Effective Continence. A seamless flow of care

The value of using an integrated family centred model of care to support effective continence case management FRANCES RYAN 18 JULY 2012

Integrated Family Support Co-ordinates services Encourages professional collaboration Networks and connections that focus the continuum of health care delivery around the patient Accenture: Connected Health (2012)

Shaping The System Through Integration Coordination of services to empower people to manage their own health Health resource use is most effective At its heart integration "seeks to improve the quality of care for individual patients, service users and carers by ensuring that services are well co-ordinated around their needs.” (Kings Fund 2012) Jane O’Malley Chief Nurse MOH August 2012 Inaugural conference NZNO PHCC

Shaping The System Through Integration 2012, 2013 MOH focus Child and maternity Wrap around services for older adults Integrated family health centres Jane O’Malley Chief Nurse MOH August 2012 Inaugural conference NZNO PHCC – 2011 – 2012 CDHB Annual Plan A responsive and sustainable system where providers work collaboratively to wrap care around the individual

WHAT DO PEOPLE WANT People want co-ordination. Not necessarily (organisational) integration. People want care. Where it comes from is secondary Integrated Care: what do patients, service users and carers want? National Voices. January 2012

A seamless flow of care HOW???

IMPACT of INCONTINENCE ` Child and their family Minor impact Profound effect Cost Don’t discount Verbal abuse Physical abuse Humiliation

CONTRIBUTING FACTORS to Continence Problems Fluid intake Diet Environmental – social Maturation delay Missed training opportunity Toileting phobias or fears

DEVELOPMENTAL SKILLS Children become clean and dry when they have learnt to respond to both physiological and environmental cues A combination of these skills and parental awareness and responsiveness are the essentials to good bladder & bowel habits

Physiological Cues The child has to: Have voluntary control of the anal and urethral sphincter Have awareness of the sensation to void prior to elimination Also have awareness of discomfort when incontinent Have to ability to “hold on”

Environmental Cues The child has to: Be able to follow instruction Have the ability to communicate Have the mobility to move to the toilet Wish to want to please care givers Want to behave like their peer group Know where and when is appropriate

Other skills needed The child has to be able to: Open doors Manage clothing, including zips and buttons Climb on toilet Wipe bottom Climb off toilet Flush toilet Wash and dry hands

Boys Rules Boys also have to learn: To pass urine standing Recognise that a urinal is OK to use Boys can pass urine in front of other boys

ASSESSMENT A tool by which we develop a treatment plan Accurate assessment is the key to successful outcomes. It is not a one off exercise. (Christine Norton 2004)

Child Factors Chronological age Physical development Cognitive development Emotional social factors Behavioural Child's perception

Family Factors Family history Environmental issues Stressful life event Family attitudes Parent child relationship

Environmental Issues School toilets Toilet accessibility Peer Pressure Clothing Lack of privacy Attitudes of others

TREATMENT Goals To establish regular toileting habits To restore normal bladder / bowel control To help reduce conflict within the family To reduce concerns within the family

TREATMENT Education Proposed course of treatment Normal variation in bowel habits Symptoms may get worse initially

MAINTENANCE Fluid/food/bladder/bowel diary Adequate fluids Ensure balanced diet with adequate amounts of fibre Individualised toileting program Bladder retraining Timed toileting Medication Increase physical activity Encourage correct toileting position Cleanliness and hygiene Management of wetting/soiling

Management Strategies Disposable product Reusable product Chair covers Change of clothing School camp Household management strategies

Overview Child must be included in any planning Remove any stigma/blaming Discuss normal bladder function Set realistic goals Monitor regularly Focus on gains Use rewards and incentives Anticipate duration of plan

Overview Encourage regular toileting bladder retraining, timed toileting Consider environmental factors e.g. access to school toilets Consider management strategies Refer to health care professional

MotherFather Step Father Child AChild BChild C

Mental Health Diabetic Step Father EnuresisAutisticPreschool Heart Disease Diabetic Mental health Dementia Frail Elderly Alcoholic

CHILD School Health Professionals Family After school Sport Work Community CHILD

WINZAunties/uncles FriendsGrandparents GPPaediatric dept AfterschoolSchool camps Before schoolSporting group Respite careMentors TruancyDental Life links Police Parents workplace School – teacher, teacher aid, RTLB, support staff, SWIS, FWIS NGO’s Health Camp, Presbyterian support, Pura Pura Whetu etc

Family WINZHNZ GPHospital services Mental Health services Grandparents Brothers / Sisters Friends Sporting groups Respite care Parents workplace Church Life links NGO’s; Early Start, Barnadoes, etc

Implications Education and training Up Skill : Doctors, Nurses, Allied Health Care co-ordination; care planning; working with other professionals across boundaries Primary Health Primary health gains through good care and planning

OUTCOME By efficiently deploying multi- professional resources, integrated care systems should be better able to deliver the other things patients require: Fast access, Effective treatment, Respect for their preferences, Support for self care Involvement of family and carers

References Accenture. Connected Health: The drive to Integrated Healthcare Delivery Christine Norton CDHB Annual Plan National Voice: Integrated Care: what do patients, service users and carers want? 2012 Jane O’Malley Chief Nurse MOH August Inaugural Conference NZNO PHCC NZCA Wright LM, & Leahey MC; Nurses and families a guide ro family assessment