Incontinence in palliative care: assessment to promote dignity
This article will explore the district nurse (DN) role in caring for palliative service users and their responsibility to prepare them and their family members to understand the trajectory of their prognosis and the possible decline in urinary function and incontinence. Educating DNs to advise service users in appropriate management options and collaborating with the wider multidisciplinary team (MDT) to ensure service users' individual goals and aims are followed as closely as possible.
Urinary incontinence (UI) is not a natural part of the ageing process, although the prevalence of UI is increased as people age, through multi-morbidities, polypharmacy, cognitive decline, mobility limitations or life-limiting conditions. UI affects an individual's dignity and can cause a negative impact on self-esteem, and it is often accompanied by a perceived stigma that can lead to anxiety, depression and a reluctance to ask for help and advice.
Palliative care in the UK is an estimated 40% of the district nurse (DN) caseload (Queen's Nursing Institute (QNI), 2021). National Institute for Health and Care Excellence (NICE) (2019) guidelines states that palliative care aims to support service users to remain active by providing relief from pain and distressing symptoms. It advocates the use of regular assessment, employing practical and emotional support strategies. Palliative care can be delivered along the trajectory of any illness in various settings, but many service users prefer their own home (Midlöv and Linberg, 2019; Walshe, 2020). The British Geriatric Society (BGS) (2021) further endorses community care, as the familiarity of home can increase quality of care and service user satisfaction. The NHS Long Term Plan (2019) also encourages home care wherever possible, avoiding unnecessary hospital admissions. It is suggested that over 60% of individuals in the UK would prefer a home death (McIlfatrick et al, 2017; Ramplin, 2019; Kelly, 2021); however, due to complications, choices made by family and unfeasibility, only half achieve this goal. Further, Boot (2016) and Stoddard et al (2021) found that service users find the home environment comforting at the end of life, and it also allows for family members to be involved in all aspects of care.
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