First of its Kind: A Core Curriculum for Urologic Nursing

Published in Everyday Urology - Oncology Insights: Volume 1, Issue 4
Published Date: December 2016

The Core Curriculum is a first-of-its-kind textbook that can be used by nurses to study for specialty certification as a urology registered nurse, and is a source of material to support urology nursing instruction in academic programs. It has applicability to nurses in acute care, long term care, home care and rehab settings as all encounter patients with urologic problems.

Dr. Newman collaborated with two co-editors on the Core Curriculum for Urologic Nursing: Dr. Jean Wyman, PhD, CNP, GNP-BC, FAAN, a certified gerontology nurse practitioner with a subspecialization in incontinence care and Valre W. Welch, MSN, CPNP, a specialist in pediatric urology for more than 30 years. Dr. Wyman is Professor and the Cora Meidl Siehl Chair in Nursing Research at the University of Minnesota School of Nursing, directs the Center for Aging Science and Care Innovation, and is the co-director of the Deborah E. Powell Center of Women’s Health in the Medical School. Ms. Welch is currently working in a private pediatric urology practice with two pediatric urologists—Dr. Boyd H. Winslow and Dr. John D. Edmondson—and has taught pediatric nursing in the Bachelor of Science in Nursing (BSN) program at Elmhurst College in Illinois. She has lectured extensively both nationally and internationally on pediatric urology, and has also served as a nursing consultant on a variety of industry nursing clinical boards.

The Core Curriculum for Urologic Nursing is designed to be a thorough and evidence-based textbook for registered nurses, nurse practitioners, physician assistants, and healthcare providers involved in the care of urology patients. The material in the textbook is unique as it covers the urology across the lifespan. It is wide-ranging and has 51 chapters that cover pediatric urology; the assessment of adult urological conditions; urological management of genitourinary cancers; and interventions for acute and chronic adult urologic conditions, such as urinary stones, urinary tract infections, BPH, and urinary incontinence.

The text also addresses special popu.lations, including geriatric patients; women with chronic urologic conditions, such as sexual dysfunction and pelvic organ prolapse; and men with common conditions such as benign prostate disease, male sexual dysfunction, and infertility. The book is also an important learning tool, since it provides a comprehensive view of embryology and genitourinary tract development and urologic health promotion. In addition, special.ized assessments are covered, including radiological imaging, endoscopic evaluation, and cystoscopy. As nurses take on an expanding role in urologic practices, they need to be conversant in these diagnostic procedures and assessments.

The Core Curriculum for Urologic Nursing also covers surgical interventions extensively, and provides a great deal of information about best practice standards in urologic surgery. The text delineates specific details about such surgeries, even the correct position for placing patients on the operating table! There are also special chapters on the most current expert advice for perioperative and post-opera.tive care following urologic surgery.

We wanted the text to be authoritative and comprehensive, so each chapter is written by an advanced practice regis.tered nurse with a specialty in urology. One of the roadblocks we faced is the requirement that authors be experts in their field—experts who could provide reliable and practical advice about caring for urology patients AND who were also proficient writers. This was a challenge!

To ensure the material in the book included the latest scien.tific advances and practice standards, we also reviewed hundreds of scientific papers in urology, as well as treatment guidelines from the American Society of Clinical Oncology, the Association VOLUME 1, ISSUE 4 11 of Perioperative Registered Nurses, the American Urological Association, the National Comprehensive Cancer Network, and the National Cancer Institute, among others. Information discov.ered became an integral part of the book. We also reached out to many reviewers to critique all the chapters in the book, to make sure that the content met our exacting standards for scientific accuracy and reliability.

The role of the urology nurse has continued to evolve and change over the last 10 years, as more urologists have retired and fewer young doctors enter the field. Thus, there’s now a shortage of qualified urologists. Many urology practices—particularly in rural areas—have increasingly turned to advanced practice nurses to provide accessible, safe, high-quality care for patients with urologic disorders.

An advanced practice registered nurse, when properly trained, can enable urologists to provide more, and improved, services within a practice. As a result, urologists can provide high-quality care in a more timely way. Advanced practice nurses in a urology practice can take on patient care tasks that are more complex than those usually delegated to registered nurses (RNs) and office assistants with less stringent training.

In 2012, an American Urological Association survey revealed that 3,300 advanced practice RNs were practicing in urology departments and practices throughout the United States.Yet, there were no formalized training programs for generalized nurses or advanced practice nurses in urology who wanted to increase their knowledge and practice in the field. The Core Curriculum for Urologic Nursing helps provide that training as an adjunct to professional courses, enabling advanced practice nurses to take on more important roles within the urology practice.

The development of this inaugural edition of the Core Curriculum for Urologic Nursing took four years, due to the scope and size of the text. Much of the content has not been published previously. There are no current urology nursing textbooks, and little information for the urology nurse about maintaining best practice standards. So, there is no blueprint for RNs who decide to practice in urology, and want to provide evidence-based care for patients with urologic disorders. This textbook serves as that blueprint, and will help expand the urology nurse’s knowledge, and educate allied healthcare practitioners about the responsibili.ties of a urology nurse in different patient populations.

The text includes unique chapters that discuss specialized and necessary skills in urology nursing, such as techniques for using urinary catheters, and hard-to-find information about procedures like bladder irrigation. We also discuss urologic interventional radiology, a field that is becoming increasingly important with the advent of medications such as radium-223 for the treatment of prostate cancer1. (see Table 1) In addition, we included discussions of conditions that are increasingly prevalent in this country, such as urinary stones. We included a table on urinary stones that provides information on stone prevention and treatment.

All the chapters are accompanied with many stellar illustra.tions by medical illustrator Robin Noel, as well as photos that can help the urology nurse truly understand the concepts discussed in the text. A related Society of Urologic Nurses and Associates supplement, titled Guide to Urologic Medications, was developed in conjunction with the Core Curriculum for Urologic Nursing textbook.

The section on pediatric urology includes chapters on urogenital tumors in children and conditions such as Wilms tumor, one of the most common cancers affecting children. Urologic can.cers are fairly rare in children, but can cause significant morbidity and mortality due to the age at which children are diagnosed, and to the increased toxicity of cancer therapies in children.

There is really no book out there that has the depth and scope of information on pediatric urologic conditions that can be found in the Core Curriculum for Urologic Nursing. We even included several interesting chapters on the wide variety of pediatric urological congenital anomalies. Children can be born with two kidneys or two ureters or may have genitalia disorders— disorders that are important for us to understand in an era of transgender surgeries. Congenital anomalies of the upper urinary tract in children include renal agenesis, in which children are born without kidneys, or genetic renal cystic disease, in which the kidneys develop abnormally. These are rare conditions, but can require extensive monitoring and follow-up, since treatment often revolves around controlling symptoms and slowing the onset of renal failure.

The Core Curriculum for Urologic Nursing also provides significant guidance about the treatment of lower urinary tract symptoms (LUTS), including urinary retention, urinary incon.tinence, overactive bladder, pelvic pain, and interstitial cystitis. Although LUTS can have a significant effect on a patient’s quality of life and self-esteem, in both men and women these conditions are often inadequately treated and poorly addressed by current urology practice.

However, there’s been tremendous growth in the use of advanced practice nurses and physician assistants to treat LUTS with nonsurgical and behavioral interventions. The Core Curriculum for Urologic Nursing offers guidelines about the assessment and treatments of LUTS, which can ideally be used in a multidisciplinary bladder and pelvic floor disorder center. The text discusses how to assess LUTS with a detailed history, and describes pelvic floor muscle training, which is often the first-line treatment in patients with LUTS. Pelvic floor muscle training is frequently used in patients who have symptoms of urinary incontinence, overactive bladder, urinary frequency and urgency, nocturia, pelvic floor muscle spasms, and incomplete bladder emptying. The textbook describes how to perform important assessments of the pelvic floor muscles and anal sphincter with digital exams prior to initiating pelvic floor muscle training.

Written by: Diane Newman, DNP, ANP-BC, FAAN, BCB-PMD, is co-editor of the recently released 1st edition of the Core Curriculum for Urologic Nursing, published by the Society of Urologic Nurses and Associates. Diane Newman is an Adjunct Professor of Urology in Surgery and Research Investigator Senior at the Perelman School of Medicine, University of Pennsylvania in Philadelphia. She has more than 40 years of experience practicing in the field of urology. Dr Newman serves as co-director of the Penn Center for Continence and Pelvic Health. Her urology expertise involves the evaluation, non-surgical treatment, and management of urinary incontinence and related pelvic disorders

1. Newman, DK, Wyman JF and Welch, eds. Core Curriculum for Urologic Nursing, 1st edition. Pitman NJ: Anthony J. Jannetti Inc. and Society of Urologic Nurses and Associates, 2017.
2. Newman DK and Wein AJ. Office-based behavioral therapy for management of incontinence and other pelvic floor disorders. Urol Clin N Am. 2013; 40: 613-635. VOLUME 1, ISSUE 4 13

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