As ICS is marking its 50th year, nurses have long been active and contributing members of the society and its committees. The idea for an ICS committee specifically focused on continence nursing was initially discussed in 2007 and in 2009 the ICS Nursing Committee was officially established soon after ICS revised its bylaws and terms of office in 2008. There was a nurse member on the ICS Advisory Committee in 2008. The first chairperson of the ICS Nursing Committee, who is elected by the entire membership of ICS, was Mandy (Amanda) Wells, from the UK in 2009 and the second, current chair in 2020 is Donna Z. Bliss, from the US. As of 2012, there is a dedicated position for a nurse on the Scientific, Education, Ethics, and Neurourology Committees of ICS and an elected position on the ICS Board of Trustees for either a nurse or physiotherapist. Katherine Moore of Canada served as a member of the Board of Trustees from 2009 to 2015 When ICS initiated its Institute to promote and focus education for its members, a Nursing School was among those established. Sandra Engberg is its first Director.
The ICS Nursing Committee is currently comprised of 12 members including the chair and organized into three subcommittees led by a chair: Research, Education and Practice, and Communications. The subcommittees plan and implement the routine activities of the committee while committee members work on task forces to implement special projects. The committee chair has also appointed a doctoral nursing student as an ad hoc member to the Nursing Committee to provide opportunity to foster interest and engagement in ICS, gain leadership experience, and encourage sustained ICS membership.
The ICS Nursing Committee has successfully planned and provided an interactive and educational Nursing Workshop and a Nursing Forum focused on global continence nursing practice issues annually at the ICS scientific meeting. These conference sessions address current varied topics and have included experts in continence nursing from the meeting’s host country to participate as speakers. Numerous nurses have presented their original research on continence related topics at the scientific sessions of the meeting and participated as experts in roundtables. The Nursing Committee most recently offered a live webinar entitled “Continence Nursing during the COVID-19 pandemic: Adjustments and Future Implications” during which ICS members discussed the impact of the pandemic on their practice, patients, and students.
With support of the ICS Educational Committee, the Nursing Committee has provided educational courses and workshops introducing continence nursing to several hundred nurses in different cities in China, mainly from urology departments in 2018 and 2019; plans for a course in 2020 were postponed due to the COVID-19 pandemic. Professor He and Mr. Larry Tsang from China have been appointed as liaisons to the Nursing Committee to assist in planning these courses. Donna Bliss, Kathleen Hunter, and Joanne Dean of the ICS Nursing Committee and Frankie Bates from the ICS Education Committee were the first two pairs of speakers.
An ongoing focus of the ICS Nursing Committee is identification or development of specialty competencies of the continence nurse. Nurse members of ICS specializing in the management of bladder, bowel and pelvic floor health have played a key role in articulating their specialist and/or advanced role and scope of their practice. An initial project (see Paterson article above) resulted in international consensus asserting that continence nursing is is a distinct specialty area of nursing practice with unique knowledge and skills that are continually developing and being refined. Moreover, nurse continence specialists work in a wide range of primary, secondary, and tertiary health and social care settings across diverse age groups, and employ assessment skills to implement targeted conservative measures to prevent, manage, and treat incontinence, and other bladder, bowel, and pelvic floor disorders. Different regulatory and professional frameworks mean the nurse continence specialist role is likely to be further developed in some countries than others. The role profile establishes a global theoretical and practice-based framework for nurse continence specialists. A chapter in the text of the Management of Fecal Incontinence for the Advanced Practice Nurse book proposes a set of competences and education from basic to advanced practice continence nursing care. The chapter presents an overview of the global development of continence nursing as a specialization and describes the advanced practice continence nursing role, explaining specialist practice and advanced nursing practice.
Advanced Practice Continence Nursing
The emergence of the advanced practice role offers has forwarded the practice scope and of continence nurses and benefitted patients. The widespread incidence of both urinary and faecal incontinence globally is expected to rise in the coming years, with significant health and economic costs for patients and healthcare systems, particularly in the community and long-term care settings. The advanced practice nurse has the potential to contribute significantly to resolving incontinence and decreasing costs to the healthcare system. Advanced practice nursing (in continence care and other specialities) is characterized by role autonomy and diagnosis and management of health problems/illnesses, including pharmacological and non-pharmacological interventions. The role also encompasses health promotion and patient education. It requires advanced clinical knowledge, skills and reasoning and professional leadership. As with the practice of other healthcare disciplines, the education, regulation, and clinical practice of advanced practice nurses differ among countries.
Assessment and diagnosis of patients with symptoms of urinary and/or fecal incontinence by an advanced practice continence nurse involves taking a history, conducting a physical examination, ordering laboratory tests as needed and the development of a differential diagnosis. The advanced practice continence nurse is able to develop and order a management plan based on best evidence, considering the patient’s goals and perceived degree of bother from their incontinence, and available resources. Advances in behavioural therapies and technologies, self-management tools including mobile applications, and incontinence containment devices and products are resources supporting the practice of the advanced practice continence nurse to achieve a satisfactory outcome for the patient. Many interventions of the treatment/management plan encourage self-management and behavioral approaches to care. Depending on the setting and problems, these can include: Lifestyle modification (e.g., weight loss, increasing water intake, supplementing dietary fibre), Behavioural therapies (such as pelvic floor muscle rehabilitation, biofeedback, bladder/bowel training, toileting programs), Use of special devices (e.g. pessaries, penile clamps, enuresis alarms, anal plugs or inserts), Techniques such as intermittent self-catheterization, posterior tibial nerve stimulation, transanal irrigation), and Containment products or devices (such as urinals, commode chairs). The advanced practice continence nurse can also identify causative factors of incontinence and refer the patient to seek further medical or surgical advice if necessary.
ICS nurse members join ICS in celebrating its 50th anniversary. As society members, nurses make a positive impact in improving the quality of life of individuals with incontinence and pelvic floor disorders through their education and practice expertise and research dissemination. At the same time, ICS nurse members have been able to contribute to advancing their continence nursing specialty.
Recent Scholarly Activities and Products of the Nursing Committee
Recent special projects of the Nursing Committee have resulted in scholarly publications. Among those are the first book of its kind focused on Management of Fecal Incontinence for the Advanced Practice Nurse, published by Springer, FR, in 2018 edited by Donna Bliss and including members of the Nursing Committee and ICS nurses as chapter authors. This book is a comprehensive resource for continence nurses about the assessment, diagnosis and management of fecal incontinence for patients in a variety of clinical settings from community to critical care. A “Consensus Statement on Bladder and Bowel Training” was recently published in Neurourology and Urodynamics in 2020 with Jo Booth, Donna Bliss and ICS as lead authors and including contributions by ICS nurses and Nursing Committee members. This project filled a major gap in knowledge about recommendations for bladder and bowel training for urgency. A manuscript about the “Development and Validation of the Role Profile of the Nurse Continence Specialist: A Project of the International Continence Society” was published in the Journal of Wound, Ostomy, & Continence Nursing n 2016 authored by Jan Paterson, Joan Ostaszkiewicz, I Gede Putu Darma Suyasa, Jennifer Skelly, and Lesley Bellefeuille (see more info below).
Current scholarly and clinically relevant projects underway by the Nursing Committee include a scoping review of evidence for dietary and fluid alternations in the management of fecal and urinary incontinence to be followed by consensus recommendations for patient management, a multidisciplinary project to develop a standard bowel diary for fecal incontinence, and the development of standard terminology for nursing interventions for LUTS and pelvic disorders. The ICS Nursing Committee is building on the role profile project to identify, describe and analyse existing competencies for all levels of continence nurses.