30th Anniversary Invited Editorial reflecting on Smith J.P. (1982) The problem of incontinence. Journal of Advanced Nursing 7, 409–410
In celebrating 30 years of JAN, we have the opportunity to look back at history and acknowledge achievements to date in nursing, research and scholarship. Looking to the past to inform the present allows us to celebrate success, identify gaps and set future directions. The Editorial written in 1982 by James P. Smith, JAN's Founding Editor, provides an opportunity for us to reflect on the problem of incontinence in 2006. That 1982 Editorial (Smith 1982a) was prompted by a workshop held in 1981 in Windsor Castle in England convened by the Royal College of Nursing in association with Squibb Surgicare and the workshop was followed by 16 regional study days on ‘The Problem of Promoting Continence’. The original workshop identified healthcare professionals’ lack of knowledge about the prevalence of incontinence and its management. The workshop participants considered finance and economics, in particular the indiscriminate use of pads and pants, and suggested that cost benefit analyses should be undertaken. There was concern that patients obtained inappropriate and expensive products and that industry was not involved in informed debate. Participants also identified that industry could fund research, but there was a dilemma if health services could not pay for quality products. The workshop and subsequent study days focused on the consumer and suggested improvements in the education of healthcare professionals who could alleviate suffering and improve quality of life. Eleven recommendations were identified for taking forward the incontinence agenda, including a recommendation that now is seen as being of crucial importance: namely, ‘recognition should be given to the different needs of individuals and also to the very different needs of the major groups of individuals with long term incontinence problems’, in particular older people, those with mental health needs, dementia and learning disabilities (Smith 1982b, p. 209). It is of note that the focus of present-day health policies for older people, mental health, person-centred care and the management of long-term chronic conditions had resonance back in 1982. The recommendations made then were related to identification of needs, service provision, a national working group, an association for sufferers, research, evaluation of equipment, resource centres, specialist nurse advisers, education, voluntary sector pressure groups and clarification on the use of terminology (Smith 1982a).
An additional ‘Incontinence Action Group’, convened by the Kings’ Fund in 1981 (of which Chris Norton, the following commentator, was a member), also made six key recommendations namely: establishing knowledge on incontinence and its management; education of health professionals; the provision of continence clinics and services; the introduction of specialist nurse advisers; evaluation of current aids and equipment; and the development of new products. The Group also called for greater emphasis on public education via the media, health education and voluntary sector (Incontinence Action Group 1983).
These initiatives and recommendations in the early years of the 1980s provided the impetus for national developments in the UK in the previously-neglected field of incontinence – notably in terms of identifying prevalence, diagnosis, assessment of needs, treatment, service provision, prevention and research. Similar developments internationally were also gathering pace. Research and effective treatments continue to be developed as evidenced by the systematic reviews on incontinence that have been published in the Cochrane Library, for example a recent review by Wallace et al. (2004) based on 10 randomized controlled trials.
More than 20 years on from the events of the early eighties that prompted J.P. Smith's Editorial in JAN, two noteworthy international events have taken place, one in the form of a ‘research summit’ on Incontinence in Minneapolis in 2003 and the other being the third International Consultation on Incontinence (ICI) in Monaco in 2004. The ICI is a multidisciplinary meeting of 25 expert committees that reviews and categorizes the research evidence on incontinence and makes recommendations for clinical practice and future research (Abrams et al. 2005). As such, the ICI provides international consensus and ‘state of the art’ information for informing policy, practice and research on incontinence, and is an excellent resource along with the evidence provided by the systematic reviews in the Cochrane Library. The purpose of the 2003 international nursing summit in Minneapolis was specifically for the purpose of shaping future directions for incontinence research. The summit involved keynote presentations, response papers, audience discussion and recommendations. It resulted in writing groups and a publication that was issued for international dissemination in the form of a supplement in the journal ‘Nursing Research’ (Wyman & Bliss 2004). The summit and the supplement are key to informing the future international research agenda, and make explicit the topics that now need to be investigated. One of the topics of focus was the emerging body of knowledge on translating research on incontinence into practice (Roe et al. 2004). Nursing leads the way in these initiatives and there is a developing methodology and cadre of experts and expertise in these endeavours.
We have come a long way in the two decades since James P. Smith's Editorial of 1982. There is now a sound evidence base to inform clinical practice and future research on incontinence. The challenge remains as to how we ensure that all of the available information is used to underpin everyday clinical practice in all settings, and, as a result, detect, manage, alleviate and prevent a condition that has enormous costs in terms of individual suffering and health and social care provision, more effectively.