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Stroke and Incontinence
Focus on incontinence The Role of Continence Advisers in England and Wales by Penny Rhodes and Gillian Parker. Department of Health. 1993. Copies obtainable free from the Health Publications Unit, No 2 Site. Manchester Road, Heywood, Lancashire OL 10 2PZ. 27 pages.
This is a report of a study of the role of continence advisers in England and Wales which was commissioned by the Department of Health from the Social Policy Research Unit of the University of York. The research was conducted in four stages between the winter of 1991 and May 1993. First a postal questionnaire was sent to all known continence advisers in England and Wales (375) which achieved an 80% response rate; secondly semi-structured taped interviews were carried out with 23 continence advisers, thirdly small group discussions were held with continence advisers in York, Bristol, London and Birmingham, and finally 51 health and social service managers were interviewed by telephone. The resulting report is authoritative and thoughtful. It is divided into six chapters covering the development of the continence advisory services in England and Wales, a profile of continence advisers, their changing role, quality and accountability, the changing structure of the National Health Service, and implications for the continence advisory service. There is also a useful reference list. Of the respondents to the postal questionnaires, 98% were registered nurses, and three of the remaining five respondents were physiotherapists. The three most important aspects of a continence adviser’s role were considered to be clinical practice, advice and training, with management and research taking second place. However, it was evident that a t present there is no single model which encompasses continence advisers’ practice. Over the last twenty years individuals have developed a service according to their own lights and the apparent needs of a locality. Thus some have concentrated on a clinical specialist role, while others have become trainers and managers of resources. Elderly dementia suffers were identified particularly as a group which was poorly served by the continence service; people with mental health problems and children were also mentioned in this respect. People who were considered to be falling outside the catchment of the continence advisory service included women who developed incontinence after childbirth and women between 50-60 years of age. This is an important report. The Department of Health’s ‘Priorities and
Planning Guidance 1994-95’ (EL 1931 54) requires District Health Authorities to ensure that continence services conform to the ‘Agenda for Action on Continence Services’ (Sanderson, 1991). It is to be hoped that physiotherapists will wish to be involved in planning and reviewing the service in their area, and this report would be most useful t o them and their managers. Jill Mantle BA MCSP DipTP
Reference Sanderson, J (1991).An Agenda forAction on Continence Services, Department of Health, London, unpublished report.
Guidelines for Continence Care published by and available from the Association for Continence Advice, The Basement, 2 Doughty Street, London WClN 2PH. 1993. 28 pages. f6.50including postage.
This A 4 size booklet was published last year by the Association for Continence Advice a s a resource for consumer organisations and to assist deliverers of health and care and social care in the development of services. The introduction defines continence and incontinence, a n d explains t h a t incontinence is not a disease but a symptom which has many different causes. The main causes are listed in simple language. Over 3 million people in Britain are thought to have bladder and bowel problems, and many are too embarrassed to seek professional advice.
Stroke and Incontinence by Dorothy Mandelstam and Christine Norton. The Stroke Association, CHSA House, Whitecross Street, London EC1 Y BJJ (Booklet S13). 13 pages. 50p.
This small booklet is one of a series published by the Stroke Association, which was formed in 1991.The contents are structured to answer 20 questions, including ‘What is incontinence? ‘Why may people be incontinent following a stroke?’ ‘Can anything be done about incontinence after stroke? ‘What is a continence adviser?’ ‘Will it help to drink less? ‘Will drugs help? ‘Can the lavatory be made easier to use? ‘Is a catheter the answer?’ There are lists of sources of help and further reading, of stroke services and stroke centres. The booklet contains a great deal of valuable and important information but it is spoilt by several presentation problems. First it is printed in blue small script type on a pale blue background
Yet people have the right to be properly continent whenever this is achievable; where this is not possible they have the right to t h e highest standards of continence care a n d incontinence management to enable social continence. There follow six sections presenting clear and basic guide lines for assessment, treatment, continence services, types and provision of continence products, the education in continence matters needed by health and social care professionals, and how information regarding continence problems and their treatment should be formulated for and channelled to the widest possible audience. There is a reference section and a list of organisations to approach for further information. This booklet clearly recognises the role of physiotherapists in the care of people with continence problems. Physiotherapists will find it a useful outline and checklist when planning, negotiating and/or appraising continence services. It would also make a suitable giR for all unit managers within the health and social services, bearing in mind that continence problems amict all sorts and conditions of person. The content of the booklet has been abbreviated into a neat A5 size 12-page booklet (price f2)entitled A Seven-point Guide to Continence Care: Guide lines f i r consumer organisations on people’s rights to continence care Seven points are presented on each of the guide lines’ main sections eg assessment, treatment, continence services. Consumers should find this information, from such a respected source, invaluable ammunition when lobbying for their rights to the highest standards of continence care and incontinence management. Jill Mantle BA MCSP DipTP
which makes it extremely difficult to read, particularly in artificial light. Secondly it looks unattractive, the text is lack-lustre, and there are no pictures or light touches. Thirdly it is difficult to decide for whom the booklet was designed, carers or patients. The text switches from one to the other, sometimes addressing ‘you’at other times referring to the ‘stroke person’, and to ‘him’. In passing, would colleagues please note that, if when I have a stroke, I shall object to being referred to as ‘a stroke person’! I consulted a friend, who had a stroke some time ago, and she was horrified a t the term. Investigations suggest that the two highly regarded authors of this booklet wrote the outline about five years ago and may not have been involved in the final production in 1991.I would respectfully ask the Stroke Association to put a revision in hand at once. We need a leaflet on this topic and it needs to be good. Jill Mantle BA MCSP DipTP
Physiotherapy, March 1994, vol80,
no 3
This is a report of a study of the role of continence advisers in England and Wales which was commissioned by the Department of Health from the Social Policy Research Unit of the University of York. The research was conducted in four stages between the winter of 1991 and May 1993. First a postal questionnaire was sent to all known continence advisers in England and Wales (375) which achieved an 80% response rate; secondly semi-structured taped interviews were carried out with 23 continence advisers, thirdly small group discussions were held with continence advisers in York, Bristol, London and Birmingham, and finally 51 health and social service managers were interviewed by telephone. The resulting report is authoritative and thoughtful. It is divided into six chapters covering the development of the continence advisory services in England and Wales, a profile of continence advisers, their changing role, quality and accountability, the changing structure of the National Health Service, and implications for the continence advisory service. There is also a useful reference list. Of the respondents to the postal questionnaires, 98% were registered nurses, and three of the remaining five respondents were physiotherapists. The three most important aspects of a continence adviser’s role were considered to be clinical practice, advice and training, with management and research taking second place. However, it was evident that a t present there is no single model which encompasses continence advisers’ practice. Over the last twenty years individuals have developed a service according to their own lights and the apparent needs of a locality. Thus some have concentrated on a clinical specialist role, while others have become trainers and managers of resources. Elderly dementia suffers were identified particularly as a group which was poorly served by the continence service; people with mental health problems and children were also mentioned in this respect. People who were considered to be falling outside the catchment of the continence advisory service included women who developed incontinence after childbirth and women between 50-60 years of age. This is an important report. The Department of Health’s ‘Priorities and
Planning Guidance 1994-95’ (EL 1931 54) requires District Health Authorities to ensure that continence services conform to the ‘Agenda for Action on Continence Services’ (Sanderson, 1991). It is to be hoped that physiotherapists will wish to be involved in planning and reviewing the service in their area, and this report would be most useful t o them and their managers. Jill Mantle BA MCSP DipTP
Reference Sanderson, J (1991).An Agenda forAction on Continence Services, Department of Health, London, unpublished report.
Guidelines for Continence Care published by and available from the Association for Continence Advice, The Basement, 2 Doughty Street, London WClN 2PH. 1993. 28 pages. f6.50including postage.
This A 4 size booklet was published last year by the Association for Continence Advice a s a resource for consumer organisations and to assist deliverers of health and care and social care in the development of services. The introduction defines continence and incontinence, a n d explains t h a t incontinence is not a disease but a symptom which has many different causes. The main causes are listed in simple language. Over 3 million people in Britain are thought to have bladder and bowel problems, and many are too embarrassed to seek professional advice.
Stroke and Incontinence by Dorothy Mandelstam and Christine Norton. The Stroke Association, CHSA House, Whitecross Street, London EC1 Y BJJ (Booklet S13). 13 pages. 50p.
This small booklet is one of a series published by the Stroke Association, which was formed in 1991.The contents are structured to answer 20 questions, including ‘What is incontinence? ‘Why may people be incontinent following a stroke?’ ‘Can anything be done about incontinence after stroke? ‘What is a continence adviser?’ ‘Will it help to drink less? ‘Will drugs help? ‘Can the lavatory be made easier to use? ‘Is a catheter the answer?’ There are lists of sources of help and further reading, of stroke services and stroke centres. The booklet contains a great deal of valuable and important information but it is spoilt by several presentation problems. First it is printed in blue small script type on a pale blue background
Yet people have the right to be properly continent whenever this is achievable; where this is not possible they have the right to t h e highest standards of continence care a n d incontinence management to enable social continence. There follow six sections presenting clear and basic guide lines for assessment, treatment, continence services, types and provision of continence products, the education in continence matters needed by health and social care professionals, and how information regarding continence problems and their treatment should be formulated for and channelled to the widest possible audience. There is a reference section and a list of organisations to approach for further information. This booklet clearly recognises the role of physiotherapists in the care of people with continence problems. Physiotherapists will find it a useful outline and checklist when planning, negotiating and/or appraising continence services. It would also make a suitable giR for all unit managers within the health and social services, bearing in mind that continence problems amict all sorts and conditions of person. The content of the booklet has been abbreviated into a neat A5 size 12-page booklet (price f2)entitled A Seven-point Guide to Continence Care: Guide lines f i r consumer organisations on people’s rights to continence care Seven points are presented on each of the guide lines’ main sections eg assessment, treatment, continence services. Consumers should find this information, from such a respected source, invaluable ammunition when lobbying for their rights to the highest standards of continence care and incontinence management. Jill Mantle BA MCSP DipTP
which makes it extremely difficult to read, particularly in artificial light. Secondly it looks unattractive, the text is lack-lustre, and there are no pictures or light touches. Thirdly it is difficult to decide for whom the booklet was designed, carers or patients. The text switches from one to the other, sometimes addressing ‘you’at other times referring to the ‘stroke person’, and to ‘him’. In passing, would colleagues please note that, if when I have a stroke, I shall object to being referred to as ‘a stroke person’! I consulted a friend, who had a stroke some time ago, and she was horrified a t the term. Investigations suggest that the two highly regarded authors of this booklet wrote the outline about five years ago and may not have been involved in the final production in 1991.I would respectfully ask the Stroke Association to put a revision in hand at once. We need a leaflet on this topic and it needs to be good. Jill Mantle BA MCSP DipTP
Physiotherapy, March 1994, vol80,
no 3