Biomedical subjects
Publications and source records attributed to Rachel Gilbert.
As part of the funded nursing care agenda, the NHS now has responsibility to provide a continence service free of charge for residents of nursing homes. This article explains how such a service was implemented in one PCT.
An ultrasound scan of the bladder using a portable bladder scanner is a reliable, non-invasive way of estimating the volume of residual urine that remains in the bladder after voiding (the post-void residual) (Addison, 2000a). Nurses now use bladder ultrasound scanners in a variety of clinical settings (Lewis, 1995). It has been argued that ultrasound should be a standard investigation for the assessment of patients with bladder problems (Addison, 2000a), in particular when emptying their bladder. Older people, particularly men and those with a neurological disorder, including stroke, are most at risk of having a problem emptying their bladder effectively (Addison, 2000b; Brittain et al, 1998).
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Disposable, body-worn pads are the product most commonly chosen to contain and absorb urine and faeces (Pomfret, 2000). The cost to the NHS of supplying continence pads has been estimated at 80 million pounds per annum (Euromonitor, 1999) and is a huge financial burden on local services.
Catheterisation is an established procedure and is usually performed by nurses (Bissett, 2005). According to Crow et al (1988) 10-12 per cent of hospital patients have an indwelling urinary catheter for short- to medium-term use (up to 28 days). Up to 80 per cent of urine infections (bacteriuria) are associated with the use of indwelling urinary catheters (Pinkerman, 1994; DoH, 2003).
Rachel Gilbert discusses the importance of adequate fluid intake for bladder and bowel health and the nurse's role in assessing and managing fluid balance.
Collecting midstream specimens of urine (MSU) is a common nursing activity. It is indicated for adults and children who are continent and can empty their bladder on request. The general principle is to collect the midstream or middle part of a void if a urinary tract infection (UTI) is suspected. Since this is one of the most frequently occurring infections, an MSU may be required in many areas of clinical practice. Yet despite being a regular nursing activity, the procedure is often undertaken incorrectly.
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Rachel Gilbert outlines the evidence and theory underpinning the procedure for a trial without catheter, including the rationale, patient education, monitoring and evaluation methods and potential complications.