UROLOGY Update September 2013

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DISCLAIMER:Articles presented in this newsletter are the opinions of the authors and do not reflect the opinions of NZUNS.

Inc.

NZUNS COMMITTEE

CHAIRPERSONJeanette Townend – Palmerston Northjeanettet@midcentraldhb.govt.nz

VICE CHAIRPERSONAndrea NixonK4anix@xtra.co.nz

SECRETARYPene Meiklejohnpene@promed.co.nz

TREASURERVivienne Dyer – NelsonVivienne.dyer@nmdhb.govt.nz

COMMITTEELucy Keddle - Palmerston NorthCassandra Raj - TaurangaMegan Mellsop - TaurangaTrish White - Napier

QUARTERLY REPORT

“A REAL FRIEND IS ONE WHO WALKS IN WHEN THE REST OF THE WORLD WALKS OUT”

-(Regina Brett, Cleveland, Ohio)

Welcome to another edition of NZUNS ‘Urology Update’ newsletter. Winter is almost over and I hope that not too many of you have been struck with those winter ailments. Your NZUNS committee has been working very hard over the last 12 months. A big achievement this year for the committees is the completion of our strategic plan. This required several revisions to ensure that we have a robust plan for the society and will continue to develop over the coming years. Hopefully this will be available for members at our conference in November. The committee has also been working on an electronic calendar, aimed at raising awarenerss of National and International education sessions available, hopefully this move will not only increase awareness but also attendance at such events.

NZUNS Conference 2013 this year is combined with USANZ NZ Sectional Group is almost here and the planning committee has been enlightening us as to the exciting things planned. The conference will be in the beautiful Bay of Plenty – referred to as the ‘Jewel of Northland’ in the town of Paihia which promises to be impressive. There will be plenty of informative and educational sessions, international speakers not to mention a Pirates of Paihia Conference Dinner which is not to be missed. Here is a great opportunity to network with your colleagues and meet new ones too.

Abstract submissions is open until the end of September – so here is your opportunity to showcase something you or your team have done or researched in your workplace. A prize of $2500 for the Best Paper which is sponsored by OBEX, also the NZUNS sponsors $500 for the best New Presenter.

The conference also heralds the time in the year when we encourage members to consider nomination for the committee. Forms are enclosed in this newsletter. As always the committee is always looking for new members to join us. .

The responsibilities involved are not onerous and generally engaging and responding with viewpoints or ideas to issues as they are raised. We hold two meetings per year and another on the day preceding the annual conference. New Zealand Urological Nurses Society Inc. (NZUNS Inc.) is going through a period of new development and growth and we have a committee who is committed to these new initiatives. We are looking for a further 2-3 who are equally as enthusiastic and keen to be a valued contributor to these ideas and the forward direction and growth of the society, both within NZUNS and internationally.

So do consider nomination for a position on the NZUNS committee. As current chairperson I am certainly very happy to discuss this further so please feel free to contact me directly. Alternatively, you may wish to pass this on to a colleague who would be willing to stand as your regional representative. We aim to have a wide representation so encourage regions that have no representation on the committee to step up to this exciting challenge.

I look forward to meeting some of you at our conference – happy reading and enjoy this edition.

Jeanette Townend Chairman.

THANKS TO ABBVIE, OUR NEWSLETTER SPONSOR

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WEDNESDAY 6 NOVEMBER 2013

11.00am – 7.00pmRegistration OpensVenue: Copthorne Hotel & Resort, Paihia, Bay of Islands

6.30pm – 8.30pmUSANZ NZ Section Meeting| NZUNS Conference 2013 Welcome Reception Te Whare Runanga

THURSDAY 7 NOVEMBER 2013

NZUNS USANZ

8.00am – 8.10am Welcome and Opening of the Conference Treaty Room 1 and 2:Tony Nixon, Andrew Williams and Andrea Nixon

8.10am – 8.25am USANZ Presidential Address

8.25am – 8.35am NZUNS Chairperson Welcome

8.35am – 9.35am Improving Patient Outcomes

8.35am – 9.05am Murugesan Manoharan – Predictors of Progression in patients on Active Surveillance

9.05am – 9.35am Lance O’Sullivan - Improving outcomes for Maori Patients.

9.35am – 10.30am USANZ | NZUNS Inspirational AddressJohn Anderson Guest Speaker proudly sponsored by MMT

10.30am – 11.00am USANZ | NZUNS - Morning tea with the Sponsors and Exhibitors Waitaha Events Centre

NZUNS

11.00am – 12.30pm Exploring the Pelvis Treaty Room 1:

11.00am – 11.20am Sheryl Geddes – Nursing Role in Urodynamics

11.20am – 11.40am Sharon English – Interpretation of Urodynamics

11.40am – 12.10pm Donna Hardie – Vulval Conditions

12.10pm – 12.30pm Eva Fong – Surgical Intervention for Pelvic Problems

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12.30pm – 1.30pm USANZ | NZUNS - Lunch with the Sponsors and Exhibitors Waitaha Events Centre

1.30pm – 3.30pm Genito Urinary Cancer Treaty Room 1:

1.30pm – 2.00pm John Matthews – Advances in Radiotherapy for Prostate Cancer

2.00pm – 2.20pm John Childs – Prostate Cancer Task Force Update

2.20pm – 2.50pm Sue Osborne – Haematuria Nurse Lead Clinic

2.50pm – 3.30pm Murugesan Manoharan – Renal Cell Carcinoma with IVC Thrombus

3.30pm – 4.00pm NZUNS Afternoon tea with the Sponsors and Exhibitors Waitaha Events Centre

4.00pm – 5.00pm What’s New in Urology Treaty Room 1:

4.00pm – 4.30pm Hawkes Bay Project Team - New Catheterisation Guidelines

4.30pm – 5.00pm Andre Westenberg – Research Highlights

6.00pm - midnight Pirates of Paihia Conference DinnerBoarding 6.00pm sharp – Copthorne Hotel and Resort Jetty The Duke of Marlborough, Russell Theme: Pirate

FRIDAY 8 NOVEMBER 2013

7.30am – 8.30amNZUNS Annual General Meeting Rangatira Room:

NZUNS USANZ

8.30am – 10.00amCombined NZUNS | USANZ: Financial Issues in NZ Health Care Treaty Room 1 and 2:

8.30am – 9.00am Andrew Wong

9.00am – 9.30am Ian McPherson Southern Cross

9.30am – 10.00am Don Mackie – CMO – PHO – Financial issues facing the New Zealand health care system

10.00am– 10.30amUSANZ | NZUNS - Morning tea with the Sponsors and Exhibitors Waitaha Events Centre

NZUNS

10.30am – 12.30pmFree Paper Nursing Presentation: Proudly Sponsored by: Obex Medical Ltd and NZUNS Treaty Room 1:

10.30am – 10.45am Jean Bothwell – Best Paper 2013

10.45am – 12.30pm Presentations to be advised

Thursday 7 November (Continued)

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12.30pm – 1.30pmUSANZ | NZUNS - Lunch with the Sponsors and Exhibitors Waitaha Events Centre

1.30pm – 2.30pm

TREATY ROOM 1 Urological Nursing – Perioperative

RANGATIRA ROOMAdvanced Urological Practice Nurses

Murugesan Manoharan - Robotic assisted surgery – Expanding Horizons

Sue Osborne - Lower urinary tract symptom assessment: formulating differential diagnosisNurse presentation

Nurse presentation

2.30pm – 3.30pmMedication Prescribing in Urology Treaty Room 1:

2.30pm – 3.00pm Marama Parore - Pharmac

3.00pm – 3.30pm Sharon Scott, Pharmacist – Medication Management, Effective and Rational Prescribing

3.30pm – 4.00pmNZUNS - Afternoon Tea with the Sponsors and Exhibitors Waitaha Events Centre

4.00pm – 4.45pmMedication Prescribing in Urology Continued Treaty Room 1:

4.00pm – 4.25pm Trish White – Prescribing for Urinary Tract Infections

4.25pm – 4.45pm Thigesh Naidoo – Near Fatal Renal Stones - Case Studies

NZUNS USANZ

4.45pm – 5.00pm Combined NZUNS Conference 2013 | USANZ NZ Section Meeting Prizes Treaty Room 1 and 2

4.45pm – 5.00pm

Tristel Trainee Award NZUNS - Best New Presenter Obex Medical Ltd – Best Paper Close of Conference

7.00pmNurses, Urologists and Trade - Survivors Dinner – at own cost and details to be advised.

Disclaimer: The conference organisers reserve the right to alter or delete items from the conference programme.

Proud to be Principal Sponsor

Friday 8 November (Continued)

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SEMINAR PROGRAMME UROLOGY INTEREST GROUPSATURDAY SEPTEMBER 14 2013 | Majestic Church, 85 Moorhouse Ave, Christchurch

0815 Registration

0900 wme ..................................................................................................................Pam Ayres 0910 Renal Evaluation – History, Examination & Bloods ................................ James Johnston

0935 How is urine made? .................................................................................. Sharon English

1005 Making sense of renal radiology- USS, CT, Nuclear Med...........................Andrew Laing

1030 Morning Tea

1100 Renal Tumour Types .................................................................................. Louise Barlass

1120 Surgery for Renal Cancer ......................................................................... Peter Davidson 1140 Medical Oncology for Renal Tumours .......................................................... Jim Edwards

1200 Palliative Care for patients with advanced renal tumours .............................Kate Grundy 1230 Lunch

1315 Testicular Function / Assessment of Testicular Mass ........................................ Kevin Bax

1340 Benign scrotal conditionsJane MacDonald

1400 Testicular cancer, Treatment & Follow up .................................................... Marc Heinau 1420 Patient ......................................................................................................................... TBA 1440 Oncologic treatment of testicular cancer ..................................................... Chris Wynne

1510 Lance Armstrong - Testicular Cancer & Drug cheat .................................. Stephen Mark

1530 The Antarctic Experience ......................................................................... Sharon English

1600 The Summit attempt of Europes highest mountain: ........................................Ted Arnold Not standard retirement activity! 1615 Finish

UROLOGY SPECIAL INTEREST GROUPARE HOLDING A STUDY DAY

Date: September 14th Venue: Majestic Church - 85 Moorhouse Ave, Christchurch Cost: $40 (morning tea & lunch included)

Social function following this day until approximately 6pm.

Contact: Barbara Gordon Phone 03 355 2426 | barbara.gordon@urology.co.nz

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In late June 2013 I had the privilege of attending the last two days of the 68th Annual Meeting of the Canadian Urological

Association (CUA) held at Niagara Falls, Ontario. I had planned to attend the entire meeting from 22-25th June but my decision

to holiday in the Rocky Mountains prior, left my husband and I stranded in the beautiful town of Banff due to road closures

resulting from devastating floods in the region. Three days late, we charted our escape via the only road reopened at the time,

travelling six hours in the wrong direction to get to an airport where we could leave our rental car and fly to Toronto. While I

was very disappointed to miss the early part of the programme, particularly relevant for my work with its focus on prostate

cancer, my inconvenience was nothing compared to the heartbreak of the residents of Calgary and other smaller devastated

communities whose homes and businesses had been subject to the destructive forces of the Bow River breaking its banks.

As you read this I can only hope that those people affected are well on the way with the daunting task of cleaning up and

rebuilding their homes and infrastructure after the unprecedented damage cause by this, the worst flood in Alberta’s history.

I arrived for day two of the main programme, which started with a focus on bladder cancer. Presentations included data on

the utilisation and impact of perioperative chemotherapy for muscle invasive bladder cancer, as well as outcomes for total

cystectomy. The variance in access to chemotherapy was deemed to be related in part to referral patterns and differences

in the practical application of a multidisciplinary care approach. Other changes discussed in the arena of bladder cancer

included the potential for improved detection of carcinoma insitu with the emergence of fluorescence cystoscopy utilising an

optical imaging agent (e.g.Hexvix) and improved treatment outcomes for non-muscle invasive bladder cancer through the

use of intravesical electromotive drug administration- EMDA (e.g. Mitomycin C). Speakers reported that Canada has been

slower to embrace these modalities than its USA neighbour, due to the funding constraints of their publicly funded health

sector. The afternoon sessions included a comprehensive state of the art lecture on the assessment and management of

nocturia, stressing the importance of involving primary care physicians or other specialists where assessment indicated a

systemic cause. The content of this session reiterated for me the suitability of advanced practice nurses to the assessment and

management of this patient group.

A session on emerging therapies in the treatment of overactive bladder symptoms revealed the prescription of Mirabegron,

a medication only recently approved in Canada and not yet funded in NZ. Mirabegron is a B3 adrenergic agonist which

stimulates the bladder to relax during the storage phase of filling thereby increasing bladder capacity, reducing urinary

frequency, urgency and urge incontinence. It appears to achieve this symptomatic improvement with very low urinary retention

rates and with significantly less people experiencing dry mouth as a side effect. This medication has however been associated

with hypertension and blood pressure monitoring is recommended when it is prescribed. Mirabegron’s mechanism of action

differs from oxybutynin and solifenacin which reduce detrusor contractility by their antagonist action on muscarinic receptor.

The Urology Nurses of Canada (UNC) had a small representation at the meeting with approximately 15 of the 600 plus

delegates attending the full programme being registered nurses. The UNC committee manned an exhibit in the exhibition hall

providing an excellent point of contact for nurses as well as explaining their mission statement and encouraging nurses to

join the National Organisation. Membership provides affiliates with increased opportunities to network with urological nurses

Canada wide as well as access to the SUNA peer reviewed journal Urologic Nursing and the UNC bi-annual newsletter

‘Pipeline’ plus educational scholarships. The organisation welcomes contributions to Pipeline even from non-members, so

this provides all of us with another option for sharing practice ideas and protocols that may be of interest to other urological

NIAGARA FALLSONTARIO

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nurses. The UNC’s next annual conference is 26-28th September 2013 in New Brunswick, one of Canada’s three Maritime

Provinces. The programme looks interesting and varied with a mixture of medical, nursing and consumer speakers. UNC’s

website is www.unc.org.

The Canadian conference was both educational and thought provoking, with many opportunities to reflect on the challenge

of delivering quality urological healthcare in differing westernised healthcare systems. The issues of increasing antibiotic

resistance, increasing healthcare costs, best practice for active surveillance of prostate cancer and the delivery of penile

rehabilitation programmes post radical prostatectomy in cost contained environments are common topics at many international

meetings at present. Registered urological nurses can and should be involved in writing protocols, searching literature,

and designing and implementing research projects to contribute to the body of knowledge and / or improve the patient’s

experience of such dilemmas. Attendance at international urological conferences, such as the CUA meeting, does much to

ignite enthusiasm for such activities. I am lucky enough to know from experience that attendance of NZUNS and ANZUNS

meetings foster similar passion.

Don’t forget to register for NZUNS next conference in Paihia …..

Sue Osborne

Nurse Practitioner Waitemata District Health Board

As part of our on-going commitment to nurses and continuing education, Obex is happy to provide resources to aid your presentations where we can. Whether it be in the form of product images, animations or procedure videos, we have access to a fair amount of information. It may not be everything you need, but please feel free to ask us and we are happy to share what we have.

From : Steve BloemBusiness Unit Leader

D +64 (9) 631 1397 | M +64 (0) 21 678 081 | E steve.bloem@obex.co.nz

A message from:

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I was asked by the Continence Association to talk about ‘Catheterisation and self-catheterisation’ at the workshop this year in Auckland, it was fantastic timing as I was able to raise awareness of the Catheterisation clinical guidelines that ANZUNS produced in April 2013, which were edited by Trish White, Lynn Brinson and Julia Glentworth.

The delegates attending the session were quite varied in their background ranging from Doctors, Physiotherapists, Midwives, Continence Advisors and general Nurses. It is always difficult to judge the level of knowledge for such sessions therefore it was good to see it sparked off interest and questions.

There was a presentation from a Midwifery perspective on bladder damage during birth and how well this is detected amongst Midwives. It raised the question of standardising care of the bladder to prevent long-term complications from ineffective emptying during the time frame of the birth and immediately afterwards. Examples were given about women who had been left with residuals greater than a litre, unaware or unable to void but were missed due to ineffective monitoring and charting. It was also interesting to hear that the departmental ruling where she worked was that intervention would only occur if the residual was above 800mls which the Continence Advisors in the audience felt was higher than acceptable for them.

The Continence Association this year trialled workshops aimed at Children specifically one day then adults the following day to see whether this approach would ease the difficulties with release time off work and appropriateness of the sessions. I did get the impression that this more specific approach was more acceptable to the delegates attending and enabled them to get more out of the sessions as they were more appropriate to their needs.

Lucy KeedleCNS Urology/Continence

CONTINENCE WORKSHOP 26/7/2013 AUCKLAND

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IntroductionExcretion and excretory behaviour are rigidly controlled in each culture and in each society, and in Western societies there are strong prohibitions on the uncontrolled passage of urine and faeces (Black, 2000: 4). Black adds that most people feel that bodily elimination is a private function, best managed in one’s own home. Incontinence is a loss of bladder or bowel control that may result in involuntary leakage of urine or faeces (New Zealand continence Association, 2008: 1). Incontinence is due to many problems related to disease or other concerns. Incontinence is not a topic that can easily be discussed in public as it is associated with shame and disgrace. In this discussion, I will discuss a case study which involved a man with metastatic bladder cancer. He became incontinent of both urine and faeces. The study highlights the importance of carrying out assessments and need to provide quality and individualized care to people with issues of incontinence. Confidentiality is vital to successful establishment of a mutually trusting professional relationship between the person with incontinence and the nurse or health care provider.

DiscussionThis case study involves Dominic (not his real name), male aged 74 years old. Dominic was diagnosed with metastatic bladder cancer, with high grade invasive urothelial carcinoma. Staging CT scans showed a thickened abnormal pelvis. The bladder was grossly thickened and there was considerable radiotherapy fibrosis in the pelvic soft tissues. There was a fistulous tract between the bladder and the rectum. Recto vesico fistulae are commonly caused by bladder or

colorectal carcinomas (Pandey, Sonawalla and Trivedi, 1987). Dominic experienced urine and faecal incontinence via anus with foul smelling rectal ooze. He received chemo radiation which was followed later by palliative pelvic extenuative surgery, with formation of conduit urinary diversion and permanent colostomy. Prior to this operation, Dominic was incontinent of both urine and faeces for a considerable period of time. During that time he would not go out or socialize, he was totally confined to his home.

Dominic was miserable, he experienced abdominal pain, anxiety, distress and felt socially isolated. The misery, distress and social isolation was mainly due to incontinence as he thought he was inconveniencing other people due to smell of his urine and rectal discharge. How is incontinence managed? Is this a topic for public consumption/discussion? This was not an easy case to deal with as Dominic was also depressed. What can be done? If appropriate assessment, support and information are provided to the person with incontinence there can be a reduction in the effects of anxiety and distress. A Continence or Stomal Therapy CNS or continence advisor can have a positive influence as they play a crucial role in the assessment and management of patients with incontinence. In this Case Study, I will discuss the continence assessment and management strategies which were initiated for Dominic. Informed consent was obtained from the patient to use his clinical record for study and conference purposes. It is hoped that this discussion will assist nurse clinicians to identify tools to use to do comprehensive continence assessment, care planning, execution and evaluation of care outcomes.

Incontinence affects people socially, emotionally, physically, psychologically and economically (Australian Government, n.d.). Continence continues to be a taboo topic and many people will denigrate it as having no place in the health service (Williams, 2007: 4). Faecal incontinence is a neglected problem that receives

A MAN’S JOURNEY THROUGH THE RAVAGES OF METASTATIC BLADDER CANCER AND INCONTINENCE

Lawrence Mutale RN, DipNEd, MN (Hons), PG Cert. STNClinical Nurse Specialist GI Cancer Care & Stomal Therapy MidCentral District Health Board Palmerston North Hospital

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limited medical attention, and despite its profound negative impact most patients do not tell their doctor about it (Norton, Thomas and Hill, 2007: 1). Bowel incontinence is viewed by many people as a socially stigmatised condition. It is a common problem among elderly people and can affect anyone. The authors add that simple, low cost interventions will often improve or even cure symptoms. Joseph’s condition was very complex and simple treatment measures wouldn’t help much apart from advanced surgical procedures.

An individual assessment was essential for Dominic so that the causes or contributing factors of his incontinence were identified. A continence assessment based on Marjory Gordon’s framework of functional health patterns (Gordon, 2002: n.p.) was conducted. Gordon’s framework enables the nurse to complete a comprehensive assessment of client’s health problems with a holistic approach. The assessment incorporated interview, physical examination, documentation of bowel habits, and dietary habits.

Health AssessmentDominic was a European New Zealander, with no special beliefs or cultural needs of concern. Dominic was married with an adult daughter. Both wife and daughter were very supportive. No concerns about home situation. He was retired, liked gardening and helping his wife with house work. He had no cognitive impairment, affect; appropriate, mood; slightly elated possibly due to metastatic cancer diagnosis and incontinence, but generally cool and soft spoken. Once in a while, he experienced lower quadrant pain, pain rating scale 7-8/10 on rest and movement, precipitated by movement and deep breathing. He was on oral analgesics and they were effective. Dominic understood the reason for his admission to hospital. He ate a normal diet, but his appetite was generally poor due to nausea and vomiting. He lost weight ≥16kg and was somehow dehydrated.

Prior to surgery, he had incontinence of urine via anus, foul smelling rectal discharge. Types of continence problem/s identified: Mixed incontinence: Continuous urinary incontinence, as Dominic experienced continuous urine leakage. He also had Passive faecal leakage. Passive leakage is involuntary soiling of liquid or solid stool without patient awareness (Staskin et al, 2005: 489). Precipitating factors: Coughing and sneezing. He was using pads, faecal collector and deodorizers to reduce smell. None of these products were effective, henceforth the indication for palliative surgery. Following surgery, he had a regular bowel motion once daily via colostomy. Stool was of normal consistency and brownish in colour. Dominic had stoma education and he was confident and independent with pouch management of both colostomy and ileal conduit. He lacked sleep due to worry, anxiety and distress. Dominic was independent with activities of daily living, but has been inactive due to malaise and general body weakness. He had no risk of falls. He experienced occasional shortness of breath. He was a former smoker. He had a cough and had previous history of emphysema. Dominic had chronic obstructive pulmonary disease, and he was on medications. Dominic reported erectile dysfunction since the last bowel operation and that was not a concern for him or his wife.

Health Issues Based on the assessment of Dominic, the following health issues or nursing diagnoses were formulated in order to design the plan of care:

• Pain related to cancer diagnosis.• Anxiety and emotional distress related to metastatic cancer diagnosis, incontinence, hospitalisation and unknown

outcome of condition.• Risk for loss of self esteem related to incontinence and foul smelling rectal ooze.• Risk for social isolation (stigma) associated with incontinence.• Risk for fluid volume deficit (dehydration) related to nausea and vomiting.• Altered nutrition; less than body requirements related to nausea, vomiting and inadequate intake of essential nutrients.• Impaired urinary elimination related to urine leakage due to fistula.• Altered body temperature related to infection and pain.• Self care deficit; activities of daily living related to lack of energy and body weakness.• Activity intolerance related to fever, weakness, fatigue and general malaise.• Risk for complications related to surgical procedures and infection.

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Attitudes or beliefs associated with continenceThere are various attitudes or beliefs associated with incontinence such as:

• Dominic believed that incontinence is not a common problem; he believed he was probably the only unlucky person suffering from it. Dominic was informed that it is a very common problem in western countries and the rest of the world. Incontinence commonly affects elderly people due to mobility, cognitive issues and chronic health problems etc. People don’t just talk about it due to shyness.

• It is a simple condition: Incontinence is not as simple as most people think. It affects a wide age range of people and it can be due to many different causes. Williams (2007: 1-12) advises that if incontinence goes untreated it can have devastating psychological impact on people, affecting their self esteem, confidence, social life and everyday activities.

• Some people believe that incontinence is a problem of elderly people: this is not true because getting older alone dose not cause urine or faecal incontinence. Incontinence is never normal (Williams, 2007: 1-11). Dominic developed incontinence not because of his age but mainly due to his metastatic bladder cancer.

• Some people believe that incontinence has no treatment. Dominic never thought that he would be treated prior to surgery. Incontinence is treatable and with good assessment and advice it can be controlled and treated depending on the cause. Faecal incontinence is a neglected problem that receives limited medical attention, and despite its profound negative impact most patients do not tell their doctor about it (Norton, Thomas and Hill, 2007: 1). This statement may be disputed in some places as most patients will be given treatment as soon as the problem is identified. What is true about this is the fact that most people would prefer not to discuss their elimination pattern (taboo) and as such the doctor may not be aware that they are incontinent of faeces. Williams (2007: 4) states that continence continues to be a taboo topic and many people will denigrate it as having no place in the health service.

• Surgery is the only way to treat incontinence (Williams, 2007: 1-11). Surgery is usually the last option for treatment. Dominic had to have surgery as the first and last option due to the nature of his problems. The nurse needs to be aware of these beliefs as ignorance may influence the way they plan and deliver care.

Continence Management PlanThe principle underlying continence management is to treat the underlying condition or cause. The management plan was broad and very comprehensive in nature; it was based on the above identified health issues or nursing diagnoses. Dominic was referred to the Cancer Psychology Service for counselling. His family were involved and were very supportive.

Initially, Dominic used several naps in a day which did not stop or prevent the rectal discharge and malodour. The stomal therapy nurse recommended a faecal collector (for rectal ooze) and deodorisers to help with smell. The faecal collector was changed daily as he required several pouch changes. Dominic was also referred to the continence nurse who approved the management plan. Dominic was taking regular oral analgesics; which could not give him comfort or relief of pain. Therefore, morphine sulphate was given for breakthrough pain. Morphine is an opioid analgesic which is used for relief of severe, intractable pain and associated anxiety, especially in neoplastic disease, MI and surgery (MIMS New Zealand, 2010). These measures (above) assisted in offering temporary relief and comfort to the patient but he remained frustrated till he underwent surgery.

He was referred to the dietician who recommended nutrition supplements; oral impact and Fortisip. He was encouraged to increase oral intake though his appetite was not so good. He was commenced on antibiotics for infection. Dominic stopped smoking and was being encouraged to do other things instead. He was checked for urinary tract infections, neurological disease and diabetes mellitus and fortunately none of these conditions was identified. The stomal therapy nurse made regular contact and visits with the patient. This was just to help with reassurance, to provide ongoing support and alleviation of discomfort.

Justification of Management PlanThe management plan of care for Dominic was designed to include all professionals relevant to this case. Therefore, professionals such as clinical psychologist, dietician, continence nurse, surgeons, general nursing staff, and physiotherapists were all involved in his care. A thorough continence assessment was conducted to identify problems and design care plans accordingly. A continence assessment is necessary to determine the impact of the condition on a patient’s lifestyle and quality of life (Statskin et al, 2005: 489). The surgical procedures were very costly

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and one may argue whether it was worth doing them considering that Dominic’s metastatic cancer was so advanced and was already being considered for palliative care. The value or cost of surgery was not important at the time but Dominic’s quality of life was more important to him and the professional health care team.

Initially, the patient had lost hope, appeared miserable and helpless. However, after surgery, the patient and his wife have expressed satisfaction with the outcome of the operation. He has no incontinence of urine, no foul odour, no pain and has good sleep. His appetite has improved and has started to gain some weight. Dominic’s quality of life has somehow improved after surgery. Dominic and his wife feel good about the outcome. Dominic is aware that he doesn’t have much time left in his life but the outcome of surgery has given him some comfort and hope. He now believes that he might probably add a few more months or years to his life. His wife has been assisting him with stoma cares. Dominic has started to engage in some activities of daily living for example gardening, walking, and helping the wife with house chores. The meeting and ongoing support with stoma nurse to discuss continence management, preoperative teaching and counselling has contributed to the patient’s achievement of positive care outcomes.

Summary The clinical challenge that this patient represented has encouraged the staff to re-evaluate the care and policy around continence management. Ongoing surveillance, as well as emotional and physical support is an integral part of the relationship between the nursing staff and the patient. Nutritional support is necessary for patients with bowel cancer, incontinence, and wounds as it helps with good recovery. A multi disciplinary team approach is very vital to provision of quality and comprehensive health care. Some of the achievements and successes which were gained in this complex case would not have been possible without the involvement of the multidisciplinary team. This case study illustrates a point that the role of the stomal therapy nurse is one of educator, counsellor, researcher, and advocate, and this is not just limited to those patients with problems of incontinence or formation of a stoma but can be extended to other patients in the health care system.

ReferencesAustralian Government, n.d. Urinary Incontinence> What is it?: The National Management Startegy. n.p. Available URL: http://www.bladderbowel.gov.au/ncms/default.htm <Accessed 2008, November 08>

Australian Government, n.d. What is a Continence Assessment?: The National Management Startegy. n.p. Available URL: http://www.bladderbowel.gov.au/ncms/default.htm <Accessed 2008, November 08>

Black, P.K. 2000 Holistic Stoma Care. Bailliere Tindall, Edinburgh.

Gordon, M. 2002 Manual of nursing diagnosis. 10th edn, Mosby, St. Louis.

MIMS New Zealand. (2010). MIMS New Ethicals. Auckland: Author. Norton, C., Thomas, L., and Hill, J. 2007 Management of faecal incontinence in adults: summary of NICE guidance. Available URL: http://www.bmj.com <Accessed 2008, October 31>

Pandey, M. B., Sonawalla, F. P., & Trivedi, V. D. (1987). Recto-vesical fistula (report of an unusual case). Retrieved June 30, 2008, from: http://www.jpgmonline.com

Staskin, D., Hilton, P., Emmanuel, A., Goode, P., Mills, I., Shull, B., Yoshida, M. and Zubieta, R. 2005 Initial assessment of incontinence. In Abrams, P., Cardoza, L., Khoury, S. and Wein, A. (eds) Incontinence. The College of Nursing, Burwood.

Williams, J. 2007 Continence Management: Learning Guide. 2nd edn, The College of Nursing, Burwood.

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NOMINATION FORMOFFICER OF THE SOCIETY

Election of the Officers of the Society are to be undertaken as described in Section 11 of the Constitution of the NZUNS Incorporated rules.

We hereby nominate _______________________________________________ (Full Name)

For the position of: Chairperson Vice-Chairperson Secretary Treasurer (Please circle one of the above)

To be elected to the Committee for the ____________________________________ term

Name: ______________________________________ Signature: __________________

Name: _______________________________________ Signature: __________________

Accepted by nominee: _______________________________________________________

Signature: __________________________________________________________________

Please note:> All nominations to be received no later than ____________________________ (Date)

> Elections will be made within the committee

> Positions will be announced at the AGM on ____________________________ (Date)

> Officers of the committee shall serve no more than four consecutive years

Nominations to: NZUNS Secretary Pene Meiklejohn @ promed.co.nz

New Zealand Urological Nurses Society Inc.

www.anzuns.org

UROLOGY update 18

New Zealand Urological Nurses Society Inc.

www.anzuns.org

NOMINATION FORMCOMMITTEE MEMBER OF THE SOCIETY

Election of the Committee Members of the Society are to be undertaken as described in Section 11 of the Constitution of the NZUNS Incorporated rules.

We hereby nominate _______________________________________________ (Full Name)

For the position of: Chairperson Vice-Chairperson Secretary Treasurer (Please circle one of the above)

To be elected to the NZUNS Committee for the ____________________________ term

Name: ______________________________________ Signature: __________________

Name: _______________________________________ Signature: __________________

Accepted by nominee: _______________________________________________________

Signature: __________________________________________________________________

Please note:> Voting to take place at the AGM on: ____________________________________ (Date)

> All nominations to be received no later than: ____________________________ (Date)

> Committee members shall hold office for two years but may be eligible for re-election at that time.

Nominations to: NZUNS Secretary Pene Meiklejohn @ promed.co.nz

ConferenCe 2014A great opportunity has arisen for a local centre to

undertake the convening the next NZUNS Conference.

This is a great chance to be able to show case your area and inform the rest of the country of any initiatives that are happening in your region as well as being able to create and produce an educational scientific programme.

NZUNS will support the area – so here is an opportunity to showcase your region.

Key Benefits• Informational and educational scientific programme

• Presentation of Nursing Papers

• Amazing prizes – 1st time presenters $500 and OBEX best paper award $2500

• Sharing nursing knowledge and networking with colleagues from round the country

• Key Note speakers

• Support industry trade exhibition

• NZUNS’s on going support to convene the conference

Come and discuss with

Jeanette Townend (Chairman NZUNS) jeanettet@midcentraldhb.govt.nz

or Andrea Nixon

(vice chairman K4anix@xtra.co.nz)

19UROLOGY update

Thanks to AstraZeneca, our newsletter distributor

join

us n z u n snew zealand urological nurses society inc.

Membership forms are available on our website

www.anzuns.org

Promoting Excellence and

Education in Urological Care

Networking with other Urology Nurses, CNSs, & NPs throughout Australia & New

Zealand, in order to promote standards of Urological Nursing Practice.

Urology Nurse Conferences & Australasian Scientific Meetings.

Newsletters from Australia & New Zealand – quarterly.

Study days with colleagues - Study Grants available.