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V4: Last Reviewed September 2017 | This programme has been accredited by the RCN Centre for Professional Accreditation until 4th September 2018. Accreditation applies only to the educational content of the programme and does not apply to any product.

Module 4Assessment Of Urinary Incontinence

V4: Last Reviewed September 2017


Module 4Learning Outcomes

• Understand the importance of a comprehensive continence assessment

• Discuss in detail the key elements of the continence assessment

• Outline the baseline investigations carried out as part of a continence assessment

• List some additional investigations that may be performed by the specialist nurse or doctor

• Appreciate the importance of effective interpersonal and communication skills when discussing continence

issues with an individual


Module 4

Section 1 | Assessment


Module 4Nursing Assessment

• The nursing assessment has been recognised as the cornerstone of good nursing practice and effective planning

of care for the individual

• This belief resonates in all of the continence care guidelines and policy documents where the focus must be always

of assessment and treatment instead of one of containment

• Indeed nurses are ethically, legally and professionally accountable for their standards of practice, and the principles

outlined in the professional practice documents (e.g. Code of Professional Conduct, Scope of Professional Practice)

should be applied to the provision of good continence care


Module 4Why Assess?

1. To identify or rule out any reversible or transient cause of incontinence

2. Identify those individuals who require specialist intervention such as Continence Nurse,

Physiotherapist or Urologist

3. Decide on the most appropriate management or treatment strategies to enable the person to maintain or

improve their quality of life

4. A continence assessment encourages evidenced based practice and supports practice development in continence

care


Module 4The Continence Assessment Tool

• A thorough continence assessment is the first step to developing an individualised continence care plan

• While it is seen as advantageous to adopt a standardised format for continence assessment (Norton, 1996; Saxer et

al, 2008), there are key areas that should be included in all assessments irrespective of the format

• A continence assessment will cover both urinary and faecal incontinence. Please see module six for information on

bowel assessment.


Module 4Essential Elements of a Continence Assessment

• Precise information about the presenting incontinence e.g. duration, frequency, amount of urine leaked (light,

moderate, heavy), any symptoms such as nocturia, hesitancy, pain, dysuria, impact on the person’s quality of life,

any other presenting factors

• General medical/surgical history: any previous surgery, bladder or urinary tract infections, obstetrical history,

prostate problems, menopause, neurological history

• Lifestyle history: smoking, fluid intake including drinks containing caffeine and alcohol, physical activity, weight,

fibre intake, present bowel habits. The Bristol Stool chart can be used to determine the characteristics of a stool.

• Urinalysis to rule out infection or any other condition that may be aggravating the bladder symptoms and that may

be treated


Module 4Urinalysis Indicators

• Leucocytes: Infection of urinary tract

• Ketones: Diabetes mellitus, starvation

• Specific Gravity >1025: Urine concentration, dehydration

• Nitrates: Urinary tract infection

• Blood: Infection, trauma, renal stones, urinary tract tumour,

menstruation

• Glucose: Diabetes mellitus, starvation

• Protein: Renal disease, heart failure, hypertension, infection, pre-

eclampsia

• Specific Gravity <1010: Excessive fluid intake, Diabetes insipidus

• Bilirubin: Liver disease, obstructed bile ducts

• PH>7: Infection



• Current medications: e.g. sedatives, hypnotics, anti-hypertensives, diuretics which may contribute to incontinence.

Also consider any over the counter non-prescription medication.

• Functional factors: Consider mobility (walking with or without assistance aids / balance – able to stand without

assistance), transfer ability (bed to chair/sitting to standing), eyesight, manual dexterity (adjust clothing, manage

buttons, zips etc.), ability to maintain personal hygiene and manage incontinence products if used

• Environmental factors: Is the distance to the toilet/commode appropriate to the individual’s mobility? Are toilets

easily identifiable? Are the doors easily opened? Are supports required and available such as hand rails, grab bars? Is

the toilet seat at the right height? Is the toilet clean, with adequate hand washing facilities? Can the door be locked

to ensure privacy? Is there wheelchair access?

• Physiological factors: How has the bladder problem affected the person’s personal life? Has it impacted their

quality of life in any way? How are they coping with their incontinence?



• Mental status: Can the person recognise the need to use the bathroom? Is the person alert, able to communicate

their needs, understand and follow instruction? Are they able to recognise a socially acceptable place to void? Do

they want to overcome their incontinence?

• Social history and social network: It is important to establish if the person has someone available to assist them

or if they live alone. Has the bladder problem restricted their social activity?

• Current management strategies: Are there any toileting programmes in place e.g. timed voiding, prompted

voiding? Are any products being used and if so, what type of product and how many used per 24 hour period?


Module 4Advantages of Keeping a Bladder Diary

Bladder Diary. A completed bladder diary, that should be maintained for a minimum of three days, can:

• Assist in history taking

• Act as a record to be interpreted alongside the assessment

• Aids nursing diagnostics and management

• Helps to provide a baseline which evaluates progress during treatment

Please see the reference module for an example of a bladder diary.


Module 4

Time for Myth or Fact


Module 4Myth or Fact?

Leucocytes and Nitrates in the urine would indicate a urinary tract infection

Myth or Fact?



Fact

Leucocytes and Nitrates in urine would indicate an infection. A further indicator would be the presence of blood.

However, you should always ensure when using urinalysis sticks to dipstick urine, that they are not out of date and

that the lid of the container has been tightened effectively, to ensure results are accurate.

You should also check for the following clinical symptoms:• New onset of Confusion• Fresh blood in urine• Rigors• Frequency• Urgency• Dysuria• Urinary Incontinence• Frank or Supra- pubic pain



Bilirubin present in the urine would indicate diabetes mellitus

and/or starvation

Myth or Fact?



Myth

Bilirubin in the urine would indicate liver disease, hepatitis and/or obstructed bile ducts.



The presence of glucose in the urine would indicate renal disease, heart failure,

hypertension, infection and/or pre-eclampsia

Myth or Fact?



Myth

The presence of glucose in the urine would indicate diabetes mellitus and/or starvation


Module 4

Section 6 | Communication


Module 4Key Points for Initiating a Discussion with the Person

• Always ensure that the environment is quiet and conducive to maintaining the privacy and dignity of the person

• Allow sufficient time to enable the person to feel relaxed and feel able to discuss their continence

• A combination of effective observation and communication skills will help to build a comprehensive assessment

• Through good clinical observation, sometimes factors affecting a person’s ability to remain continent may be

noticed that have previously gone undetected


Module 4Interviewing Skills

• When asking questions, ensure the right terminology is used to ensure the person understands what you are

saying

• For example “How often do you go to the toilet?” may be a better way to ask someone if they have urinary

frequency

• “How long are you able to hold on once you feel the need to pass urine?” may be preferable to “Do you have

urgency?”

• Use open ended questions to encourage discussion, reflective, probing questions to elicit more information, “How

do your bladder problems affect your day to day life?”


Module 4Interviewing Skills

• The assessment should always be a two way process and, where appropriate, family members/ carers

should be involved

• Always display a professional, empathetic approach when questioning

• Incorporate active listening skills and maintain good eye contact throughout the discussion


Module 4

Section 6 | Recap


Module 4Recap

• Undertaking a comprehensive continence assessment is key to understanding a person’s condition

• Key areas of a continence assessment include:

- Precise information about the presenting incontinence

- General medical/surgical history

- Lifestyle history

- Urinalysis

- Current medications

- Functional factors

- Environmental factors

- Psychological factors

- Mental status

- Social history

- Current management strategies

- Bladder diary


Module 4Assessment

• Test your knowledge of this module by using the interactive quiz in step two of the eLearning tool

• A certificate will be available on a pass rate of 80% or over

Good luck!


Module 4

Section 7 | References


Module 4References

• Abrams, P., Andersson, K.E. (2007). Muscarinic receptor agonists for overactive bladder. BJU International. 100: 987-1006.

• Cotterill, N. (2011). Quality of life issues in continence care. Nursing Standard. 28 (8): 51-56.

• Easton, W.A .(2010). Overactive bladder symptoms in women :current concepts in patient management. Can J Urology. 17: 12-17.

• Getliffe, K., Dolman, M. (2007). Promoting Continence A Clinical and Research Resource. 3rd Ed. London: Bailliere Tindall.

• Gibbs, G. (1988). Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit Oxford Polytechnic.

• Hanzaree, Z., Steggall, M.J. (2010). Treatment of patients with urge or stress urinary incontinence. Nursing Standard. 25 (3): 41-46.

• Norton, C . (1996). Nursing for Continence. 2nd Ed. Bucks: Beaconsfield Publishers Ltd.

• Prynn, P. (2012). Continence issues in the elderly. Practice Nurse. 42 (1): 20-22.

• Saxer, S., de Bie, R.A., Dassen, T., Halfens, R.J.G. (2008). Nurses’ knowledge and practice about urinary incontinence in nursing home care. Nurse Education Today. 28: 926-934.

Module 4 Assessment Of Urinary Incontinenceontexknowledgehub.com/wp-content/uploads/2018/01/... · Nursing Assessment • The nursing ... continence care plan ... Blood Infection,

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