Good nursing practice is based on evidence and undertaking a community health needs assessment is a means to providing the evidence to guide community nursing practice. A community health needs assessment is simply a process that examines the health status and social needs of a population. It may be conducted at a whole-of-community level, a sub-community level or even a sub-system level. Nursing practice frequently involves gathering data and assessing individuals or families to determine appropriate nursing interventions. This concept is transferable to an identified community, when the community itself is viewed as being the client. This chapter focuses on exploring the principles and processes involved in undertaking a community health needs assessment.

The third industrial revolution saw the creation of computers and an increased use of technology in industry and households. We are now in the fourth industrial revolution: cyber, with advances in artificial intelligence, automation and the Internet of things. Both the third and fourth revolutions have had a large impact on health care, shaping how health is planned, managed and delivered, as well as supporting wellness and the promotion of health. This growth has seen the advent of the discipline of health informatics with several sub-specialty areas emerging over the past two decades. Informatics is used across primary care, allied health, community care and dentistry, with technology supporting the primary health care continuum. This chapter explores health informatics by examining the building blocks of the discipline and analysing how technology, governance and the workforce are supporting digital health transformation.

Despite current and predicted ongoing primary health care (PHC) nursing workforce shortages (Heywood & Laurence, 2018), the undergraduate nursing curricula in Australia and internationally remain largely directed towards acute care (Calma, Halcomb & Stephens, 2019; Mackey et al., 2018). Additionally, the efforts of schools of nursing in supporting the career development of new graduate nurses and their transition to practice also remain largely focused on employment in acute care tertiary settings. This chapter highlights the extent to which current undergraduate nursing curricula prepare registered nurses to work in PHC, reviews the attitudes of nurses regarding PHC employment and discusses the current challenges regarding nurse transitions between acute and PHC practice environments. Understanding the preparation nurses have for a PHC career, nurse attitudes towards and knowledge of PHC, andchallenges associated with transitions between practice environments are important to promote recruitment and retention of the PHC nursing workforce.

Good nursing practice is based on evidence and undertaking a community health needs assessment is a means to providing the evidence to guide community nursing practice. A community health needs assessment is simply a process that examines the health status and social needs of a population. It may be conducted at a whole-of-community level, a sub-community level or even a sub-system level. Nursing practice frequently involves gathering data and assessing individuals or families to determine appropriate nursing interventions. This concept is transferable to an identified community, when the community itself is viewed as being the client. This chapter focuses on exploring the principles and processes involved in undertaking a community health needs assessment.

The term ‘neurogenic’ bladder is non-specific and applies to any lower urinary tract (LUT) dysfunction which is a consequence of neurological disease. A neurogenic bladder can result in disruption of storage and voiding functions of the LUT depending on the associated neurological pathology, which often (but not always) leads to the LUT symptoms and requires prompt evaluation. Urodynamic testing is frequently undertaken to evaluate such patients, as their disease or injury to the nervous system can have profound consequence. The sequelae of neurological LUT dysfunction can include chronic urinary infection, formation of urinary tract calculi, incontinence, vesico-ureteric reflux, acute kidney injury and chronic kidney disease. There is, therefore, a low threshold for urodynamic investigation within this patient group.

The publication ‘United Kingdom Continence Society: Minimum Standards for Urodynamic Studies, 2018’ was commissioned by the UK Continence Society (UKCS), to replace the Joint statement on minimum standards for urodynamic practice in the United Kingdom: Report of the urodynamic training and accreditation steering group (published in April 2009 by the UKCS). The 2009 document has been completely rewritten with the prime aim of providing information, advice and guidance to help with best practice in urodynamic study services. The full version of the 2018 document has been accepted and published in Neurourology and Urodynamics [1]. This work is a shortened version of the document and appears with the permission of NAU under a joint copyright agreement between NAU and UKCS.

Conventional urodynamics (laboratory cystometry) is considered the ‘gold standard’ for measuring bladder function. However, it is a static short test, typically 20–30 minutes, and is considered ‘nonphysiological’. It involves rapid retrograde filling of the bladder in a laboratory setting, which does not always allow reliable reproduction of symptoms. Ambulatory urodynamic monitoring (AUM) relies on physiological bladder filling with natural stressors, including patient mobilisation over a longer time frame, to monitor bladder function which can then be directly compared to presenting symptoms. It is a useful additional test for women in whom conventional urodynamics fails to reproduce or explain the lower urinary tract symptoms of which they complain [1]. AUM is performed through a portable system which allows information to be recorded digitally, and downloaded and reviewed during or at the end of the test. The trace can then be expanded or compressed without loss of information.

A bladder diary provides an objective evaluation of the severity of urinary storage symptoms and associated urinary incontinence. Bladder diaries are not used to diagnose detrusor overactivity or urodynamic stress incontinence; however, they help to guide conservative management and to provide lifestyle advice, and keeping a bladder diary is the only method available to diagnose nocturnal polyuria.

Patient-centred questionnaires and patient-reported outcome (PRO) measures are terms that are used interchangeably to reflect an instrument that provides evaluation of the lived experience of symptoms from the patients’ perspective. PRO use has grown significantly in the past 10–15 years, due to recognition of the importance of placing patients at the centre of their care [1]. It is recognised that only those individuals experiencing symptoms can report on the more subjective elements [2]. This is particularly important in the case of urodynamics, which is a clinical test. PROs provide a method of measuring subjective phenomena in an objective way and provide context to the data provided by clinical measurements. PROs can be used to record the presence and severity of symptoms and also to measure their impact, in particular on quality of life. This is useful when interpreting patients’ priorities for treatment and understanding the most bothersome aspect of their symptoms.

Videocystourethrography (VCU), also known as videourodynamics, comprises synchronous radiological screening of the urinary tract during subtracted dual-channel filling and voiding cystometry [1].

According to the International Continence Society (ICS) (2016), cystometry is the continuous fluid filling of the bladder via a transurethral catheter (or other route, e.g. suprapubic or mitrofanoff), with at least intravesical and abdominal pressure measurements and display of detrusor pressure, including cough (stress) testing. Cystometry ends with ‘permission to void’ or with incontinence of the total bladder content [1].

The urethra is a complex organ essential for the maintenance of urinary continence. It has always been suggested that as long as the urethral pressure exceeds the one generated by the bladder, continence is maintained. This is a plausible explanation when the patient is at rest but cannot fully explain how this pressure differential is maintained during periods of raised intra-abdominal pressure.

Pad testing, most often used as an objective assessment of urinary incontinence, involves the use of pre-weighed continence pads to capture urinary leakage over a period of time. On completion of the tests, the pads are then weighed to calculate the amount of leakage.