Calgary’s Pelvic Floor Clinic: Empowering women to improve their quality of life

by admin admin | Feb 01, 2009
Recognizing pelvic floor disorders as a growing health problem, the Calgary Health Region needed an innovative solution – one that minimized costs and maximized resources. For the past 10 years, the clinic has used the skills and abilities of its nursing staff to their full extent: in fact, many patients who receive care in the clinic never see a doctor.

Key Messages

Advanced practice nurses play a central role in Calgary’s Pelvic Floor Clinic, which provides comprehensive, multi-disciplinary, and clientcentred care to women who suffer from pelvic floor disorders.

The clinic’s model of care uses the skills and abilities of the nurses to their full extent. The approach is proving to be cost-efficient: most patients are getting the care they need from nurses.

To deal with long waiting lists, the Pelvic Floor Clinic offers an education class as patients’ first session, which reduces wait times and allows for a larger volume of referrals.

Calgary’s Pelvic Floor Clinic was, for a short time, a victim of its own success.

About 10 years ago, the Calgary Health Region recognized pelvic floor disorders as a major and growing health problem. Pelvic floor disorders, which include urinary incontinence, pelvic organ prolapse and bowel evacuation problems, affect at least one-third of adult women. In southern Alberta and south-eastern British Columbia alone, there are more than 300,000 women diagnosed with pelvic floor disorders.

Traditionally, treatment is segmented into different specialties. However, the Pelvic Floor Clinic – an innovative initiative funded by the Calgary Health Region – offers a holistic approach to care. By bringing together in one location the expertise of urogynecologists, family doctors, advanced practice nurses, physiotherapists and others, the clinic serves as a single, central resource for patients.

A model of care based on trust, respect

The advanced practice nurses play a critical role in providing client-centred care at the clinic. “The role of the nurse is huge here, and very rewarding,” says

It's very empowering for patients to understand what's  going on, and to feel supported. They are able to take control, make some changes on their own, and notice the results.

Grace Neustaedter, a clinical nurse specialist. Nurses practise independently and have their own clinic bookings with patients. They assess patients, discuss treatment options, and provide care and follow-up. In addition, the nurses conduct patient education sessions, work in the urodynamics room, participate in research projects, and provide telephone triage and counselling.

Clinic nurse Betty Weckman appreciates the
client-centred philosophy whereby the nurse supports the patient in her decision-making to achieve the best possible outcomes. “This means I have a role in providing information, that I support the [patient] as she learns new behaviours and skills, and that I advocate for her choices,” she says.

Neustaedter feels that the clinic’s model of care uses the skills and abilities of the nurses to their full extent. This is satisfying for the nurses – and good for patients. In the big picture, she says, it also saves healthcare dollars because most patients are getting the care they need from nurses rather than from physicians, who are generally reimbursed for their services at a higher rate. Weckman believes it is a somewhat unique situation that many patients receive care in the clinic and never see a physician. “This can only happen,” she says, “when colleagues trust one another and are respectful and supportive of each other’s roles.”

Knowledge is power

Pelvic floor disorders can have significant repercussions, such as social isolation, sexual inhibition, restricted employment, and inability to exercise effectively. Many women assume these problems are something they just have to live with, or are too embarrassed to seek help. However, according to Dr. Magali Robert, a urogynecologist and medical director at the Clinic, most pelvic floor disorders can be cured or effectively managed for over 90 percent of women.

Awareness and knowledge are essential; as such, a major component of the nursing role at the clinic is patient education. Neustaedter has been teaching classes on pelvic floor disorders since the clinic first opened its doors in 2002. Almost immediately, the doctors began to notice the benefits. The women who had received the education had a basic understanding of their condition and the treatment options available, were using behavioural techniques to improve their symptoms, and could make more informed decisions about treatment.

Strategies to meet increasing demand

One of the challenges of creating something new, innovative and popular is that demand can quickly exceed capacity. By 2008, the number of referrals to the clinic had increased significantly; many women were waiting eight to 12 months for an appointment with a doctor or six to eight months for a nurse assessment. Given budget shortfalls, and having once expanded its operations in 2004, the clinic was unable to keep adding staff to meet the increasing demand.

In September 2008, the clinic decided to try an innovative new approach to processing patients: redesigning the process so that the education class became the first clinic visit for new referrals. A two-and-a-half hour workshop, taught by the clinic nurses, is offered twice per week. The goal is to help participants understand pelvic floor disorders and treatment options, and enable them to make lifestyle changes to achieve optimal pelvic floor control and comfort. Following the workshop, women can choose one of four treatment options: 1) surgery; 2) pessary trial; 3) assessment by a doctor or nurse in the clinic; or 4) working on behavioural changes with a follow-up in six weeks.

Neustaedter says that making the educational class the first clinic visit has made a huge difference in the clinic’s overall efficiency. After six months of using this method of processing patients, evaluation results show a drastic cut in the wait time before the first appointment. Interestingly, the preferred treatment option for 19 percent of the women is to work on behavioural changes with a follow-up in six weeks. “We were quite surprised with the number of women who chose the option of waiting and working on things on their own,” says Neustaedter. This, she says, speaks to the strong sense of choice and empowerment that the clinic instils in its patients.

 

Client evaluations of the nurse-led workshops have been overwhelmingly positive. One survey showed that 96 percent of the women who took the workshop said it was beneficial and informative. “Many of the women we see articulate how grateful they are to have access to our clinic,” says Weckman. “They frequently describe how their increased knowledge and treatment helped to improve the quality of their lives, allowed them to re-engage in activities, or to be more comfortable.” As well, 17 percent of the women acquired enough information, education, or new skills so that, at follow-up, they didn’t need to book any additional appointments or other treatments. They chose to carry on with their lifestyle changes and noticed an improvement in their symptoms.

Neustaedter says that the nurses at the clinic feel an overwhelming satisfaction in enabling women to more clearly understand their issues and take charge of their care. The clinic’s new way of processing patients is not only reducing wait times – it’s also putting women in the driver’s seat. “It’s very empowering for women to understand what’s going on, and to feel supported,” says Neustaedter. “They are able to take control, make some changes on their own, and notice the results.”

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Pass it on! is a publication of the Canadian Health Services Research Foundation (CHSRF). Funded through an agreement with the Government of Canada, CHSRF is an independent, not-for-profit corporation with a mandate to promote the use of evidence to strengthen the delivery of services that improve the health of Canadians. The views expressed herein do not necessarily represent the views of the Government of Canada. © CHSRF 2010