Dr. Hanny Cobussen-Boekhorst wins prestigious Ronny Pieters Award

Dr. Cobussen-Boekhorst is a urological nurse practitioner at the Radboud University Medical Centre in Nijmegen (NL), with many years of experience in benign urologic care, neurogenic bladder care, stoma care, and paediatric care. She was the first urologic nurse practitioner in the Netherlands to hold a PhD and has won many awards including the Best EAUN Nursing Research Project, Best poster prize ESPU, Best presentation prize ICCS, Continence Nurse of the Year, and is an honorary member of the Dutch Continence Nurse Organisation. She contributes to EAUN and Dutch nursing guidelines and was the first ever nurse to join an EAU guidelines panel. She was previously a member of the EAUN Scientific Congress Office, and part of the Dutch committee of ZonMw developing a module on ‘continence aids’. Dr. Cobussen-Boekhorst runs an outpatient clinic to treat patients with continence, bladder problems and stoma care, and has published several articles on benign bladder problems and stoma care. She was co-author of a booklet ‘Urodynamic diagnosis, practical guidance’, and also contributed to chapters about conservative treatments in three books (Neuro-Urology/Handbook of neurourology/ Child incontinence (Incontinentie bij kinderen).

We had the opportunity to interview Dr. Cobussen-Boekhorst about her contribution to nursing, as well as her future ambitions.

What does winning the Ronny Pieters Award mean to you?
Dr. Cobussen-Boekhorst: “When I received the message, I was actually a little bit shocked! I never ever thought that I would be nominated. I am very honoured of course!”

Where did your interest in benign urologic care come from?
“As a young nurse I started working on a surgical ward in a small hospital that included urology patients. This interested me and after a few years I started working in the urology ward at the university hospital, followed by the outpatient clinic. My interest developed in benign/functional urology, and I chose to specialise in urodynamics, urostomy-continence care and urotherapy. I completed further training and education to become a nurse practitioner in functional and paediatric urology.”

Who has supported you through your career?
“During my career there have been a lot of people who supported me. In my early years at the outpatient’s clinic, it was Prof. Frans Debruyne, Prof. Philip Van Kerrebroeck, and Prof. Bart Bemelmans, then later, Prof. John Heesakkers. Together with my colleague at that time, Mrs. Marian Van Der Weide, we only had a few hours a week for our patients, nowadays we cover the full week. Our team now consists of Dr. Frank Martens, Dr. Kathleen D’Hauwers and Dr. Puck Oude Elferink, and my NP-colleagues Ms. Vera Janssen, Ms. Clair Schuurmans and Ms. Nancy Van Benthum and physician assistant Mr. Johnny Tromp. During the years we as a team have expanded our expertise and take over some medical procedures, but we do not lose sight of our nursing background.”

“In paediatric urology, Prof. Wouter Feitz, Dr. Jos De Vries, Dr. Robert De Gier, Dr. Barbara Kortmann, and Dr. Liesbeth De Wall played an important role in my career development. Prof Feitz was the driving force encouraging me to start my PhD. He told me repeatedly that I could do it and Dr. Kortmann and Prof. Heesakkers joined in on this choir. So, with a lot of support, also from my nursing manager and of course my family, I started this ‘project’, alongside my job. They were intensive years, but I completed my PhD in 2016!”

Can you tell us about your PhD on urotherapy?
“My thesis was titled ‘Effectiveness of urotherapy and specific interventions’. Through urotherapy and specific interventions, various treatment options can be offered for urinary incontinence, urinary retention, enuresis or urinary tract infections in children, adolescents, and adults, by a paediatric and/or adult nurse specialist or a urotherapist. Invasive medical interventions for these complaints are not always preferred, and sometimes they are not effective (enough), not possible, or offer only a partial solution.”

“The International Children’s Continence Society describes that comorbidity is relevant and important to consider for researchers studying LUT in children. Co-morbidity may include: constipation and faecal incontinence, urinary tract infection, ‘asymptomatic’ bacteriuria, vesicoureteral reflux, neuropsychiatric conditions (ADHD, oppositional defiant disorder, etc.), intellectual disabilities, sleep disorders (sleep apneuses, parasomnias) and body mass index. This reflects the association with the different conditions and complexity of urotherapy and specific interventions. Specific interventions like intermittent catheterisation, pelvic floor exercises or psychological care is often multidisciplinary.”

“The overall conclusion from my PhD was that in medical care it is common to substantiate the care by research and to translate this into evidence-based guidelines. For nursing care this is still a big challenge for a lot of areas, including urotherapy and specific nursing interventions. But at least in (paediatric) urology there is growing interest in research and implementation of (nursing) studies and guidelines. Medical interventions, like new medication, operation techniques or new ideas about treatments are an ongoing process. The involvement of conservative treatment options one way or another always needs to be (re-)considered. To be aware of new developments, medical as well as nursing, nurses need to keep up their knowledge and training and, if relevant, need to adapt to new insights and discuss this with all caretakers involved.”

“Nurse practitioners play an important role in these developments. They have learned to interpret literature, how to set up and perform research, how to implement new developments and how to discuss these developments with medical specialists. They need to transfer this knowledge to nurses, urotherapists, residents and medical specialists in the field.”

“Due to these developments, together with Dr. De Wall, we have expanded our multidisciplinary third line urotherapy with some additional therapies, like neuromodulation (PTNS/TENS) and a urotherapy/ bladderscan (SensU) study.”

What are your future aspirations for nursing guidelines?
“I have been actively involved in the EAUN guidelines, ‘Catheterisation indwelling catheters in adults – urethral and suprapubic’, ‘Catheterisation urethral intermittent in adults’, and ‘Male external catheters in adults – urinary catheters management’. I am also a panel member of the first multidisciplinary EAU Guideline Non-neurogenic Female LUTS. This is particularly important as cooperation from different disciplines (also patient representatives) is the key for further development in the guidelines and our work. For the future, prevention and sustainability are important issues to me, and I believe nurses can play a vital role in these issues.”

What is on your urology bucket list still?
“In my work I like to coach the young NPs/nurses and together with them, expand our expertise. My aim is to encourage these colleagues to join in projects, developing guidelines, teaching, and nursing associations. I am also involved in sustainability projects, such as how we can use less material or more sustainable materials.”

“Last year I started a new role in our organisation as a ‘Care programme leader’. We have a new structure with 11 centres and 3 institutions, and urology is part of the Radboudumc Centre for Abdominal and Pelvic Care. Together with a colleague nurse and a gynaecologist, we have started to set up our benign padways together with nursing and medical care pad leaders (i.e. pelvic pain, LUTS, fertility, congenital diseases). This is a novel approach for benign care, and I hope this will result in even better care for these patients.”