1. An Insight into Vaginal and Rectal Examinations amongst
An Insight into Vaginal and Rectal Examinations amongst
Nurse Continence Specialists
J. Thompson, Nurse Continence Specialist and President, CoNSA
Introduction and Aim:
The Continence Nurses Society Australia (CoNSA) is a special interest group and peak body for continence nurses in Australia. The draft CoNSA Practice Standards for Nurse Continence Specialists (NCS) guides continence nursing practice in Australia. The CoNSA Practice Standards include Standard 4 - Comprehensively conducts assessments which covers the need to be proficient in an advanced health assessment¹. This involves physical examination of a client which may include vaginal and/or rectal assessment¹. Therefore, CoNSA wanted to determine its members knowledge, competence and confidence in attending vaginal and rectal examinations and then develop a plan to address any educational needs.
Materials and Methods:
A convenience sample was used for the audit with all current members of CoNSA sent an online survey in late 2016 to early This included trade and/or associate members as some may also hold continence nursing roles.
The data collected included:
Performance of vaginal and rectal examinations
Knowledge, competence and confidence in attending vaginal and rectal examinations
Education and training undertaken and desired with performing vaginal and rectal examinations
The data was analysed using descriptive statistics.
Ethics approval was obtained from Alfred Health .
Results:
An electronic survey request was sent to 283 CoNSA members from all state branches throughout Australia. With 133 responses received, a response rate of 47% was achieved respondents completed the survey completely and 12 partially.
Vaginal Examinations
56% of respondents routinely performed vaginal examinations.
Regarding knowledge, competence and confidence in performing vaginal examinations, the respondents rated themselves as follows:
With regarding to training and education, 26% of respondents reported having received no training in vaginal examinations. Mentoring was the most common form of training. See Figure 1.
The majority of respondents felt they had learning needs regarding performing vaginal examinations (79%) with 77% interested in undertaking further education and/or training in vaginal examinations.
The majority (59%) had a preference for the education/training to be in the form of a hands on full day course with a competency certificate. See Figure 2.
Rectal Examinations
33% of respondents routinely performed rectal examinations.
Respondents rated themselves as follows with regard to knowledge, competency and confidence in performing rectal examinations:
When looking at training and education, 39% of respondents reported receiving no training in rectal examinations. Of those reporting some training, mentoring was the most common form of training received. See Figure 3.
Most respondents considered themselves to have learning needs regarding performing rectal examinations (76%) with 78% interested in undertaking further education and/or training.
The most common preference for the education/training was in the form of a hands on full day course with a competency certificate (50%). See Figure 4.
The themes of the written responses as to why the respondents do not routinely attend vaginal and rectal examinations were:
Not within role or scope of practice
Works in paediatrics
Not trained or confident or doesn’t attend
Other discipline attends
Against organisational or management policy
Not done or difficult in home or environment not appropriate
Non clinical role or not applicable to role or male NCS
Conclusion:
The draft CoNSA Practice Standards fro NCSs includes the requirement to attend a physical examination as part of a comprehensive continence assessment ¹. This is also reflected in the Joanna Briggs Institute Urinary Incontinence: Assessment and Conservative Management best available evidence paper² and the International Continence Society (ICS) update on the role of the nurse continence specialist in continence services³.
Therefore, the role of a NCS requires skills in vaginal and rectal examinations as part of such a physical examination. This survey has shown Australian NCSs have learning needs with regard to vaginal and rectal examinations and they are interested in pursuing further education and training in these areas. CoNSA is looking at supporting its membership to address these learning needs such as with the inclusion of a vaginal and rectal examination workshop at the 2018 CFA National Conference on Incontinence.
References:
¹CoNSA (2017) ‘Continence Nurses Society Australia Practice Standards for Nurse Continence Specialists’.
²Lizarondo, L. (2016) ‘Urinary Continence Assessment and Conservative Management.’ The Joanna Briggs Institute
³ Hunter, K. (2016) ‘ICS updates in continence care: the role of the nurse continence specialist in continence services.’ Urology News 21(1)6-10.
Area (%)
Excellent
Good
Average
Poor
Very Poor
Do not attend
Knowledge
4.8
23.2
36.8
13.6
1.6
20.0
Competency
3.3
23.6
32.5
13.8
4.1
22.8
High
Moderate
Low
Confidence
13.7
35.5
28.2
22.6
Area (%)
Excellent
Good
Average
Poor
Very Poor
Do not attend
Knowledge
4.8
34.9
31.7
7.9
6.3
14.3
Competency
4.9
27.0
30.3
9.8
9.0
18.9
High
Moderate
Low
Confidence
16.9
37.1
26.6
19.4