A nocturnal enuresis service for a deprived inner city

Abstract

Aim: Glasgow is a city where 80% of the most deprived children in Scotland live within 20% of the overall population. Of 168 000 children in Glasgow, an estimated 5000 aged 5–15 y have primary nocturnal enuresis. The aim of this study was to establish a nocturnal enuresis service for Glasgow. Methods: Needs assessment was performed and the incident cases were documented at school entry healthcare appraisal, at the age of 5 y. A cohort of these children was followed up at 8 y of age and symptom resolution was no better than natural remission. Parents, general practitioners, clinical medical officers and a hospital paediatrician were interviewed face‐to‐face about their need for a service. Results: Ten of 11 general practitioners expressed a need for a specialist service. Ten school nurse‐led local nocturnal enuresis clinics were established. Accommodation, funding, default and managing alarms were major problems. School nurses enjoyed extra training and quickly became skilled therapists. Two research projects highlighted that most children at first attendance did not believe they could ever be dry, which predicted outcome. Deprived families, once motivated, could successfully undertake complex behavioural therapies. Conclusion: A comprehensive nocturnal enuresis service begins when children stop using night nappies at the age of 3–4 y. Appropriate waterproof mattress, duvet and pillow coverings should be advocated until 5 y, when desmopressin may be helpful. For continued wetting at the age of 7 y, a local service should be led by a team of well‐trained nurses using enuretic alarms.

Development of an early nurse led intervention to treat children referred to secondary paediatric care with constipation with or without soiling

“…The important 2 week follow-up after the first visit was unlikely to happen in a routine consultant-led general paediatric setting. Nurse-led services for elimination disorders had been successful for night-wetting in Glasgow [10]. The audit as well as Royal College of Paediatrician and Child Health guidance [18] supported development of a nurse-led secondary care service for children referred by their GP with constipation.…”

“…He was also a behavioural therapist [9], instructing parents to help their child to sit on the toilet on a regular daily basis to try to pass a stool. An experienced general paediatrician (DT) had implemented a nurse-led service for nocturnal enuresis [10]. He updated the Cochrane Review of Behavioural and Cognitive Interventions [9] and was a member of the NICE guideline development group for constipation in children – CG99 [2].…”

“…SN and CM were supported by consultant paediatricians who were generally on-site at the same time seeing patients of their own. This model follows the successful nurse led care pathway for night wetting in Glasgow [10]. Glasgow outreach general paediatric services are geographically based usually in large GP run health centres and patients are allocated to them by their postcode of residence.…”

“…He established and runs nurse-led services for other elimination disorders – night [10] and day wetting. He served on the NICE guideline development group for constipation in children (CG99) [2].…”

Paediatric bladder dysfunction: A single centre experience of public hospital wait times

“…The treatment strategy for these patients is well defined and could be delivered through a nurse‐led clinic specialising in alarm therapy. Evidence in the literature suggests that the development of enuresis clinics, staffed by well‐trained nurses, such as clinical nurse consultants, successfully motivated families to undertake complex behavioural therapies . As part of quality improvement initiatives aimed at reducing wait times across outpatient clinics, the RCH has commenced redesign of the triage and management pathway for monosymptomatic enuresis patients.…”