The best of EAUN23: Key takeaways

Meeting the needs of the elderly population
EAUN23 kickstarted with Plenary Session 1: Increasing urological care in an aging population where Prof. Chris Chapple (GB) and Mr. Kevin Ancog (AU), Chair of ANZUNS (Australia and New Zealand Urological Nurses Society) presented vital viewpoints on the topic.

During Prof. Chapple’s lecture “Influence of an aging population on the urological care”, he discussed that the elderly population is increasing and along with this rise are more problems with bladder control and sexual function. As a consequence, this increase will influence the number of people seeking urological care. By 2050, about 30% of people in Europe will be older than 60 years of age; and access to healthcare will even be a bigger challenge.

Regarding functional urology, the lower urinary tract symptoms (LUTS) presenting in overactive bladder (OAB) was addressed. This can be caused by a change in bladder function when getting older; there is a change in the Pontine metrician centre.

Furthermore, incidences of urinary incontinence (UI) increases with age in women as in men. Often due to OAB symptoms, frail older people in particular have worse outcomes when it comes to surgery. One must take into account of the patient as a whole and not only his problem; for example, one could look into behavioural strategies such as frequency volume chart and lifestyle measures.

According to Prof. Chapple, UI is a common condition in older people that is usually multifactorial and a burden to the patient. Devices, aids, and technical solutions can have the potential to improve quality of care.

Another aspect to consider in aging is brain health (i.e. getting older healthy). The expression “use it or lose it” points to the direction of lowering the risk of dementia through engagement in intellectual, social, and physical activities. In addition, social isolation and loneliness are factors to consider as well. Pet therapy can help against loneliness and can help in survival.

In the lecture “How to prepare to an increase of urological elderly patients”, Mr. Ancog underscored that being prepared is crucial. He stated, “Are we prepared to the changes in healthcare now and in the near future? The elderly population is increasing faster every year. Moreover, helping the elderly patients prepare for appointments or hospital stays can be challenging. This is something we need to take into account as nurses.”

According to Mr. Ancog, healthcare is not only about getting better, but also about maintaining the maximum functional capacity of patients which can improve overall health and well-being. “As nurses, we should be prepared because of the increase of urological conditions such as haematuria, UTI (urinary tract infections), LUTS, penile disorders, and sexual activity in > 60 years. Research shows, 90% of elderly people are sexually active.

Mr. Ancog also covered service mapping in his lecture. Service mapping is a method wherein the availability of a specific healthcare is matched according to a nurse’s area of responsibility and expertise. An example of this is upskilling the competencies of nurses to adapt the process of healthcare such as prostate biopsies in prostate cancer patients.

Mr. Ancog concluded that nurses have a critical role in responding to the health needs of elderly urological patients. He stated, “Since there is no ideal way of preparing services for the increase of elderly patients, we have to redesign our services, including upskilling of nurses to perform procedures that were traditionally done by doctors.”

Care for patients with a urostomy
Thematic Session 2: Supportive care and use of technology for patients with a urostomy provided updates and important insights on self-care strategies, the use of technology, and the role of the psycho-oncologist in patients with an ostomy.

The adaptation process to the new condition that requires different lifestyle and development of self-care skills, involves a great challenge on physical, psychological, and social levels. In her lecture “Self-care in ostomy patients – the experience of having a urostomy”, Dr. Giulia Villa (IT) presented the latest literature on ostomy nursing care, which also included support for both patients and their families with a focus on the results of expert group opinion on urostomy care.

Self-care is considered essential in the maintenance of psychological stability and quality of life among patients with urostomy. Promoting effective self-care is extremely important for an optimal adjustment. It is influenced by some factors such as cognitive and functional abilities; social support; access to care; experience and ability; motivation; cultural beliefs and values; confidence in abilities and habits.

Healthcare professionals have a key role in supporting adaptation by encouraging patients to be directly involved in stoma care, and creating the best conditions to promote an effective self-management. Dr. Villa presented a study that investigated the most important factors in predisposing high level of self-care: female gender, high educational level, high levels of information received, autonomy in stoma management, and high self-efficacy.

Qualitative literature showed that the first challenge seems to be the decision-making about urinary diversion. During her presentation, Dr. Villa spoke about the patients’ experience after radical cystectomy with urostomy. The literature results showed that a urostomy brings important changes in all possible personal aspects, resulting in the need for a relational support system. The literature also stated that characteristics of self-care levels and the experience were similar to intestinal ostomy patients. Therefore, it is fundamental to support patients particularly in shared decision-making and self-management of their urinary diversion.

The clinical nurse specialist is vital in the educational and emotional support for patients. When patients receive sufficient information, it can help reduce their emotional stress, as well as increase communication skills.

Mrs. Danila Maculotti (IT), presented a telemedicine implementation experience in ostomy patients. The digital health revolution in recent years has huge potential benefits but has increased risks concerning personal sensitive data and privacy. The Smart Ostomy Support (SOS) represents an innovative model to offer remote assistance to ostomy and incontinent patients, based on a telemedicine app.

To find support and help, patients would generally rely on internet searches and use non-secure tools that may fail to protect privacy and uphold confidentiality. The main goal of the SOS project is discourage potentially dangerous self-treatment and increase a safe ostomy management. The SOS project could decrease the environmental impact by helping patients with reduced mobility to receive a nursing or medical consultation without leaving the house. This technological support can reduce costs for the healthcare system, and prevent inappropriate emergency departments admissions.

The final lecture of the Thematic Session was by Dr. Alex King (GB), who discussed the psycho-oncologist’s support and role, ranging from the diversion’s choice of urinary diversion to ostomy post-discharge daily management.

Therapeutic relationship between nurses and patients
On behalf of Italian National Association of Urology Nurses (AIURO), State-of-the-art Lecture 1 AIURO keynote lecture: Italian research on measurable outcomes of the nurse-patient therapeutic relationship covered the clinical and human value of spending time in a therapeutic relationship during pelvic floor rehabilitation.

At present, there are more patients who suffer from UI and access rehabilitation services compared to more than a decade ago. Rehabilitation is not a linear process and similar to stock market performance, there are improvement, relapse, and plateau. Success depends half on the rehabilitation personnel and half on the patient. Is there a way to assess the contribution of the therapeutic nursing relationship to the achievement of therapeutic objectives?

The characteristics of the nurse-patient therapeutic relationship was investigated from the point of view of adults living with UI during a conservative rehabilitation pathway. A monocentric, descriptive, mixed-method study was conducted in the nurse-led continence clinic of a teaching hospital in Milan on a sample of consecutive patients of both genders with non-neurogenic UI. Birthmothers and neurogenic LUTS were excluded, as the clinic does manage these types of patients.

A semi-structured interview, the Short Form 12 questionnaire, and a modified Mishel Uncertainty in Illness Scale(MUIS) questionnaire were administered. The rehabilitation programme was led by a nurse specialist using pelvic floor muscle training (PFMT), Functional Electric Stimulation, and Transcutaneous Tibial Nerve Stimulation according to EAU Guidelines and ICS (International Continence Society) indications [1-3]. The interview was conducted as part of standard practice. Thematic and phenomenological analysis was conducted (interview guide available upon request) [4]. Regarding uncertainty, the theoretical framework was maintained and adapted the inventory based on Mishel’s theory created for oncologic patients. The result is the MUIS-Pelvic Floor questionnaire, which we validated.

Ninety-one interviews and 91 SF-12 questionnaires were obtained (54M, 37F). The mean age was 67±4 years, and medial initial leakage was 245 grams/day, IQR[90;370], with 79% of the patients gaining continence after a median of 12 weeks. The patients had stress (n=63, 69.23%), urge (n=18, 19.78%) and mixed UI (n=10, 10.09%), similarly distributed in both genders (p=0.13). Eighteen persons (10M, 8F) required electric stimulation other than PFMT. The results were the following:

• The physical scores showed everyday activities requiring moderate effort (p<0.001), working ability (p=0.002) and limitation in everyday life (p<0.001).
• Psychological scores demonstrated emotional situation generated by UI (p=0.015), ability to concentrate (p=0.0145), perception of serenity (p=0.003), feeling of discouragement (p<0.001) and interference of UI with social activities (p<0.001).
• The psychological scores were higher at six weeks among patients explicitly reporting effective support from nurses (p=0.03).
• The MUIS-PF proved reliable (alpha=0.93) and valid (loadings range [0.62-0.95], KMO=0.937, Bartlett p<0.001).

Four domains emerged from the questionnaires and the interviews: ambiguity, incongruence, complexity, and unpredictability.

The supportive relationship (SR) aims to develop and foster the person’s ability to understand the meaning of their situation and form a cognitive-behavioural scheme. The study was the first on rehabilitation nurses to have investigated in-depth the contribution of nurses’ SR to adherence and patients’ well-being.

Therapeutic success requires dedication, education, and spending time understanding the challenges faced by patients. As the Italian code of nursing ethics says, “The time spent in therapeutic relationship is caring time.”

References

1. Harding CK, Lapitan MC, Arlandis S, Bo K, Cobussen-Boekhorst H, Costantini E et al. EAU guidelines on management of non-neurogenic female LUTS 2023. Retriewed from www.uroweb.org on Feb 23, 2023.
2. Cornu JN, Gacci M, Hashim H, Herrmann TRW, Malde S, Netsch C. EAU guidelines on management of male LUTS 2023. Retriewed from www.uroweb.org on Feb 23, 2023.
3. Abrams,P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 6th Edition (2017). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733.
4. Priest H. An approach to the phenomenological analysis of data. Nurse Res. 2002;10(2):50-63. PMID: 12518666.

Access EAUN23 content
Webcasts are available of the presentations given at EAUN23. Visit www.eaun23.org and browse the scientific programme or the EAUN23 Resource Centre. Access is free if you attended EAUN23, or can be purchased separately. (https://resource-centre.uroweb.org/resource-centre/eaun23). View the presentations in full, as well as abstracts, poster and video presentations.

We look forward to seeing you in Paris at EAUN24!