Band 6 Bladder & Bowel Clinical Specialist

Job overview

The Specialist Clinician will work with the Bladder and Bowel Service and will assist in shaping the future delivery of Bladder and Bowel care and treatment across Birmingham Community Health Care NHS Foundation Trust.

They will undertake the clinical assessment, supervised diagnosis, planning, implementation and treatment of patients with bladder and bowel dysfunction and evaluate individualized programmes of care for patients with mild to moderate bladder and bowel care needs They will be clinically supported in the management of patients with complex benign and neurological bladder and bowel dysfunction.

They will support and guide patients, carer’s, relatives and fellow health care professionals with fundamental components of bladder and bowel dysfunction treatment and management and will be confident and competent in providing information, advice and psychological support.

They will be required to take responsibility for prioritizing their own workload and caseload along with identifying and reporting areas of risk management concern.

The post holder will support the Clinical Team Leaders and Team in all aspects of service delivery, development and training and play an active role in the implementation of standards and associated national and trust guidelines.

Main duties of the job

• Make a differential diagnoses
• Assess, treat and evaluate a variety of Bladder and Bowel dysfunctions
• Assimilate and interpret with support clinical findings to make appropriate decisions in relationship to diagnosis and treatment of dysfunction
• Set appropriate treatment goals in collaboration with the patient
• Set appropriate treatment goals with due regard to NICE guidelines
• Assess the condition of skin and refer to tissues viability team as appropriate
• Perform vaginal examination and teaching of pelvic floor exercises including use of biofeedback and electrostimulation.
• Perform bladder sonography were required to establish presence of retention / manage side effects of drug therapy.
• Teach self catheterisation to patients and carers if required
• Teach and support patients and carers with rectal irrigation and bowel management regimes.
• Prescribe appropriate medication to patients requiring treatment with anticholinergic therapies, antibiotic treatment.
• Implement skin care measures to prevent infection and maintain integrity of the patient’s skin
• Implement and monitor agreed protocols developed for rapid and effective treatment of acute and recurrent urinary tract infections.
• Carry out female, male and suprapubic catheterisation when patient condition requires this.

Detailed job description and main responsibilities

They will undertake the clinical assessment, supervised diagnosis, planning, implementation and treatment of patients with bladder and bowel dysfunction and evaluate individualized programmes of care for patients with mild to moderate bladder and bowel care needs They will be clinically supported in the management of patients with complex benign and neurological bladder and bowel dysfunction.

They will be required to take responsibility for prioritizing their own workload and caseload along with identifying and reporting areas of risk management concerns.

Work in accordance with the NMC code of professional conduct or similar professional      body.

The Bladder and Bowel specialist Clinician will be responsible and accountable for the direct delivery of a clinical caseload in either a clinic setting or the community.

Undertake holistic assessments of patients with Bladder and Bowel dysfunction using up to date knowledge and skills- including physical examination and bladder ultrasonography and interpretation of results in planning care.

Plan, implement and evaluate care ensuring patient safety at all times.

Ensure patient/carers are provided with relevant written information regarding their plan of care.

Provide clinical care that is evidence-based and appropriate to the needs of the patient

Refer to other professionals for any specialist support that the patient may require as appropriate

Be able to promote patient autonomy through education and support so that an individual can make informed decisions about their care

Act as the support and contact for individual patient care management between other agencies

Communicate effectively and support clients and their carers when dealing with embarrassing and distressing situations caused by their bladder and / or Bowel dysfunction. Demonstrating sound empathic interpersonal and communication skills in dealing with patients and carers through the patient pathway

Adhere to trusts medicines management guidelines when independently prescribing medication and appliance.

The Specialist Bladder and Bowel dysfunction Clinician with the support of the Advanced Bladder and Bowel Clinical Lead and team will work towards developing skills in order to:

• Triage patients with undiagnosed cause for their bladder or bowel dysfunction onto the caseload
• Make a differential diagnoses
• Assess, treat and evaluate a variety of Bladder and Bowel dysfunctions
• Assess the impact of dysfunction on patients and or carers
• Assimilate and interpret with support clinical findings to make appropriate decisions in relationship to diagnosis and treatment of dysfunction
• Set appropriate treatment goals in collaboration with the patient
• Assess the condition of skin and identify need for onward referral
• Assimilate and interpret clinical findings to make appropriate decisions in relationship to bladder and or bowel dysfunction
• Set appropriate treatment goals with due regard to NICE guidelines
• Assess the condition of skin and refer to tissues viability team as appropriate
• Accurately measure bladder volume and nature of dysfunction using recognised bladder diaries
• Assess the degree and extent of bowel dysfunction using recognised tools.
• Assess the symptom profile to accurately identify the type of bladder dysfunction as described by International Society for Incontinence.
• Assess the degree and extent of bladder and bowel dysfunction and plan appropriate care in line with NICE approved pathways.
• Identify any complex factors which may predispose the patient to the bladder and bowel problems or affect treatment outcomes
• Assess the level of patient quality of life and symptom severity score using recognised tools i.e. global outcomes, ICIQ symptom specific scores.
• Provide specialist intervention for patients requiring condition guided treatment.
• Perform vaginal examination and teaching of pelvic floor exercises including use of biofeedback and electrostimulation.
• Perform bladder sonography were required to establish presence of retention / manage side effects of drug therapy.
• Teach self catheterisation to patients and carers if required
• Teach and support patients and carers with rectal irrigation and bowel management regimes.
• Prescribe appropriate medication to patients requiring treatment with anticholinergic therapies, antibiotic treatment.
• Implement skin care measures to prevent infection and maintain integrity of the patient’s skin
• Implement and monitor agreed protocols developed for rapid and effective treatment of acute and recurrent urinary tract infections.
• Carry out female, male and suprapubic catheterisation when patient condition requires this.
• Assess patients for continence aids working alongside occupation health and physiotherapy services.
• Where treatment is not appropriate assess patients for containment products to ensure patients dignity and quality of life. Identify timely review and reassessment.
• The above skills will be clinically accountable to the Team Manager and Clinical Lead

Contribute to research as requested.

Be confident and competent to actively participate with and fulfil all data collection requirements

Maintain own CPD in relation to knowledge of Bladder and Bowel research and developments

Act as a role model and provide mentorship to Junior Staff and those undergoing training

Be proactive in teaching service users techniques to self-manage their Bladder and Bowel dysfunction

Participate in the induction of new trust staff

Provide advice, guidance to other professionals within the scope of your knowledge, skill and experience

Support the Bladder and Bowel Clinical Lead and team in the delivery of a trust wide teaching programs

Meet competencies as identified in the PDR/KSF as discussed with Lead Bladder and Bowel Clinician Specialist for your team.

Be prepared to undertake a disease specific course; further training if necessary in relevant areas related to Bladder and Bowel dysfunction and keep up to date qualification review requirements.

The Bladder and Bowel dysfunction specialist nurse must possess a prescribing qualification, have completed the Trust Continence care course and be working towards recognised Bladder and Bowel dysfunction qualifications.

To undertake other duties commensurate with this grade of post in agreement with the relevant line manager.

To establish effective working relation with the following work collaboratively with community and acute trust multi-disciplinary teams, General Practitioners, Community Nurses, AHP’s particularly physiotherapy and occupation health, residential care home staff.