Stress Urinary Incontinence
Discuss about the Nursing Care and Women’s Health.
Promoting health includes the element of providing health care facilities for the overall well-being of an individual. Women’s health is very significant for the better health of children and families. The purpose of health promotion is to make healthy communities and society. Paper is based on the case study of Mrs Gulcin Ozdemir, who lives in St Albans. According to the information obtained from the case study, Mrs. Gulcin is suffering from urinary incontinence, which is a problem associated with involuntary leakage of urine. There are four kinds of urinary incontinence, stress incontinence, urge incontinence, overflow incontinence and total incontinence. The involuntary loss of urine is the problem, which is faced by many women suffering with Diabetes. The risk of being embarrassed in the public is the reason that many women, due to which they stop enjoying daily life activities. This is happening in the case of Mrs. Gulcin, she is suffering from Stress urinary incontinence, as she suffers from the leakage of urine during physical movement. The determinants of health involved in her case her change of lifestyle, social isolation, lack of social and family support, education/literacy, language barrier, personal health practices and coping skills. Paper will discuss and identify the health needs of Mrs Gulcin and will provide a plan of care for promoting health to optimal level. Discussion will further followed by a plan based on five Ottawa Charter areas and also role of district nurse.
Stress urinary insentience (SUI) is the problem of the involuntary leakage of the urine at the time physical movement (sneezing, coughing, exercising or laughing) (Fritel et al, 2010). SUI can also occur due to pregnancy, some surgical procedures and also due to menopause. Due to pregnancy and labor, the scaffoldings that support the bladder can be damaged. The physical changes caused due to pregnancy, child birth results in stress incontinence (Kocaöz, Ero?lu, & Sivasl?o?lu, 2012). Bladder is supported by the pelvic floor muscles, ligament and vagina. The weakening of these structures results in downward movement of the bladder more towards vagina. Some of the studies have also related to diabetes mellitus in adult women (Wood & Anger, 2014, p. 4532). Stress urinary insentience (SUI) is the most common kind of urinary insentience found in women. The current body of literature explains that this problem occur due to the abnormalities in the vaginal position (Deng, 2011, p. 108). Earlier studies have also associated SUI with the unequal movement of the anterior and posterior bladder walls (Danforth et al, 2006, p. 341). The most common risk factors associated with SUI are pregnancy, child birth and obesity. The study of Danforth et al (2006) stated that prevalence of SUI is mainly found in the women between the age of 30 to 59 years (p. 346). The involuntary loss of urine is the problem which is being faced by Mrs. Glucin. She face problem during physical movement and exercising. She has given birth to four children. Therefore, the problem urinary incontinence has mainly occurred due to pregnancy and baby birth.
Health Promotion Plan Based on Five Ottawa Charter Areas
Health promotion is the process that allows people to have control over their health and improve their health subsequently. Health is considered as the most important part of daily life as it affects all the major areas of life. Promotion of health is important for the overall well being of individuals. The Ottawa Charter of Health promotion includes five specific strategies. Individuals and families are involved for making their live better by improving health.
- First strategy is to build healthy public policy. The health promotion policies or approaches are related to organization change, legislations, taxation and fiscal measures used to promote health. Health promotion policies require focusing on eradicating the obstacles to adopt health related public policies (Ottawa Charter for Health Promotion, 2017).
- Second approach is to create supportive environments. This approach states about protecting the natural environment and natural resources.
- Third approach is to strengthen community actions. The community actions include the promotion of the social support for the vulnerable population, enhancing self help among population and developing flexible systems and strengthening direct or indirect involvement of the people in public health (Ottawa Charter for Health Promotion, 2017).
- Fourth approach is to help people in developing personal skills, so that they can stay prepared for coping up with all stages of illness, chronic illness and injuries. This strategy can be applied in various settings such as, home, schools, work places and community.
- Fifth approach is the reorientation of the health services for promoting health and taking the responsibilities of providing curative and clinical services. This approach also focuses on encouraging clinical research in health sector, as well as enhancing training and education skills in professionals (Ottawa Charter for Health Promotion, 2017).
Health promotion plan for Mrs. Glucin will include referring her to appropriate health services and healthcare professionals, who can provide her with optimal care and can improve quality of her life. The care plan or the health promotion plan for Mrs. Glucin will include the health care issues and needs of the patient. According to her condition she requires support of appropriate service, which can help her to understand the severity of SUI and can provide her with social and health support to promote her health. Plan will include the rationale that what is her needs and how she is being affected by the progression of disease. The consultation process will be indentified for her, which will include consultation to appropriate health service and health care professional in Australia. The action plan for her health promotion will include “plan including consultation and joint planning, develop relationships, arrange, implement, conduct, participate, assist, deliver, evaluate and complete” (A Guide to Developing Health Promotion Programmes in Primary Health Care Settings, 2003, p. 6). The organizations working within the principles of Charter are the community health services, some of the government hospitals and some healthcare services.
Role of district nurse is to provide patient centered care and coordinate for care of the patient with other professionals. The role of nurse is also to understand the scope and purpose of providing care to patients. The nurse also understands the priorities of the patient and referring them to illness management care, continence management, and also referring to diabetic clinic (Community And District Nursing Service Models, n.d.). Mrs. Glucin is suffering from diabetes and also Stress urinary continence. She was diagnosed with type 2 diabetes six years ago and recently started to experience urinary incontinence. Therefore, as the district nurse it is important to focus on multi-disciplinary team approach for the purpose of case management and fulfilling complex care needs of patients. District nurse works with a established network of various health care services alongside providing primary care (Community And District Nursing Service Models, n.d.). The key feature that would be applied for providing primary care to Mrs. Glucin will include multi-disciplinary approach, intense case management to coordination, and referral to specialist nurse clinics. The first approach of healthy public policy is maintained by the health care service to whom patient will be referred. The second standards of Ottawa Charter of Health promotion will be applied by providing supportive environment to the patient. All the referrals for the patient will made to make the process easy for her. Third strategy of strengthening community actions is also applied by providing her with community support services and help of interpreters to receive better health information. The fourth approach of the Ottawa charter strategies have been followed by referring the patient to the community based service, where she can develop new skill and develop new knowledge. This will help her to cope with every stage of her disease. The fifth action will be considered in providing appropriate help to the patient in terms of receiving quality care and treatment through healthcare services and professionals.
Role of District Nurse
Consumer directed care will be offered to the patient. Consumer directed care allow the consumers to have better control over their lives and care. Care is offered to culturally and linguistically diverse population. District Nursing Service provides varied care facilities to patient. Mrs. Glucin is from Turkey and has difficulty in speaking English. A professional translator will be appointed through National Language line, who will translate the concerns of the patient to us, and all the health information to patient (Community And District Nursing Service Models, n.d.). Providing care via complete health promotion strategies believes that language should never become barrier to access health information. Therefore, health information will be provided to the patient in her language. Talking books are also available for patient related to diabetes, which she can use to understand the complications of diabetes and self management of disease. Through diversity framework provide services to people over 150 nationalities and around 120 languages.
The first referral provided to Mrs. Glucin, would be to St Albans Medical Centre. Appointment to the hospital will be made from our end. First appointment with the diabetes and women’s health educator nurse will be made for her. The appointments from the nurses Nicola Pratelli or Suzanne Nail (practice nurses) will be taken. They will help the patient to understand general health related complication. Nurse will also provide diabetics clinics and assistance in managing urinary incontinence. She will be referred to Dr Chau Le (female) at the St Albans Complete Health Care. She will be referred to Western Continence Services situated in St. Albans by the GP. Patient will be assessed by the continence nurse and a diabetes nurse at the Western Continence Service. According to her health status of the Patient will be referred to Sunshine Hospital Melbourne. Mrs. Glucin will also feel supported and safe, as she will be referred to female nurse and doctor. Dr Dorota Urbaniak is GP from St Albans Medical Centre, which is close to Mrs. Glucin’s house. All appointments will be made for the patient from the end of district nurse, as the patient has language barrier.
Hospital and clinicians will also be informed about booking a female Turkish interpreter. A letter notifying the GP of the client’s presenting problems & past history will also be provided with the consent of patient. Sunshine Hospital Melbourne provides translators for the non-English speakers. Hospital provides Turkish translators as well. Therefore, Mrs. Glucin will feel more comfortable (Sunshine Hospital Melbourne, n.d.).
Referring the Client to Appropriate Service in Melbourne
The referral to the service will be provided to the patient, where she can receive appropriate care and treatment for SUI, which is situated close to her home. The professionals working at the service are experienced and work according to the health promotion strategies. Patient Mrs. Glucin is eligible to take the treatment from Sunshine Hospital Melbourne, as she fulfills all the criteria for getting an appointment from the health care professional of the hospital. The service is also appropriate for Mrs. Glucin in terms of transportation, language barrier, culture, child care and cost.
The health care service is specifically dedicated to promote women’s health in various areas. Health equity is the mission of the hospital, which means that Mrs. Glucin can get appropriate assistance regardless of her different ethnicity. The service is committed to meet the needs of diverse community and equity framework reduces health inequalities. Hospital provides comprehensive services for Stress urinary continence. The problem is treated according to age, health and medical history of the patient..
Patient will be referred to the Turkish Community Service in her area, as she is not able to drive, so she can reach the community center close to her house easily. The major health determinant for her is social isolation and lack of social support. She faces financial constraints due to which she is not able to visit her family in Turkey and feels lonely. She is also not very keen about her health, which displays lack of health literacy, as she believes that the tablets which she is taking will cure her soon. District nurse can help the patient to gain health literacy. The referrals, which will be made for her, will also help her to gain health literacy and more knowledge about her health issues and how they can be managed.
She is in dire need of social support, so that she may not feel lonely in Australia. District nurse will refer her to Australian Turkish Cypriot Cultural and Welfare Association. The referral will be made through phone calls and providing her with a letter from district nurse with her social, personal and emotional needs. All information will be provided to community center with the consent of patient. This cultural and welfare association is located in St. Albans. This association is involved in providing social support to women, youth, unemployed and migrants from Turkey (Australian Turkish Cypriot Cultural and Welfare Association, n.d.). This community service caters the cultural, social and recreational needs of the members. Women are encouraged to participate in cultural, social and community activities to reduce social isolation and promote social support.
Mrs. Glucin will feel comfortable and connected to the community, as there are many Turkish women associated with this community service. The community service also encourages social functions, seminars, different learning courses and conferences to help Turkish women to cope with their life style in Australia (Australian Turkish Cypriot Cultural and Welfare Association, n.d.). Australian Turkish Cypriot Cultural and Welfare Association also help Turkish people to employment through their training courses. She can develop a social network through this community service by coming in contact with other Turkish migrants. This will improve her confidence and will encourage better coping skills (Razurel et al, 2011). Social activities will encourage better health and resilience.
Conclusion
Paper refers to the case study of Mrs. Glucin, who is a mother of four children and loves to look after her children and to cook traditional food for them. She is from turkey and shifted to Australia 9 years back. She is suffering from Diabetes since last six years and has been facing the problem of urinary incontinence since last few weeks. She is embarrassed about sharing her problem with GP. According to her case study, it is found that she is suffering from Stress Urinary incontinence.
Paper discussed the Pathophysiology associated with Stress Urinary Incontinence and what are the main causes associated with the disease. Paper provides the details about the risk factors associated with disease. A comprehensive set of literature is provided to discuss SUI in terms of causes and risk factors. Paper also discusses the association of SUI with diabetes. Paper is followed by the health promotion plan based on the five principles of Ottawa Charter. According to the health care needs of the patient, paper also offers the information about the health care service, which can provide appropriate care and treatment to the client.
References
A Guide to Developing Health Promotion Programmes in Primary Health Care Settings. (2003).
Retrieved from: https://www.hauora.co.nz/assets/files/PHO%20Info/dvpinghealthpromotionprogs.pdf Australian Turkish Cypriot Cultural and Welfare Association. (n.d.). Retrieved from: https://www.atccwa.websyte.com.au/site.cfm?/atccwa/1/
Community And District Nursing Service Models. (n.d.). Retrieved from: https://www.bopdhb.govt.nz/media/57859/paper-community-and-district-nursing-service-models.pdf
Dannecker, C., Friese, K., Stief, C., & Bauer, R. (2010). Urinary incontinence in women. Dtsch Arztebl Int, 107(24), 420-6.
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(2006). Risk factors for urinary incontinence among middle-aged women. American journal of obstetrics and gynecology, 194(2), 339-345.
Deng, D. Y. (2011). Urinary incontinence in women. Medical Clinics of North America, 95(1), 101-109.
Fritel, X., Fauconnier, A., Bader, G., Cosson, M., Debodinance, P., Deffieux, X., … & Haab, F.
(2010). Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. European Journal of Obstetrics & Gynecology and Reproductive Biology, 151(1), 14-19.
Golbidi, S., & Laher, I. (2010). Bladder dysfunction in diabetes mellitus. Frontiers in pharmacology, 1, 136.
Kocaöz, S., Ero?lu, K., & Sivasl?o?lu, A. A. (2012). Role of pelvic floor muscle exercises in the prevention of stress urinary incontinence during pregnancy and the postpartum period. Gynecologic and obstetric investigation, 75(1), 34-40.
Ottawa Charter for Health Promotion. (2017). Retrieved from:https://www.betterhealth.vic.gov.au/health/servicesandsupport/ottawa-charter-for-health-promotion?viewAsPdf=true Razurel, C., Bruchon-Schweitzer, M., Dupanloup, A., Irion, O., & Epiney, M. (2011). Stressful
events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study. Midwifery, 27(2), 237-242.
Sunshine Hospital Melbourne. (n.d.). Retrieved from: https://www.westernhealth.org.au/OurSites/SunshineHospital/Pages/default.aspx Wood, L. N., & Anger, J. T. (2014). Urinary incontinence in women. Bmj, 349(15), 4531-4542.
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