Excellence in Continence Care: A Guide for Care Professionals 

Continence care is a crucial part of maintaining dignity, comfort, and quality of life for individuals in care settings. As a care professional, the role in providing effective and excellent continence care is fundamental, as it can empower an individual to feel they are maintaining their dignity and comfort. It can also empower the care workforce to reduce preventable time wastage, which has never been more important in a sector facing more challenges and time constraints than ever before. 

Care England have worked closely with Ontex who are experts in the field of continence care to produce support for care providers and improve the standards of continence care nationally.  Ontex have a national team of qualified Nurse Advisors, who are passionate about delivering great continence care who take the holistic approach that each person’s needs are unique, and the products they use should be selected according to clinical need. Ontex provide a multitude of free resources and an On Demand portal to promote excellent care, and this guide will focus on five key points to ensure a high standard in continence care: 

 

1. Assessment and Individualised Care Plans 

1. Maintaining Dignity and Respect 

1. Promoting Bladder and Bowel Health 

1. Appropriate use of Continence Products  

1. Ongoing training and support 

 

Assessment and Individualised Care Plans Dignity and Respect 

Understanding and promoting the importance of a comprehensive continence assessment is the foundation of effective continence care. It involves gathering detailed information about health status, bladder and bowel habits, medications, and lifestyle. Completing this assessment is the best way to ensure that a person is wearing the right product at the right time for them, this should be completed by a continence nurse or suitably qualified health care professional.  Assessments templates can be provided by emailing marketing.uk@ontexglobal.com .  

Steps in conducting a continence assessment can include the following points: 

• Medical History: Including any conditions that may affect continence, such as diabetes, health conditions, or recent surgeries. 

• Bladder and Bowel Diary: Maintaining a diary documenting fluid intake, toileting patterns, and any incidents of incontinence over three days. 

• Physical Examination: The suitably qualified professional could conduct a physical examination to identify any anatomical or physiological factors. 

• Risk Factors: Identify risk factors such as mobility limitations, cognitive conditions, or medications that might contribute to incontinence. 

Once this assessment is complete, an individualised care plan can be created that focuses on the specific needs of the individual. This plan should include: 

• Goals: Realistic and achievable goals for improving continence. 

• Interventions: Specific interventions such as scheduled toileting, fluid management, dietary modifications, and pelvic floor exercises (if appropriate). 

• Monitoring and Review: Schedule regular monitoring and review of the care plan to ensure it remains effective and to make necessary adjustments. 

 

Maintaining Dignity and Respect 

Maintaining dignity is paramount in continence care and this includes creating a respectful environment. Approach the subject with sensitivity and respect, understanding the potential embarrassment or shame an individual may feel. 

When Ontex provide their complimentary training in care settings, they spend time discussing what are some realistic steps to maintain dignity for the individual. This includes putting yourself in their shoes and thinking about what would matter to you. 

Practical tips for maintaining dignity could include: 

• Privacy: Ensure privacy during assessments, discussions, and care activities. Use private rooms and ensure doors are closed. When the individual is using the toilet, be aware of who else is present and how you can ensure that they don’t feel embarrassed. 

• Language: Use respectful and non-judgmental language. Avoid terms that may be perceived as infantilising or derogatory. 

• Involvement: Involve the individual in their care decisions as much as possible. Empower them to express their preferences and concerns. 

• Compassion: Demonstrate empathy and understanding. Reassure the individual that they are not alone and that you are there to support them. 

• Respecting Cultural and Personal Preferences: Be aware of cultural, religious, and personal beliefs that may influence their approach to continence care. Respect these preferences and incorporate them into the care plan wherever possible. 

Care providers could also revisit their communication policy to ensure that communication is clear and compassionate, making use of active listening and feedback techniques. This could provide the person with information, reassurance and support. 

 

Promoting Bladder and Bowel Health

Encouraging healthy habits that support bladder and bowel health can support the individual’s continence experience, potentially reducing the impact and severity of the incontinence. 

This could include diet and hydration focus points, such as: 

• Fluid Intake: Encourage adequate hydration. Ensure the individual drinks enough fluids but avoid excessive intake of caffeine, artificial sweeteners and alcohol. Care England’s recent study showed that switching to decaffeinated drinks in a care home led to a 35% reduction in toileting-related falls. 

• Diet: Promote a balanced diet rich in fibre to prevent constipation. Include fruits, vegetables, and whole grains in their meals. 

• Scheduled Toileting: Encourage regular toileting schedules to train the bladder and prevent accidents. 

• Physical Activity: Encourage regular physical activity to enhance overall health and support bladder and bowel function. Exercises such as walking or swimming can be beneficial. 

• Pelvic Floor Exercises: If possible and appropriate, encourage individuals to do pelvic floor exercises, which can strengthen the muscles that control urination and defecation. A selection of pelvic-floor exercise videos created in conjunction with Phillipa Bulter, can be viewed here. 

 

Appropriate Use of Continence Products 

Selecting the most appropriate products is at the heart of excellent care and is essential for comfort and effectiveness and is often referred to as the three Rs: The right product for the right person at the right time. This is to reflect that a person’s needs can change, and this means that a product type change might be required. It should never assumed that because a product is right for one person that it will automatically be the same for somebody else. 

When comparing different products, consider: 

• Assessment: Choose products based on the individual’s level of incontinence, the persons size, mobility, and skin condition based on the completed assessment. 

• Comfort: Ensure products are fitted correctly and are comfortable. This is also related to the application of the product and other factors, such as creams. 

• Discretion: When using the products, consider how this can be done in a discrete manner that helps maintain the individual’s dignity. 

• Cost-effectiveness: Consider the cost without compromising quality. But remember that if a style of product is lower in cost compared to another, this doesn’t automatically mean it is an inferior product. A popular style of product referred to as a ‘two-piece system’, consisting of a reusable net fixation pant and a disposable small or large shaped product. This is often more cost-efficient than other styles available but is suitable for a lot of people for several reasons.  

Once selected the correct containment product, it is also paramount that the application of containment products is given the same care and attention that other medical devices need. Often, there are complaints that a product isn’t right for a person when it is instead due to the incorrect fitting of the products – refreshing this knowledge can lead to the product then being ideal for the person. 

 

Ongoing training and support 

Continual education is essential to maintain high standards in continence care. Regular training sessions and updates on best practices ensure care professionals are well-equipped to provide excellent care. Ontex have recently created free RCN-accredited online training, called the Ontex Academy, to support ongoing training and support. The educational modules are on topics about continence care in general, rather than product-specific information, and is there in addition to their product training. 

Like Ontex, product manufacturers should provide complimentary continence care training for those using their products. It is advisable to ask the product manufacturer for training as appropriate as they can provide the best practice for use. These can include the following key topics: 

• Application and Removal: Demonstrate the proper technique for correct fitting and removing products to avoid leakage and skin irritation. 

• Skin Care: Emphasise the importance of regular skin inspection and care to prevent rashes and infections. 

• Hygiene: Ensure strict adherence to hygiene protocols to reduce the risk of infection. 

 

Family education could also be provided for the users loved ones. This could include informative sessions about the care and use of products, support and appropriate record sharing. This ensures that the individual is fully supported on their continence care journey from all angles as needed. 

Conclusion 

Providing excellence in continence care requires a multifaceted approach that includes thorough assessment, respect for dignity, appropriate use of products, promotion of health, and continuous education and communication. As a care professional, dedication to these principles significantly enhances the quality of life for individuals, ensuring they receive the compassionate and effective support they deserve. 

Continence care is not just about managing a physical condition, but also about respecting and supporting the individual’s overall wellbeing and dignity which is vital in making a positive impact on their daily lives. 

 

Ontex is a leading international personal hygiene group. They manufacture high quality adult continence care solutions; you may be using their iD or Lille Healthcare products in your care setting already.  As a gold sponsor to Care England, they’re passionate about supporting you to deliver excellent continence care through using reliable products. 

They also manufacture baby nappies and feminine hygiene products. Their focus is to develop their people and work to deliver sustainable value to their shareholders, partners, customers and suppliers, while making a positive impact on the communities around us. This includes a commitment to achieving climate neutral operations by 2030 and moving towards circular products and packaging solutions.