Educating the Neighbours (and Others) – by Ainsley

For many years I worked in the community as a specialist nurse. My specialization was 
in the area of continence, a topic not widely discussed in public, and a conversation 
stopper when anyone asked what I did for a job! Even my kids were too embarrassed 
to tell their friends the specifics of my occupation! One of my friends said every time 
she saw me, she pulled in her pelvic floor muscles!
Anyone who has watched the UK television series, ‘Call the Midwife’, would have some 
idea of what nursing in the community is all about. Going into patients’ homes was a 
real privilege, and one soon learnt that having a judgmental approach would not build 
rapport with those we worked with. The principles of the Treaty of Waitangi, 
partnership, participation and protection, were not just some ‘pie in the sky’ idea, but 
essential in working with patients if one was to achieve mutually agreed outcomes. 
Otherwise, health professionals risk being patriarchal do-gooders imposing their own 
norms and beliefs on the very people they are trying to help, and without the patient 
and/or the whānau buy-in, success is limited.
Three years after retiring, I find I sometimes reflect on some of the interesting people 
and situations I found myself in during fifteen years working as a community nurse. In 
hindsight, I wish I had kept a journal as my memory of amusing, sad, tragic, joyous, 
frustrating and satisfying days has faded somewhat, and I struggle to remember some 
of the details.
However, there are always cases that remain firmly in the memory and one of these 
was an elderly man who lived in a cluster of small pensioner flats. He had a number of 
medical conditions that predisposed him to urinary retention, so that every time he 
passed urine, only a small amount was released. This resulted in a rather large 
abdomen although he had no discomfort and was not aware of his bladder problem 
until diagnosed by a specialist. I was asked to visit him at home to teach him how to 
pass a catheter into his bladder four times a day to completely drain it. This is
something that specialist nurses are asked to do frequently, but in the case of this 
particular man, he was extremely deaf. The day of my visit was a hot February day 
and all the windows were open. I taught the procedure in his bathroom, yelling out 
instructions as he carried it out step by step. When I left his house some time later, the 
next- door neighbor was doing her garden. As I passed her, she commented “that was 
very interesting, I learnt a lot”!!
One of the first times I was ever required to teach self-catheterisation also stands out 
in my memory. The patient and his daughter listened as I explained what was involved, 
then the patient agreed to learn the procedure, however he then stated that his 
daughter would do it for him as had not seen his “willy” for many years because his 
puku was too big! He assured me this was his wish, and his daughter affirmed that she 
was willing to do this for him. So, all my preconceived ideas about family boundaries 
had to be adjusted to the situation, and we went ahead without any problems. 
In subsequent years I taught several husbands how to catheterize their wives, and a 
mother to do the procedure on her disabled daughter. With changes in technology, we 
went from using just a leaflet as a teaching aid, to a DVD, and then to a website on a 
DHB provided Ipad. I taught catheterization in a caravan, on a boat at a marina, and 
quite a few times at the men’s prison, much to the embarrassment of one particular 
prison guard who went redder and redder as we proceeded! The use of technology 
made a huge difference especially when there were language barriers. One day the 
Mandarin interpreter got held up in a traffic accident and arrived just as the patient and 
I were finishing, she with no English, me with no Mandarin. In fact, the whole family 
watched the DVD through twice before the patient and I disappeared into a bedroom!
Most people have never heard that self-catheterization is performed not uncommonly 
in the community. Children as young as five can learn it, while my oldest patient was 
a 99 year old man. Sometimes it is needed short-term until the body heals itself, eg. 
after surgery, but for many people this is a regular occurrence and something they 
learn to build into their daily routine. Next time you watch the Paralympics on television, 
spare a thought for the athletes with spinal injuries who may be using a catheter up to 
six times a day.
(Writing Group 2, May 2022)