Neurogenic continence. Part 2: Neurogenic bladder management.

This article addresses physical and psychosocial issues in neurogenic bladder management. The impact of neurogenic bladder and its assessment will be discussed. There are a wide range of treatment options available to manage neurogenic bladder dysfunction and this article offers an overview of key management techniques, including non-invasive techniques, self-intermittent and suprapubic catheters, medication and surgical management. The importance of the nursing role in assessment, teaching and supporting patients by enabling them to make informed choices about their bladder management is addressed.

The nurse's role in promoting a good night's sleep for patients.

Sleep is a vital activity of daily living as it restores and refreshes. However, there are environmental, physiological and psychological factors that can affect normal sleep patterns. There are many ways in which nurses can help patients achieve a good night's sleep. This article discusses environmental, non-pharmacological and pharmacological interventions that can be used to promote sleep in hospital and community settings.

Urinary elimination: Part 2--retention, incontinence and catheterization.

In part two of this article, the nursing role in relation to the assessment and management of urinary retention, urinary incontinence and catheterization are considered using recent literature and best practice statements. Retention of urine and incontinence have a major detrimental impact on a person's life and nurses have an important role to play in supporting patients. Catheterization is often necessary for acute retention of urine but is the last resort for incontinence. However, when catheter use is appropriate, asepsis technique during insertion and continuing management can help to minimize associated problems. Urinary elimination problems are embarrassing and distressing and nurses need to deal with them with sensitivity and empathy.

Anatomy and physiology of urinary elimination. Part 1.

Elimination of urine is an essential bodily function, but independence in this activity may be affected by physical and mental disability. Part 1 of this article discusses the anatomy and physiology of the renal and urinary tract and the production of urine. Urinalysis is a vital nursing assessment and the collection of specimens and the range of tests undertaken are outlined. Assisting patients to use the toilet, commode or bedpan is an essential nursing skill. The importance of sensitivity, empathy and moving and handling risk assessment is discussed, and the assessment and management of urinary tract infection and urinary tract stones are addressed. The importance of prevention of cross infection for nurses and patients is highlighted throughout the article.

Clinical skills: bed making and patient positioning.

Providing a clean, comfortable bed and positioning a patient in the optimum posture for prevention of complications and to enable maximum independence are fundamental nursing skills. Bed-making is a daily routine that requires practical and technical skills. Selecting the correct posture for a patient in bed or in a chair is essential for physiological functioning and recovery. In this article bed-making is described, as are positioning and re-positioning in relation to patients in bed, armchairs and wheelchairs. Infection control and moving and handling issues are also considered.

Clinical skills: bowel elimination and management of complications.

Bowel elimination is a basic bodily function that most people carry out in private and are often embarrassed to discuss publicly. Nurses will encounter patients with bowel elimination issues in all areas of care. Knowledge and understanding of both normal function and the problems that can occur with that process will enable nurses to support and care for patients with bowel elimination problems. This article discusses the normal anatomy and physiology of elimination, problems, such as faecal incontinence, diarrhoea and constipation, and the nurse's role in their management. The importance of empathy, understanding, knowledge and consent is highlighted.

Patients, doctors, and therapists perceptions of professional roles in spinal cord injury rehabilitation: do they agree?

Spinal cord injury is a devastating condition, requiring extensive rehabilitation from a range of health care professionals. However, it is unclear if patients view the professionals' input into their rehabilitation in the same way as those professionals. This paper presents findings from a qualitative study into patient participation in spinal cord injury rehabilitation. The aim of the part of the study reported here was to identify whether there is agreement between health care professionals and patients perceptions of professional roles in spinal cord injury rehabilitation. Results are presented from semi-structured interviews conducted with five doctors, five physiotherapists, three occupational therapists and 20 patients in a spinal cord injury unit in England. Findings suggest considerable agreement between professionals and patients about the role those professionals play in their rehabilitation. Physiotherapists are perceived to be key to rehabilitation, occupational therapists focus on hand function but physiotherapists and occupational therapists complement each other. Doctors coordinate the team yet reduce their input as patients move out of the acute phase into rehabilitation. There are some tensions but the early input of these professionals into patients' rehabilitation may help to develop understanding of roles. Congruence between patients and professionals may mean that patients have realistic expectations and encourage a more equal relationship between them.

The role of mentors in supporting pre-registration nursing students.

Students' practice experience is one of the most important aspects of their preparation for registration. There is currently considerable emphasis on improving this practice experience with adequate support and supervision. Mentors play a vital role in supporting, teaching and assessing students in practice. This article offers a literature-based discussion of the development and current practice of the mentor role in the support and assessment of students undertaking pre-registration programmes. The development of the mentor role is discussed. Issues relating to the role in nurse education today are addressed in relation to supporting, teaching and assessing students in practice and mentor accountability. This article discusses how Higher Education Institutions and universities and service managers might support mentors in their role. The implications for practice are outlined and include the NMC standards to support learning and assessment in practice due for publication in 2006.

The safety and dignity of patients and nurses during patient handling.

Since the implementation of the Moving and Handling Operations Regulations (Health and Safety Executive, 1992) there has been considerable effort to reduce back injury among nurses by developing patient handling policy that eliminates actual manual handling. Recently, however, there have been challenges to 'no manual handling' policies by patients as an issue of dignity and human rights. This article offers a literature-based discussion of patient handling in relation to safety and dignity for both patients and nurses. The literature does not offer a solid evidence base for handling practice, and research, involving patents, is limited. However, nurses' handling practice is governed by legislation and NHS Trust policies. Patient handling that is safe and dignified for both patient and handler is a vital skill that requires knowledge and competence. This article suggests ways of developing practice that is safe and dignified for both patient and handler.

Patient-professional partnership in spinal cord injury rehabilitation.

There has been considerable pressure from both patients and professionals for greater patient involvement in the delivery of health services in recent years, particularly in the domain of rehabilitation. However, it has been suggested that involvement by patients is limited to rehabilitation. Accordingly, this study aimed to explore and describe patients' and professionals' experiences of patient participation in team decision-making processes. This article presents findings from a larger ethnographic study, which employed interviews and participant observation to collect data. This article focuses on the results from semistructured interviews, which were conducted with 30 healthcare professionals and 20 patients in a spinal cord injury unit in the UK. Findings suggest that the experience of team membership and decision-making is shaped by professional paternalism. Patients and professionals perceive that they are involved in a partnership where patients make decisions. However, different levels of paternalism in the professional-patient relationship within team decision-making processes emerged from the data. These have been categorized as 'open paternalism' where power and control lies with professionals; 'they tell me what they are doing' where patients are informed of decisions; 'they can always say no' where patients can agree or disagree; 'making the right choice' where patients are steered towards the choice professionals consider as the 'right' choice; and 'active participation' where patients choose the course of action. It is suggested that professionals should examine their own practice and attempt to develop ways of working that empower patients to become equal members of the rehabilitation team.

Perceptions of the nursing role in spinal cord injury rehabilitation.

In the UK, over the last 50 years there have been many developments in the rehabilitation of spinal cord-injured people leading to improvements in outcomes. In spinal cord injury rehabilitation nurses work as members of a multiprofessional team but their role is not clearly defined and, unlike other professionals, they have a 24-hour relationship with patients. This article presents some findings from a larger ongoing ethnographic research study. The aim of this section of the study was to identify how nurses and patients perceive the nursing role in spinal cord injury rehabilitation. Semistructured interviews were carried out with 14 spinal cord-injured patients and 14 registered nurses. The findings suggest that patients value the nursing contribution as a means of emotional and physical support but that they do not necessarily see nursing input as rehabilitation. Nurses see their role as multifaceted but identify difficulties in crossing over from an acute care philosophy to a rehabilitation philosophy. The 24-hours close relationship with patients may be a source of imbalanced power relationships between nurses and patients and this causes distress to some patients. It is suggested that nurses need to develop their bedrock role in a way that empowers patients in spinal cord rehabilitation.