Professor of Clinical Nursing Innovation, Bucks New University & Imperial College
Healthcare NHS Trust.
Visiting Professor, Imperial College London.
Nurse Consultant (Bowel Control), St Mark’s Hospital Harrow.
I have spent the last 30 years working with incontinent people, setting up and running clinical services, teaching programmes and a research programme. I have developed a nurse-led clinical service for people with faecal incontinence and constipation.
Excerpt from The History of the ICS 1971 - 2010 by Ted Arnold, Eric Glen and Norm Zinner
2.10 CHRISTINE NORTON and the increasing role of nurses in ICS
By way of introduction, perhaps the first allied health professional to be committed to the care of those with incontinence was physiotherapist Dorothy Mandelstam. “Working in a Cinderella branch of medicine where the general public and fellow professionals expected nothing but quiet warehousing of destitute and discarded old people, she took a single-minded interest in the causes, alleviation and management of incontinence - long a taboo subject.”, said Dorothy Stewart in her obituary for Dorothy Mandelstam.
History of involvement of nurses in ICS
In 1981, at a meeting at Bedford College, the Association for Continence Advisers was formed, co-founded by Dorothy Mandelstam and Chris Norton. Chris became its first secretary. About 100 delegates attended the first meeting in Bedford; there were 17 nurses specialising in incontinence in the UK at that time. The ACA campaigned to have a specialist nurse continence advisor appointed to each health authority in UK. By the late 1980's there were about 300 continence advisers in the UK, but there were no formal links with the ICS and most nurses could not afford to travel to international conferences. In October 1996, the ACA Executive decided to establish a bursary fund for tertiary education of its members the Dorothy Mandelstam Educational Award.
It is not clear when nurses first attended ICS, but probably within the first 5 years of ICS. Norma Hyland, Janet Blannin who worked with Roger Feneley in Bristol and Annelie Hollo from Sweden were among the first to join. Chris Norton attended her first ICS meeting in Lund in 1981, and there were few nurses there. Chris Norton wrote: “My real involvement with ICS was not until the late 1980's /early 1990's when we held networking meetings informally. Some time in the 1990's (probably 1995, it was all very informal) Paul Abrams asked me to "represent" nursing on the ICS committee. I did this for 8-10 years until 2005.”
The advent of nurses and physios was welcomed, particularly by Torsten Sundin and Helmut Madersbacher as stated in Chapter 4.5; they pointed to the non-interventional therapies, personal approaches including issues of quality of life and the need for public education. This led to the establishment of the Continence Promotion Committee, co-chaired by Chris Norton with David Fonda. See Chapter 4.
In 1995 as Director of the Continence Foundation in UK, she oversaw the production of a document “Commissioning comprehensive Continence Services. This followed a review of continence services by the Royal College of physicians of England. In 1998, the King’s Fund hosted a Consensus Group, the Interprofessional Collaboration in Continence Care (ICCC). They considered that from the patient perspective continence care should be delivered by an integrated team consisting of all health professionals working in partnership. Their steering Group comprised Mandy Wells, Mandy Fader and Jo Laycock, all ICS members. They produced a document titled: “Nurses and Physiotherapists working in Continence Care”, emphasising the importance of multidisciplinary approaches.
Chris has worked hard in establishing a momentum within ICS in regard to bowel continence problems. She pointed out that “It has been very difficult to interest the ICS in bowel problems. Most of these patients see a gastroenterologist or colorectal surgeon in most parts of the world, and even in the UK the continence nurses are mostly bladder focused. Specialist nurses who are interested in bowel tend to be stoma nurses or colorectal nurses. This is a completely different audience from the ICS.” There are relatively few sessions during the ICS meeting devoted to anal incontinence.
There have been workshops on faecal incontinence at ICS and Chris delivered the State of Art lecture in 2006. She has chaired the ICI Committee on Faecal Incontinence for the first 4 of its Consensus Consultations. She is widely travelled as a visiting professor, and been a consultant for several NHS Committees focusing on continence issues, and developing guidelines for care.
She has served as a Trustee of the Bowel and Bladder Foundation.
Christine has published widely on this topic and written several books and chapters of books. She writes and lectures extensively. She has represented nursing on the Advisory Board of the International Continence Society; she chairs the Committee on faecal incontinence for the International Consultation on Incontinence; is an editor for the Cochrane Collaboration incontinence group; and is associate editor of “Gastrointestinal Nursing”, and is editor of a book “Bowel Continence Nursing”. She has contributed as co-chair with David Fonda, of the Continence Promotion Committee of the ICS. See Chapter 4. She delivered the State of the Art lecture on anorectal incontinence at ICS in 2006, and was largely responsible for the shifting emphasis within ICS to include bowel problems.
In all this she has been a valuable contributor to the goals of ICS.