To kick off the 2021 Health Minister’s Award for Nursing Trailblazers, we will be featuring each of our Finalists in the lead up to the virtual National Nursing Forum taking place from 26-28 October 2021, where the Winner will be announced.
This week, we are featuring Julie Westaway MACN, a Urogynaecology Nurse Practitioner at Darling Downs Hospital and Health Service, who has been named one of the Finalists for offering accessible, evidence-based urogynaecology and continence care for women.
How did the idea for the Urogynaecology and Continence Service first come about?
More than 10 years ago, when I was working in a Community Continence Service, which excluded many young women from assessment and management. At the same time, I happened to meet a consultant, whose goals and philosophy resonated with my values and plans for a women-centred service. We both agreed there was a large gap in service availability for women in rural regions who experienced bladder, bowel, pelvic floor dysfunction and that’s what set the wheels in motion for our service.
What are the key issues for women living with/suffering from incontinence? In what ways are these intensified for those living in rural and remote areas?
There are significant barriers and social stigmas that influence help seeking behaviours, including embarrassment, fear, financial constraints, and lack of knowledge.
The recent advertisements normalising light bladder leakage and pad wearing as a normal part of a woman’s life is problematic. Media campaigns may influence a woman’s decision to defer early assessment as they perceive incontinence as normal.
Our region has an increasing obesity issue, a higher incidence of diabetes, heart disease, arthritis and mobility issues — all have concomitant links with pelvic organ health and incontinence.
Rural women can travel for up to 14 hours seeking health care, experience poor internet connection limiting telehealth consultations, and work seven days a week on farms undertaking heavy work. Many are extremely reluctant to take time out for their own health care needs. They often prefer a nurse-led approach to conservative management to avoid surgery for prolapse and incontinence symptoms. An interdisciplinary approach is often required to organise transport, accommodation, sick leave, family to care for other family members and obtain funding.
To add to that, there can be confusion and overlap between services. Women may be referred to Urology, Gynaecology or a Colorectal team before eventually being referred to an Urogynaecology team. It can be a frustrating and lengthy process for all. Rural regions are serviced by a revolving door of locum consultants. There is a lack of continuity of care and rapport, women often comment they need to repeat their health history multiple times.
Rural and remote localities often struggle to attract and retain permanent health professionals, therefore referring to a service and waiting on follow up reports can be arduous and lengthy.
Can you give us an example of how you continue to innovate to improve this service?
I collate patient evaluations annually. The 2020 results found 42% of women stated they did not receive discharge instructions, despite being provided with verbal instructions and fact sheets.
This year, I introduced a discharge postcard with relevant discharge information. I am yet to evaluate the responses, but I am hopeful this will improve care. Before COVID-19, I was planning a trip to the UK to undertake some observational training, which includes bladder biopsies and intravesical botulinum for neurogenic bladders. It is a natural progression for the service and improved women-centred care.
I still plan to go post COVID-19.
“Rural women can travel for up to 14 hours seeking health care, experience poor internet connection limiting telehealth consultations, and work seven days a week on farms undertaking heavy work. They often prefer a nurse-led approach to conservative management to avoid surgery for prolapse and incontinence symptoms”
What are the key challenges you have encountered with this initiative?
Prior to the commencement of the service, I completed a literature review benchmarked with international nurses, which reduced potential barriers. The immediate issues relate to funded training for an additional Nurse Cystoscopist to ensure the service is covered for any leave, succession planning and the longevity of the service.
You’ve mentioned that mentorship of young nurses is one of the most important facets of this role – can you elaborate?
I am extremely passionate regarding the nurturing of the next generation of urogynaecology continence nurses. The service has demonstrated its potential and we need to ensure the longevity, future direction, succession planning and expansion. This ensures rural women continue to receive expertise, and continuity of care from amazing nurses.
It is very satisfying seeing the growth, potential and excitement the clinical nurses bring to the service. Their IT skills, ideas and enthusiasm continue to drive my momentum.
How have you sustained this service through COVID-19?
We have increased our telehealth and phone consultations. However, many women still need face-to-face appointments for assessment and treatment. Due to the nature of urogynaecology, examinations and diagnostics are often a prerequisite to conservative and tertiary management.
International Continence Society has done considerable work in this space and presented new guidelines. I presented these on behalf of the Continence Foundation of Australia in a webinar last year. The recommendations included changes to pessary and diagnostic guidelines.
What goals are you working towards for the future of this service?
I am preparing a research project for submission to the ethics committee. I am researching midwife’s knowledge of voiding dysfunction throughout the antenatal and postnatal period and lived experience of the women with incontinence throughout their pregnancy and postpartum.
I still hope to get to the UK for an observational learning experience. Funding, changing COVID-19 restrictions, and a trained nurse Cystoscopist to relieve my role are the challenges at present. But nothing is insurmountable as long as you plan in advance, communicate and consult.
What does it mean to you to be named a Trailblazer finalist?
I am extremely humbled and excited to be a finalist; it is an important milestone, achievement and recognition of a unique model of care I have had the pleasure of developing.
I am a driver of health changes and will continue to liaise with Darling Downs Health, the Continence Foundation of Australia, and Continence Nurses Society Australia to improve awareness and elevate the profile of continence/urogynaecology.
The 2021 Trailblazer Winner will be announced during the virtual National Nursing Forum taking place from 26-28 October 2021. Stay tuned for more information about how to tune in to the ceremony.
Nominate yourself or a colleague for the year 2022.