Jana Lognon is a Nurse Continence Advisor (NCA) in the pelvic floor clinic at Foothills Medical Centre Woman’s Health Ambulatory Clinics in Calgary, Alberta. To compliment this speciality, Jana became an NCA in 2015 to add to her knowledge base and learn new approaches for her work with women struggling with incontinence of varying kinds.
The women referred to the clinic have pelvic floor dysfunction that can have consequences for bladder and bowel symptoms including incontinence (urinary and fecal), urinary retention, outlet constipation, discomfort, pain, and chronic urinary tract infections. The clinic believes that women need a proper understanding of their condition so that they can make the right treatment choices. In light of this, Jana works as part of a team to care for clients. The nurses focus on providing assessments, teaching (either in group sessions or one on one with clients) and pessary fitting and care. Some of the nurses will also assist with cystoscopies or perform urodynamic tests. The physicians focus more on medical and surgical interventions while the physiotherapists focus on the musculoskeletal rehab patients may need.
A typical day for Jana will include 2-4 one hour initial assessments and about 3-5 follow up patients. Some days she may teach group educational sessions to new incoming patients so they have some baseline knowledge before their first appointment with a clinician. She is often assigned to help teach medical residents who will take this training into their medical career. However, the one on one time she has with her patients is the most valuable part of her job because she can see how her thorough assessments can help find simple strategies to overcome continence issues, and her motivational interviewing techniques often help patients take behavioural steps to help themselves. Patients come in with a lot of fear, anxiety, or embarrassment because of the private nature of their health issues. There are often tears on the first visit as patients disclose their symptoms to someone who cares and can help them. The tears turn to smiles and laughter as patients understand how they can be helped and that they are not alone. Daily she hears comments like, “you made me feel so comfortable talking about this” or “I can’t believe I have my life back!”
“I have been a nurse for 30 years and have loved all my jobs, but working as an NCA is probably the most fulfilling because I feel that I make such a huge difference in the lives of whole families. Women are central to their families and communities, so when I help them feel better about themselves it affects their entire outlook on life.”
Brenda Callahan is a Nurse Continence Advisor (NCA) with Eastern Health* in St. John’s, NL. Brenda finished her NCA program in 2012 and joined the team of 5 NCAs working at the Women’s Health Clinic, Health Sciences Center (HSC).
Brenda and the other NCAs provide a NCA clinic at the HSC, provincial tertiary care center. Both men and women are referred to the NCA clinic if they are experiencing bladder and / or bowel incontinence. In this role, NCA completes comprehensive assessments and physical examination of clients/patients; establishes a diagnosis (stress, urge, stress/urge, overflow, functional, iatrogenic); collaborates with the physician, patient/client, family and other health care providers as required in developing treatment objectives; provides teaching and education to client/family; implements a treatment plan that works toward a better quality of life.
After caring for many women who require a pessary as part of their treatment plan, Brenda noted some women needed extra support or education with pessary care. She attended a Pelvic Floor clinic in Calgary to train in NCA pessary. She came back to NL and brought back that learning to the clinic so the other NCAs could also better care for these patients. Now in addition to the option of physician visits for pessary care, patient can also attend the NCA pessary clinic or be trained to provide self-care at home.
Brenda and NCAs also collaborate with the urologists and urogynecologists to play an integral role in the operation of a complete urodynamics testing service at the Women’s Health Clinic.
The NL NCAs work collaboratively with physicians in clinic in the Women’s Health Clinic to assess and manage incontinence issues for the residents of Newfoundland and Labrador. In looking to the future - They look forward to expanding the program with biofeedback technology and clinic.
*Eastern Health is the largest integrated health organization in Newfoundland and Labrador. We provide the full continuum of health services to a regional population of more than 300,000 and are responsible for a number of unique provincial programs. Our over 13,000 health care and support services professionals believe in providing the best quality of care and health service delivery in our region and in the province. Eastern Health extends west from St. John's to Port Blandford and includes all communities on the Avalon, Burin and Bonavista Peninsulas.
Grace Neustaedter is a Nurse Continence Advisor (NCA) at the Pelvic Floor Clinic in Calgary, Alberta. She became an NCA to build her knowledge base and credibility for her work with Urogynecologists assessing patients, providing counselling about behavioural methods, and fitting women with pessaries.
Today she works with women aged 16-100 with pelvic floor dysfunction – bladder, bowel and prolapse issues primarily. As an NCA she provides educational workshops to new patients three times a week and spends the rest of her time in clinic assessing new patients, helping them with behavioural training, fitting and following up with pessaries, as well as self-catheterization teaching, help with cystoscopies, and urodynamic testing. Grace enjoys working with patients “who are so grateful for the help that is provided for them.”
Grace works on a multidisciplinary team in an ambulatory clinic that includes nurses, Urogynecologists, a family physician and a team of physiotherapists. They also have access to a dietitian for nutrition counselling and soon a nurse practitioner will join the team. The physicians focus on surgical and medical interventions, the nurses the assessments, behavioral training and pessary fitting and care. Services are provided by referral and are covered by provincial health insurance coverage. Supplies such as pessaries are usually covered by private health insurance.
Grace’s role as a Clinical Nurse Specialist includes education, clinical practice and assorted administrative responsibilities. Most days are spent assessing and triaging new patient referrals as well as follow up appointments and phone calls. She sees patients at the Pelvic Floor Clinic but may also be called to see patients at the main hospital. Grace also teaches a patient half-day workshop several times a month as well as educational presentations to healthcare providers and students.
“Working in this area has been the most interesting and fulfilling role in my nursing career…women, men and children who are dealing with pelvic floor issues… are amazed to find out how common these problems actually are and how some simple strategies can make such a huge difference.”
Mary Kjorven is a Clinical Nurse Specialist (CNS) in Geriatrics and a Nurse Continence Advisor (NCA) in the Interior Health Region of British Columbia. She has a small continence clinic in the Central Okanagan Seniors’ Health and Wellness Centre in Kelowna, B.C. Mary obtained her NCA certification in 2012 when she recognized the great need for services specific to bowel and bladder health for the older adult population. She incorporated the NCA role into her already existing CNS role and has been advocating for a more robust inter-professional continence clinic for her region, one that serves all populations.
Mary’s current clinic is a component of an out-patient inter-professional specialized assessment clinic for older adults. Other members of the team include a Physiotherapist, Social Worker, RN with a specialty in geriatrics, Dietician, Occupational therapist, Respiratory Therapist, Speech and Language Pathologist, Primary Care Physician and Geriatrician. Because Mary’s clinic is relatively small the wait list is high. As a result she is not able to provide the full spectrum of NCA services. Mainly she provides a comprehensive continence assessment, offers behavior modification interventions and consults to other professional services. These services include both public services within the Seniors’ Health and Wellness Centre and community private partners such as Physiotherapists with postgraduate certification in pelvic floor function.
Mary has been fortunate and continues to be grateful to have excellent CNCA mentors from other regions and provinces who continue to provide guidance for her practice. Without this collegial support it would not have been possible to build and maintain her clinic. Everything from sharing business plans of existing clinics, clinical decision support tools and the evidence behind them, education and learning modules have proven invaluable.
In her words: “Even though I was the only NCA in the region I didn’t feel like I was alone. I had enough knowledge and support to get started. We need to focus more on possibilities and opportunities, in other words, look for ways we can instead of can’t. If we have the evidence to support our practice we are better prepared when those opportunities present themselves. For example, organizations have come to appreciate that incontinence is a major risk factor for residential care placement. Often NCAs can make a difference and that provides possibilities for improving outcomes for everyone”.