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
Meet the Nursing Team
Sue Wright –
Urology nurse specialist
Janet Fishwick – head of urology
specialist nursing
Cheryl Jennings - Urology Nurse
Specialist
Bev Whitnall –
Urology Nurse Specialist
Urology Preparation
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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.
Challenges
What catheterisation involves
Intermittent self catheterisation
•Distressing for child
•Invasive procedure
•Reluctance to comply
•Not short term, life long
Preparation for catheterisation.
•Magazine
•Story books/ comic book
•Step by step cards
•Catheter Ted
•DVD
•Mirror
•Catheter Play
•Catheterisation Diaries
Catheterisation Diaries
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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 Diary
Gets the child talking about their feelings towards the procedure without
feeling interrogated!
A psychological approach
Distressed child
Joint
Home visits
Play with catheters
e.g. bath time.
Locating urethra
Using a mirror.
Insert tip of catheter
Insert up to bladder
neck
Fully insert catheter.
Complete diary
For thought and
feelings
Placing catheter
Around urethral
Opening.
Bladder Assessment Clinic
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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.
Why have a work book ?
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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.
Original bladder Diary
What’s in the book ?
Simple picture of the urinary
system
Brief explanation about section
5-10 years reminder how to train
your bladder.
10 years + how to train your bladder.
Draw on how many drinks you had today.
What drinks are good /bad for
the bladder.
The good fibre guide.
Poo diary!
The wetting Diary
Simple Key for the child to
follow when filling in diary.
A5 School Diary
Easier to keep in bag at school attach it to main diary before
clinic review.
The incentive to complete the
programme.
Just a bit of fun
Sarah’s Diary
It’s really annoying me!
Abigail’s comments
Children engage with the
programme
Parents engage with the programme
and work together with their child.
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.
Thank you for listening