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CLINICAL SCENARIO
You are visiting Kathleen, a new client on your community nursing round. She is a
widow with two adult children who was discharged two days ago following cardiac
surgery.
When you ask her how she found hospital, she says that it was OK except she was
in trouble all the time for not doing her chest physiotherapy.
During you usual ‘new patient assessment’, Kathleen tells you that she’s tired after
hospital - adding that she hasn’t slept well for years. When you ask Kathleen if she
has any problem with her bowels or bladder, she says (a little quickly) that’s all
fine and looks away. She goes to the bathroom twice during your initial
assessment visit; she seems to be ‘in a hurry’ to get to the toilet; and there’s a
crinkling plastic sound when she moves out of her chair.
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How should you assess this situation?
Consider physical assessment, psychological and social factors.
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What additional information is needed? Where would you access it?

What should your actions be and why?
This resource was developed by the Tasmanian Clinical Placement Partnership Project supported by funding
from the Australian Government under the Increased Clinical Training Capacity Program. December 2012.
CLINICAL SCENARIO-ANSWER GUIDE
How would you assess this situation?
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What is the situation?


Kathleen appears to have a problem with urinary continence but does not acknowledge
this in discussion.
What additional cues or information do you need to consider?
Clinical
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Incontinence is common but not normal.
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A preliminary physical assessment may provide clues re potential causes, e.g. urinary
tract infection; dehydration; medications; previous surgery ………...
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Questions about the birth of Kathleen’s children may provide cues to potential causes.
e.g. high birth weight babies; assisted vaginal deliveries with forceps etc.
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Constipation and exercise can be significant factors in continence management.
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Employer procedures related to client/ patient assessment should be followed.
Social

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Kathleen lives alone. Her socialisation and psychological wellbeing may be limited as a
result of ineffectively managed continence problem/s.
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Multiple factors may impinge on Kathleen’s motivation to improve her situation. e.g.
physical comfort; skin care; the cost of products; confidence; laundry ………..
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Cultural factors may have a significant role—Kathleen may be an ‘adopted’ name.
Some cultural practices such as female genital mutilation impact on continence.
What are the likely options?

Kathleen may have a problem with urinary continence; or she may have a urinary tract
infection; or she may not have any problems at all.
What would your actions be and why?

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What do you want to achieve? What are you going to do?
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It’s important to achieve a thorough assessment of Kathleen’s continence, this may
include urinalysis; and asking Kathleen to maintain a diary of fluid intake and toilet
visits.
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In this scenario, the nurse’s communication skills are absolutely critical to the outcome
for Kathleen. Open-ended questions should elicit broad responses.

It is imperative that the nurse establishes a relationship with Kathleen which includes
trust and minimises any embarrassment that may be limiting Kathleen’s replies.
How do you think you may feel in a situation like this?
Refer to the following web sites for detailed information

http://www.continencexchange.org.au/
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http://www.continence.org.au/
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http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0019/11296/
fgminfohlthprofessionalsjul04.pdf (female genital mutilation)