Book Review
Urinary and fecal incontinence - Nursing management
DB Doughty (ed)
ISBN: 978-0-8016-1444-6; 1991; 274 pages; Mosby Year Book, St Louis;
Maggie Gilding
Royal District Nursing Society
Specialist continence nursing is in its infancy in Australia, but is fast equalling overseas standards of recognition and professional management. This authoritative text on the nursing management of incontinence is overdue and welcome.
Doughty has skilfully combined the knowledge of 17 contributors (nurses, medical specialists and a pharmacist) all of whom are impressively credentialed, into a reference work of value not only to nurses but to all health professionals.
She has prefaced the text with a reminder that incontinence is a symptom of a disorder. When correctly diagnosed the rate of reversal or effective management is high. The myth that incontinence is a normal component of the ageing process is strongly dispelled. I am also impressed by the equal space and consideration given to both urinary and faecal incontinence. Currently, available texts tend to afford the assessment and management of faecal incontinence to a subordinate position.
The two sections each contain four chapters. The first chapters of each section are devoted to a review of normal, relevant anatomy and physiology. Subsequent chapters deal with common pathophysiologic processes, assessment of clients and subsequent management. The chapters on assessment provide readers with a valuable, focused, systems approach to history taking. Laboratory, imaging and urodynamic studies and their interpretation are fully explained. Methods of physical examination are clearly described. Also integral to assessment are voiding and bowel function diaries. The authors explain their correct usage and interpretation. Included are excellent examples of these as well as checklists for history taking and recording of physical assessment.
The final chapter in each section concerns management. Thorough, without being exhaustive, the management options and their rationale are conveyed in the well organised, highly readable format that is a feature of the entire text.
Clinical care, pharmacological management and surgical interventions are well described. The surgical illustrations are detailed yet clearly and effectively drawn.
Credibility is gained by the authors' effective marriage of science and skill, with caring empathy regarding the effect of incontinence on clients and carers. One minor exception to the overall tone of concern for the individual's emotional state, is the suggestion that 'ideal' interviews are prefaced by asking clients to complete the sentence 'leaking urine is like...?' (p.87). Carer interviews are preferably held separately in order to 'encourage frank disclosure of feelings and perception' (p.88). The authors suggest that carers describe what 'incontinence in (name of patient) is like...' (p.88). My concern is that the suggested interview technique may pre-empt rote fashion questioning which may not elicit the desired response.
With catheter induced 'problems' being the bain of many nurses, I would have appreciated a more in depth 'trouble shooting' guide, related to concerns such as leaking, blocking, spasm and catheter expulsion, chronic discomfort and last, but not least, infection management. Unfortunately, urinary tract infection was only worthy of one indexed paragraph (p.31).
The two main sections of the book are separated by a most informative chapter entitled 'Continence Clinics' covering all issues relating to the establishment, administration and evaluation of a clinic.
Each chapter commences with learning objectives and concludes with both a summary and a self evaluation tool. In providing a text that is logical in format and comprehensive, yet not unwieldy, the editor and authors are to be congratulated. The referencing is extensive and the indexing is reflective of the high standard of content. This text will successfully complement and expand on the currently available literature. It is a reputable reference text that I highly recommend to health professionals with both an interest and a current active role in incontinence management.
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