The Role of the Practice Nurse in Bedwetting

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The Role of the Practice Nurse in Bedwetting

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• Chance disclosure
• Sensitive topic
• lt 5 years
• gt 5 years

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Incidence

• 20 5 year olds
• 10 10 year olds
• 3 teenagers
• 1-3
  adults

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Causes of primary nocturnal enuresis

• Strong hereditary component
• Exceeding bladder capacity
• Nocturnal polyuria
• Small bladder capacity /spasmodic bladder
• Delayed development of brain arousal to nocturnal
  bladder distension

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Alarm Training

• Brain arousal is central to the development of
  permanent nocturnal continence
• Enuresis alarms turn a very small signal into a
  very large signal

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Training with an alarm

• If no dedicated practice clinic
• Public health funded services
• Community based bedwetting clinics
• Web sources for information, and access to
  bedwetting alarms

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Resources

• Brochures, information sheets, databases eg
• www.keea.org.nz (Kiwi Enuresis Encopresis
  Association)
• www/continence.org.nz (NZ Continence Association)
• www.bedwet.net.nz (Bedwetting Solutions Ltd)
• www.kidshealth.org.nz (Paediatric Society of NZ)
• www.eric.org.uk (Education and Resources for
  Improving Childhood Continence, UK)
• www.bedwettingstore.com (alarms, continence
  products)

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Resources
Both these books are available online from the NZ
Continence Association 20.00 each

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Nurse-led bedwetting clinic

• Funding
• Interest commitment
• Key Points in alarm training
• Child ownership
• Parental guidance
• Consistency in alarm use
• Fluid intake

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Nurse-led bedwetting clinic

• Structuring a clinic
• Initial consultation
• Follow-ups
• Completion/Ceasing training
• Relapse/Redo
• Sourcing alarms
• Covering costs

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Initial Consultation

• Building rapport
• Information gathering and giving
• Alarm tuition
• Supportive materials
• Financial commitment

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Follow-up

• Face-to-face
• Telephone/e-mail
• Teenagers texting
• Variable need for follow-up

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Hire Data 121 First Hires over an 8 month
period
Block Total Number. Pattern Needed
Assistance
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Completion/Cessation

• Monitor progress closely after 12 weeks
• Possible over-learning stage
• Criteria of success 21 consecutive dry nights

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Relapse/Re-try

• Relapse more than two wet nights over two weeks
• Relapse rates vary from 25 to 50
• Overlearning can reduce relapse
• Relapse checks
• Variance in response
• Re-trying alarm training

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Selection of alarms

• Three main types of enuresis alarms

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Bedmat alarms
Drop Stop
Wet Call
Ramsey Coote
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Body-worn wired personal alarms
DRI-Sleeper
Malem
Wet-Stop2
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(No Transcript)
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Remote sensor alarms
Enurad
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A couple of scenarios
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References

• Nijman RJM, Butler R, Van Gool J, et al.
  Conservative management of urinary incontinence
  in childhood. In Abrams P, Cardozo L, Khoury S,
  Wein A, editors. Incontinence. Paris Health
  Publication, 2002 513-551.
• Hunskaar S, Burgio K, Diokno AC, et al.
  Epidemiology and natural history of urinary
  incontinence (UI). In Abrams P, Cardozo L,
  Khoury S, Wein A, editors. Incontinence. Paris
  Health Publication, 2002 165-210.
• Caldwell P, Edgar D, Hodson E, Craig J. (2005).
  Bedwetting and toileting problems in children.
  Medical Journal of Australia, 182 (4) 190-195.
• Yeung CK, Sit FKY, To LKC, Chiu HN, Sihoe JDY
  Wong C. (2002). Reduction in nocturnal functional
  bladder capacity is a common factor in the
  pathogenesis of refractory nocturnal enuresis.
  British Journal of Urology, 90, 302-307.
• Paediatric Society of New Zealand (2005). Best
  Practice Evidence Based Guideline. Nocturnal
  Enuresis Bedwetting. Available from
  www.nzgg.org.nz/guidelines. Accessed 3rd
  September 2008.
• Neveus T (2003). The role of sleep and arousal
  in nocturnal enuresis. Acta Paediatrica, 92(10)
  1118-23.