: the
importance of asking the right questions at the right time. Gynecol. Obstet. Invest. 64(2). 69-71.
NICE (2007) Intrapartum care: management and delivery of care to women in labour [online]
available from: http://guidance.nice.org.uk/CG55 accessed 09/10/13
Session 6: Using a Bladder Scanner
By the end of the session you will be able to:
• Evaluate indications, contra-indications and precautions for using a portable ultrasound to
assess residual urine
• Appraise the skills required in order to safely use a portable ultrasound device
• Demonstrate practical use of a portable ultrasound device
Pre/post-session reading
Addison R. (2000) A guide to bladder ultrasound. Nursing Times 96(40).
Skills for health (2008) CC10 - Assess residual urine by the use of portable ultrasound.
9Session 7: Enuresis — Student Presentations
By the end of the session you will be able to:
• Evaluate enuresis and identify the nature of the problem
• Critically analyse the evidence base underpinning commonly used interventions to treat
enuresis
Pre-session reading
Links to the Cochrane reviews for interventions for enuresis can be accessed via the KEATS site for
this module.
Session 8: Physiology of Defecation and Common Bowel Disorders
By the end of the session you will be able to:
• Identify the functions of the gut, especially the colon, rectum and anus
• Describe normal physiology of defecation
• Critically analyse common bowel disorders and the pathophysiology of constipation and
faecal incontinence
• Explore the nature of and indications for investigations for bowel disorders
Pre/post-session reading
Foxley S. & Vosloo R. (2008) An overview of bowel care: constipation. British Journal of Healthcare
Assistants. 2(6), 266-270.
Woodward S. (2012) Assessment and management of constipation in older people. Nursing Older
People 24(5), 21-26.
Woodward S. (2012) Management options for faecal incontinence. Nursing and Residential Care
14(5), 224-229.
10Session 9: Bowel Continence Nursing
By the end of the session you will be able to:
• Critically analyse the aims and nature of biofeedback for faecal incontinence and
constipation
• Appraise simple nursing interventions to improve faecal incontinence and constipation
• Evaluate the evidence base for biofeedback for functional bowel disorders
Pre/post-session reading
Chowdhury S. (2006) Exploring the science of laxatives: mechanisms and modes of action. Nurse
Prescribing 4(3), 107-112.
Collins B. & Burch J. (2009) Constipation, treatment and biofeedback therapy. British Journal of
Community Nursing 14(1), 6-11.
Hosker G., Cody J.D. & Norton C.C. Electrical stimulation for faecal incontinence in adults.
Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD001310. DOI:
10.1002/14651858.CD001310.pub2.
Norton C.C., Cody J.D. & Hosker G. Biofeedback and/or sphincter exercises for the treatment of
faecal incontinence in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.:
CD002111. DOI: 10.1002/14651858.CD002111.pub2.
Woodward S. (2012) Assessment and management of constipation in older people. Nursing Older
People 24(5), 21-26.
Woodward S. (2012) Management options for faecal incontinence. Nursing and Residential Care
14(5), 224-229.
Woodward S. (2012) The use of Resolor® (prucalopride) for chronic constipation in women. British
Journal of Nursing 21(16), 928-926.
11Session 10: Trans-anal Irrigation
By the end of the session you will be able to:
• Demonstrate an understanding of the indications and contra-indications for trans-anal
irrigation
• Discuss the evidence base for and appropriate use of trans-anal irrigation for management of
constipation (e.g. Peristeen)
• Critically appraise the information and support needs required for patients who are being
taught to use trans-anal irrigation for constipation
Pre/post-session reading
Christensen P., Bazzocchi G., Coggrave M., Abel R., Hultling C., Krogh K., Media S. & Laurberg S.
(2006) A randomized, controlled trial of transanal irrigation versus conservative bowel management
in spinal cord-injured patients. Gastroenterology 131(3), 738-747.
Christensen P. & Krogh K. (2010) Transanal irrigation for disordered defecation: a systematic
review. Scandinavian Journal of Gastroenterology. 45, 517-527.
Norton C. & Coggrave M. (2011) Guidelines for the use of trans-anal irrigation: Health
Professionals. St Mark’s Hospital Continence Service, London.
Session 11: DRE and MRF
By the end of the session you will be able to:
• Explore indications, contra-indications and precautions for digital rectal examination,
digital removal of faeces and rectal irrigation
• Appraise the skills required to undertake these nursing procedures
Pre/post-session reading
National Patient Safety Agenda (2004) Improving the safety of patients with established spinal
injuries in hospital. NPSA, London.
Royal College of Nursing (2012) Management of lower bowel dysfunction, including digital rectal
examination and manual removal of faeces. RCN, London
Spinal Cord Injuries Centres of the UK and Ireland (2012) Guidelines for the management of
neurogenic bowel dysfunction after spinal cord injury. Coloplast Ltd.
12Session 12: Psychosexual Issues in Continence Care
By the end of the session you will be able to:
• Evaluate psychosexual issues that may be associated with incontinence or its management
• Appraise nursing assessment of sexual health for people with continence problems
• Critically analyse practical methods to deal with sexual health problems for people with
continence problems.
Pre/post-session reading
Aylott J. (2000) Nurses must not ignore clients’ sexual health. British Journal of Nursing. 9(10),
609.
Cooper E. & Guillebaud J. (1999) Sexuality and Disability. Radcliffe.
Levy L. (1999) Taking a patient’s sexual history. Practice Nursing 10(2).
Session 13: Catheter Maintenance Solutions
By the end of the session you will be able to:
• Evaluate the indications for and appropriate use of catheter maintenance solutions
• Critically analyse the evidence base underpinning use of catheter maintenance solutions
Pre/post-session reading
Getliffe K. (2002) Managing recurrent urinary catheter encrustation. British Journal of Community
Nursing 7(11), 574-580.
Rew M. (2005) Caring for catheterized patients: urinary catheter maintenance. British Journal of
Nursing 14(2), 87-92.
Rigby D. (2004) pH testing in catheter maintenance: the clinical debate. British Journal of
Community Nursing 9(5), 189-194.
13Session 14: Containment – Aids and Appliances
By the end of the session you will be able to:
• Critically appraise the range of products available to promote continence and management
of incontinence
• Select appropriate products for treatment of different types of continence problem
• Critically analyse the need for both clinical and cost-effective product selection.
Pre/post-session reading
Ashurst A. & Bennet M. (2008) Managing incontinence products effectively. Nursing & Residential
Care 10(2), 82-84.
Dingwall L. (2008) Promoting social continence using incontinence management products. British
Journal of Nursing 17(9 Suppl), S12-S19.
Doherty W. (2001) Urinary sheaths: assessment, prescription and evaluation. British Journal of
Community Nursing 6(2), 80-85.
Hampton S. (2005) Importance of the appropriate selection and use of continence pads. British
Journal of Nursing 14(5), 265-269.
Pomfret I. (2005) Managing urinary incontinence with penile sheaths. Nursing & Residential Care
7(9), 403-405.
Rogers J. (2004) The supply of continence aids and products: navigating the choices. Nurse
Prescribing 2(1), 31-36.
Wells M. (2008) Managing urinary incontinence with BioDerm® external continence device.
British Journal of Nursing 17(9 Suppl), S24-S29.
Woodward S. (2007) The BioDerm external continence device: Evidence and assessment for use.
British Journal of Neuroscience Nursing 3(12), 580-584 (Dec 2007).
14Module evaluation
At the end of the module you are requested to complete the short online evaluation which will be
available on your module KEATS site. Student evaluations are very important to us and are required
by Health Education England and the regional London Local Education and Training Boards.
Action from previous evaluations
Like the use of external speakers: this will be continued for the current module.
15Timetable
Date Session Title Time Facilitator Location
Introduction to the course 11.00-11.30 Sue Woodward K2.31 King’s
Building, Strand
Physiology of Micturition and types and causes of urinary 11.30-13.00 Campus
incontinence
Lunch
10 Feb 2017
Principles of assessment in continence management – group 14.00-15.00 Sue Woodward 1.62 FWB
work
Behavioural methods of treating urinary incontinence (PFMT, 15.00-16.00 E-learning
bladder training, Stim)
E-learning: Pharmacological management of urinary 11.00-13.00
incontinence
17 Feb 2017 E-learning
E-learning: Surgical interventions for urinary incontinence 14.00-16.00
Intra and post-partum bladder care 11.00-12.00 Angie Rantell Gainsford
Lecture Theatre
Skin Care and prevention of incontinence associated dermatitis 12.00-13.00 Sue Woodward WEC
24 Feb 2017 Lunch Linda - dermasciences
Using a bladder scanner 14.00-15.00 Lena (KCH) Skills labs 3&4
WEC
Enuresis: student presentations 15.00-16.00 Sue Woodward
16Physiology of defecation and common bowel disorders. 11.00-13.00 Sue Woodward TBC
Bowel continence nursing, laxatives and behavioural methods
for bowel control
03 March 2017 Lunch Lorraine - Coloplast
Trans-anal irrigation 14.00-15.00 Sue Woodward G8 CSC Guys
Campus
Digital rectal examination, manual removal of faeces 15.00-16.00
11.00-13.00
10 March 2017 E-learning: Catheterisation E-Learning
14.00-16.00
Psychosexual issues in continence care 10.30-11.30 Sue Woodward 1.13 FWB
Catheter maintenance solutions 12.00-13.00 Maggie Rew
Lunch Maggie Rew - BBraun
Containment: aids and appliances 14.00-15.30 Sue Woodward + 1.60 FWB
28 April 2017
reps – Tony Sollo
14.00 Sally – Ontex
(+ buns) 14.30 Eric
Gaise - Hollister
15.00
Evaluation 15.30-16.00 Sue Woodward
Location key:
FWB – Franklin-Wilkins building, Waterloo campus
CSC – Chantler SaIL Skills Centre, Guy’s campus
WEC – Weston Education Centre, Denmark Hill
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