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Continence Care Part 1: Introduction for Practice Improvement

presented by Christine Cave

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Disclosure Statement:

Christine Cave receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Christine Cave has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

Accreditation Check:
This course provides an overview of the evidence-based approach used to improve bowel and bladder management in rehabilitation settings. This is the first of a five-course series and will identify the fundamental components needed to improve the current practice of rehabilitation nursing care of bowel and bladder dysfunction. These components include a rich understanding of the process of evidence-based practice in the specialty setting of acute rehabilitation using the Competency Model for the Professional Rehabilitation Nurse (Vaughn, et al., 2013). The purpose and use of informal leaders in rehabilitation units and how to promote the role of Continence Champions is addressed. Additional components include policies, procedures, resources, and administrative support needed to establish and sustain a team approach to promoting continence care in rehabilitation settings.

Meet Your Instructor

Christine Cave, DNP, FNP, MSN, RN, CRRN, CEP

Christine Cave is an advocate for the profession of nursing and the science of caring for rehabilitation patients across post-acute settings. Now in pursuit of an advanced degree as a doctorate prepared, family nurse practitioner at the University of San Francisco. Her specialty areas include bowel and bladder management and continence, functional and cognitive recovery…

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Chapters & Learning Objectives

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1. Scientific Inquiry & Evidence-Based Practice

This chapter will introduce the importance of a systematic approach to understanding phenomena using evidence-based methodologies. This begins with scientific inquiry, utilization of theoretical concepts and models in the review of the current body of knowledge, and interpretation of current evidence on the subject of inquiry. Identifying relevant recommendations from the evidence requires a degree of expertise when determining how to incorporate changes to current nursing practice.

2. Applying Evidence-Based Practice Principles to Continence Care

This chapter begins by introducing how to identify gaps in nursing practice in order to formulate a “burning question” (PICOTS question). Since this chapter provides an overview for the bowel and bladder management recommendations, samples of questions to guide scientific inquiry will be introduced along with the theoretical conceptual model: Competency Model for Professional Rehabilitation Nursing. The background to the proceeding educational content will be provided, including the literature review which resulted in the 6 evidence-based algorithms.

3. Theoretical Framework

This chapter will introduce the ARN Competency Model for Professional Rehabilitation Nursing as it is used to approach continence care. This model enhances the role of the rehabilitation nurse to lead the interprofessional team and impact patient outcomes through promoting self-management using nurse-led interventions: 1) Promotion of successful living, 2) Leadership, 3) Interprofessional care, and 4) Nurse-led interventions.

4. Sustaining Practice Improvement

This chapter will build an argument for nurse leaders and decision makers regarding the need to establish a bowel and bladder protocol for inpatient rehabilitation facilities. Data from prevalence studies regarding bowel and bladder dysfunction will be briefly introduced to build a strong case for implementing better care standards for bowel and bladder management. Reasons include: 1) Expenses related to poorly managed incontinence, 2) Impact on quality of patient experience, and 3) Impact on nursing perceptions of care delivery.

5. Policies and Procedures to Promote Adherence to Improved Practice

This chapter addresses the use of policy and procedures to establish a foundational expectation for nursing practice. This premise is to promote sustainable change of practice by setting standards of care. These standards include building a culture of continence (in which all team members value continence), maintaining a commitment to quality of care, setting goals for outcome measures (improved FIM scores, reduced frequency of accidents, discharge to community), and patient harm reduction/risk management.

6. Introducing Algorithms

This chapter will introduce the content remaining in the entire clinical module. Each algorithm will be introduced with a vision for use in organized care. Implementation strategies will be discussed, and a presentation of the supporting tools will be described.

More Courses in this Series

Continence Care Part 2: Evidence Based Bladder Assessment

Presented by Christine Cave, DNP, FNP, MSN, RN, CRRN, CEP

Continence Care Part 2: Evidence Based Bladder Assessment

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This course introduces the methods for rehabilitation nurses to begin focused assessments of bladder function by first describing the normal physiology of micturition. The pathophysiology of urinary dysfunction will then be discussed with associated diagnoses common to the rehabilitation patient population. The patient interview followed by a focused nursing assessment is then described. This course will also discuss convenient methods for collecting and trending a patient’s bladder function.

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Continence Care Part 3: Evidence Based Bowel Assessment

Presented by Christine Cave, DNP, FNP, MSN, RN, CRRN, CEP

Continence Care Part 3: Evidence Based Bowel Assessment

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
This course introduces the methods for rehabilitation nurses to begin focused assessments of bowel function by first describing the normal physiology of digestion, absorption and defecation. The pathophysiology of bowel dysfunction will then be discussed with associated diagnoses common to the rehabilitation patient population. The patient interview followed by a focused nursing assessment is then described. Methods to collecting and trending a patient’s bowel function data are key to establishing continence. This course is a pre-requisite course to the subsequent intervention course for Course 5: Bowel Dysfunction.

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Continence Care Part 4: Management of Urinary Dysfunction

Presented by Christine Cave, DNP, FNP, MSN, RN, CRRN, CEP

Continence Care Part 4: Management of Urinary Dysfunction

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
After completing a comprehensive assessment of a patient’s bladder function and capturing episodes of voiding patterns for at least 48 hours, the rehabilitation nurse can initiate interventions to address the predominant symptom of either incontinence or retention. This course will describe the various presentations of urinary incontinence as it relates to underlying structural or neurological deficits. Evidence-based nursing care recommendations that are the least invasive and least expensive will be discussed. Pharmacologic treatment will briefly be described. This course will present the symptom of urinary retention in association to various underlying pathologies, along with options for management. Neurogenic bladder will then be presented with recommended management strategies for nurses. The long-term care planning needed for affected patients will be presented, with emphasis on patient education and establishing a follow-up plan for ongoing support once a patient is discharged to the community.

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Continence Care Part 5: Management of Bowel Dysfunction

Presented by Christine Cave, DNP, FNP, MSN, RN, CRRN, CEP

Continence Care Part 5: Management of Bowel Dysfunction

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
After completing a comprehensive assessment of a patient’s bowel function and capturing at least 3 to 7 days of bowel patterns, the rehabilitation nurse can initiate interventions to address the predominant symptom of either constipation or loose stool with or without fecal incontinence. This course will describe the various presentations of bowel dysfunction as it relates to underlying gastrointestinal, musculoskeletal or neurological deficits. Evidence based nursing care recommendations that are the least invasive and least expensive will be discussed. Pharmacologic treatment will be presented and the use of these interventions as they impact the functional independence measure. The symptoms of neurogenic bowel, constipation and loose stool (with or without diarrhea/fecal incontinence) will be presented in association to various underlying pathologies and options for management will be presented. Prevention strategies that avoid constipation and diarrhea through natural and behavioral interventions will be presented, with emphasis on the rehabilitation nurse’s role to education patients and their caregivers.

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