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

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

• 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

Challenges

What catheterisation involves

•Distressing for child

•Invasive procedure

•Reluctance to comply

•Not short term, life long

Intermittent self catheterisation

Preparation for catheterisation.

•Magazine

•Story books/ comic book

•Step by step cards

•Catheter Ted

•DVD

•Mirror

•Catheter Play

•Catheterisation Diaries

• 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

Catheterisation Diary

Gets the child talking about their feelings towards the procedure without feeling interrogated!

Distressed child

Joint Home visits

Play with catheterse.g. bath time.

Locating urethraUsing a mirror.

Fully insert catheter.Insert tip of catheterInsert up to bladder

neck

Complete diary For thought and

feelings

Placing catheterAround urethral

Opening.

A psychological approach

• 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

• 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 ?

Original bladder Diary

Simple picture of the urinary system

Brief explanation about section

What’s in the book ?

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!

Children engage with the programme

Abigail’s comments

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