An Interdisciplinary Approach to Continence Problems: The Role of The Advance Practice Continence Nurse
From the Summer 2010 issue of Quality Care®, NAFC's newsletter
By Susan Rinkus Farrell, MSN, RN, GNP-BC
Ms. Rinkus Farrell has disclosed that she has no financial interests related to this topic.
Living with untreated continence problems takes a serious emotional, financial, social, and health toll on the individual, their family, and friends. There are many risks factors that, in some studies, are associated with continence problems: excess weight, cigarette smoking, pregnancy and vaginal births, menopause, pelvic surgery, prostate diseases, chronic conditions such as diabetes and Parkinson's, and medication side effects to name a few.
Just as there is not one single factor responsible for continence problems, there are a variety of healthcare provider options when seeking care. One such healthcare provider option is an Advance Practice Continence Nurse (APCN).
There are several types of APCNs with Nurse Practitioner (NP) being the most common. NPs are Registered Nurses (RN) licensed by their State Board of Nursing. They are nurses with advanced education and clinical training from an accredited nursing program. Most NPs have either a masters or doctorate degree beyond their nursing degree. NPs must also take a national credentialing exam in their specialty area. In addition to extra training, many NPs are board certified and may go through residency programs, fellowships, and specialty certifications for additional training.
NPs provide high quality health care services. They make diagnoses, order tests and prescribe medications. NPs provide a unique blend of nursing and medical care stressing both care and cure. NPs focus on health promotion, disease prevention, health education, and counseling, key element sot successful incontinence treatments. They practice under the regulations of their state RN license and are not directly supervised by physicians. NPs have been around since the 1960's, and today, many NPs are primary care providers.
Typically, a NP specializing in continence problems practices as an APCN. The APCN may also be nationally certified in continence or urology and receive additional education and training in bladder and bowel incontinence problems.
The APCN focuses on prevention, early intervention, and patient education. They help the patient establish lifelong healthy behaviors to address their continence problems. These specialists work in hospitals, offices, long-term care nursing facilities, assisted living, and skilled nursing units. Some APCNs are self-employed and own their own practice.
The APCN is a good choice when seeking help for continence problems. The nature of their practice supports the clinical practice guidelines that state, "at a minimum, a basic evaluation should be performed for those with continence problems and the least invasive treatments with the fewest potential adverse complications are offered as the first choice for the treatment of bladder control problems."
The APCN may perform basic and advanced urodynamic (uro-die-nam-ic) testing in the office, order tests, and prescribe medications and treatment. They often provide common treatment options directly in the office such as pessaries for pelvic organ prolapse, biofeedback electrical stimulation, and vaginal weights. If not, they refer to other healthcare providers such as Physical Therapists and Acupuncturists who may provide these services or other types of continence services.
For complicated cases, the APCN will either work with or refer to a physician who specializes in the care of women with continence problems such as a urogynecologist. Another type of specialist is an urologist who specializes in problems of both the male and female urinary tract and male reproductive organs. Sometimes, patients with complicated continence problems are treated by a physician specialist first, such as with surgery or other invasive procedures, and then referred to an APCN to develop a long-term plan of care for continued success.
Successful treatment of continence problems requires an interdisciplinary team approach. The first step is to not accept continence problems as a part of daily life. Second, successful treatment depends upon seeking professional medical help for a proper diagnosis. The APCN is a good option to consider.
About the author:
Susan Rinkus Farrell, MSN, RN, GNP-BC, is a board certified Gerontological Nurse Practitioner licensed in the state of Texas. She is president and owner of Healthy Bladder Solutions in Houston, Texas. Susan's practice offers women a conservative, patient-involved integrative health approach for bladder control problems. Read more on Health Bladder Solutions' website or contact Susan.
