1. How we help patients psychologically through preparation Techniques in a Urology department. Presented by Yvie Morley – Health Play Specialist (Nephro-Urology) & Cheryl Jennings Urology Nurse specialist. Royal Manchester Children’s Hospital

2. Sue Wright – Urology nurse specialist Janet Fishwick – head of urology specialist nursing Cheryl Jennings - Urology Nurse Specialist Bev Whitnall – Urology Nurse Specialist Meet the Nursing Team

3. Bladder Augmentation Mittrofanoff. Removal catheters. Bowel Management. Urodynamics. Bladder Neck repair. Formation of urostomy Bladder extrophy transition clinic. Bladder washouts. Bladder Assessments. Intermittent self catheterisation. Urology Preparation

4. Challenges

5. What catheterisation involves

6. Distressing for child Invasive procedure Reluctance to comply Not short term, life long Intermittent self catheterisation

7. Preparation for catheterisation. Magazine Story books/ comic book Step by step cards Catheter Ted DVD Mirror Catheter Play Catheterisation Diaries

8. Lots of upset children Needed to slow the process down Make the child feel involved in the process Consider their feelings and thoughts Give them hints, tips and encouragement. Simple pictures Step by step approach. Gain the child’s trust Catheterisation Diaries

9. Catheterisation Diary Gets the child talking about their feelings towards the procedure without feeling interrogated!

10. Distressed child Joint Home visits Insert tip of catheter Play with catheters e.g. bath time. Insert up to bladder neck Complete diary For thought and feelings Locating urethra Using a mirror. Fully insert catheter. Placing catheter Around urethral Opening. A psychological approach

11. Nurse led clinic Full bladder assessment Advice on fluid intake/diet Intensive bladder training programme Simple explanation on how the urinary system should work. Support for child and family. Referral for urodynamics. Work book to complete. Bladder Assessment Clinic

12. Lots of information given here and there. Nothing that was aimed directly at the child. Nothing that really engaged the child in the assessment. Long and not child friendly charts to fill in. Information that wasn’t needed. Simple clear information that both child and family can follow. A section for extra information/help/support An incentive for the child to complete the programme for 2 weeks. Why have a work book ?

13. Original bladder Diary

15. Simple picture of the urinary system Brief explanation about section What’s in the book ?

16. 5-10 years reminder how to train your bladder. 10 years + how to train your bladder.

17. Draw on how many drinks you had today. What drinks are good /bad for the bladder.

18. The good fibre guide. Poo diary!

19. The wetting Diary Simple Key for the child to follow when filling in diary.

20. A5 School Diary Easier to keep in bag at school attach it to main diary before clinic review.

21. The incentive to complete the programme.

22. Just a bit of fun

23. Sarah’s Diary It’s really annoying me!

24. Children engage with the programme Abigail’s comments

25. Parents engage with the programme and work together with their child.

26. The Results All the children engage with the programme. Children want to continue with sheets after initial 2 week assessment. Children are dry. Decreases amount of review clinics. Increases discharge rate from service. Children feel involved in their treatment. Improves self esteem and well being.

27. Thank you for listening