Observations from a Rural General Practice Nurse

By Dr Catherine W Dunne MSc.D | M.H.I.T. | Registered Nurse

After nearly four decades of nursing, I’ve learned to trust one thing above almost everything else: observation.

Sometimes it tells you everything is exactly as expected.
Occasionally it whispers that something has changed.

And every so often, something makes you pause.
Not because you have an answer.
But because, after many years of practice, your instinct quietly tells you:

“This doesn’t feel quite the same.”

This year, I have found myself pausing more than once.

It is only June, yet I have the impression that I am seeing more Escherichia coli urinary tract infections than I would normally expect.

That observation alone might not seem remarkable.

What has caught my attention is something else.

Throughout most of my nursing career, E. coli urinary tract infections were largely associated with post-menopausal women. It was a familiar pattern that remained fairly consistent over many years working in General Practice.

This year, however, feels different.

Perhaps colleagues in other parts of Ireland are noticing similar changes. Perhaps they are not. That, in part, is why I decided to write this reflection.

Before publishing this article, I posed a simple question to fellow General Practice colleagues. I wasn’t asking for explanations or theories. I simply asked whether anyone else had noticed an apparent increase in E. coli urinary tract infections, particularly in men over 70 years of age.

The early responses were striking in their consistency. Comments included “Yes,” “Definitely,” and “Yes, men with UTIs were not previously an issue, but now they are.”

These responses are, of course, anecdotal and cannot be interpreted as evidence. They do not demonstrate a national trend, nor do they explain why such a pattern might exist. What they do suggest is that the question itself may be worth asking.

I am also seeing more positive urine cultures in men.

I do not yet know why.

That is perhaps the most important sentence in this article.

And I am comfortable saying so.

As healthcare professionals, we are often expected to have answers. Yet many important discoveries in medicine did not begin with answers.
They began with observation.
Someone noticed a pattern.
Someone recognised that something seemed different.
Someone asked a question.

Nursing has always been rooted in observation. Long before laboratory reports, imaging, and sophisticated diagnostic tests, nurses were taught to watch, to listen, and to notice subtle changes that might otherwise be overlooked.

Although modern medicine has transformed healthcare in countless positive ways, that fundamental skill remains just as important today.

A Different Kind of Rural Community

When people think about urinary tract infections in older adults, they often picture frail individuals living in residential care, people with multiple chronic illnesses, or those taking a long list of medications.

That is not the population I work with.

I am privileged to work in a rural General Practice in County Wexford, where many of our older patients continue to lead remarkably active lives.

Many still farm.

Some climb into large tractors every morning without a second thought.

Others continue to care for dairy herds, beef cattle, sheep, horses or alpacas.

Many maintain vegetable gardens and allotments.

Others fish, golf, walk, cycle or participate actively in retirement groups and community organisations.

Some of my patients in their eighties appear fitter than people thirty years younger.

In fact, it is not uncommon for me to see their adult children attending the surgery more frequently than they do.

That is one of the reasons this observation has stayed with me.

While an ageing population undoubtedly contributes to many health trends, it does not fully explain what has caught my attention within my own practice.

These are, for the most part, people who have remained physically active throughout their lives.

Looking Beyond the Laboratory

General Practice nursing teaches you to notice things that rarely appear in textbooks.

You notice changes in behaviour.

You notice subtle differences in appearance.

You notice when a patient says, “This isn’t like me.”

You also notice patterns that cannot always be explained immediately.

Alongside the apparent increase in E. coli urinary tract infections, I have found myself making other observations over the years.

Patients taking allopurinol, for example, often produce urine with a particularly strong odour, yet their urine cultures are frequently completely normal.

Similarly, it has always interested me that many pregnant women produce surprisingly concentrated, dark amber urine despite having normal urine cultures and otherwise uncomplicated pregnancies.

These are not conclusions.

They are simply observations.

Perhaps they are unrelated.

Perhaps they are entirely insignificant.

Or perhaps they are small pieces of a much larger picture that we do not yet fully understand.

One of the privileges of working within the same community for many years is that you begin to recognise when familiar patterns begin to shift.

Medicine Begins With Questions

Healthcare understandably places great importance on evidence.

It should.

Evidence protects patients, guides treatment and improves outcomes.

But evidence itself has to begin somewhere.

Often, it begins with someone asking a simple question.

“Has anyone else noticed this?”

Many of the advances we now take for granted started because observant clinicians recognised something that did not fit the expected pattern.

Not every observation proves to be important.

Sometimes there is a perfectly straightforward explanation.

Sometimes seasonal variation explains everything.

Sometimes changes in testing practices or referral patterns account for what initially appears unusual.

And sometimes…

Something genuinely has changed.

The challenge is recognising which is which.

Why I Am Paying Attention

I may discover in six months’ time that my observations were simply part of an unusual seasonal fluctuation.

I hope that is the case.

Equally, I may discover that colleagues working in other parts of Ireland have quietly been noticing similar trends.

At this stage, the answer remains uncertain.

What I do know is this:

After nearly four decades of nursing, I have learned to trust the value of careful observation.

It has taught me to remain curious rather than certain.

To ask questions rather than rush towards conclusions.

To keep learning.

Perhaps that is one of the greatest lessons nursing ever teaches us.

Not that we will always have the answers.

But that we should never stop noticing.

Final Thoughts

One of the privileges of spending almost forty years in General Practice is the continuity it provides.

You care for families across generations.

You watch children become parents.

You care for people through illness, recovery and healthy ageing.

And because you see those same familiar faces year after year, you also begin to recognise when something quietly changes.

Whether my observations prove to be significant or not remains to be seen.

For now, I shall simply continue to observe, to ask questions, and to listen.

Every advance in medicine began because someone first noticed something that deserved a closer look.

I would be interested to hear whether other General Practice Nurses, Practice Nurses and General Practitioners are noticing similar patterns in their own communities.

I hope you feel inspired. Look after your body, and it will keep you healthy.

Catherine

CWD | 26 June 2026 | Ireland

Holistic Healthcare Wexford
Integrative · Mindful · Patient-Centred

About the Author

Dr Catherine W. Dunne MSc.D. is a Registered General Nurse with over 37 years of clinical experience in primary care in Ireland. Alongside her work in General Practice Nursing, she is the founder of Holistic Healthcare Wexford and co-founder of Aumvedas Academy.

With a background that bridges conventional medicine and holistic practice, Catherine has a particular interest in the area where patients are often told “everything is normal,” yet still feel unwell. Her work focuses on helping people understand what their body is communicating, especially in relation to energy, stress, metabolic function, and recovery.

Through a combination of clinical knowledge and holistic support, she works with individuals to restore balance, improve resilience, and support long-term wellbeing.

Based in Wexford, Ireland.

Disclaimer

This article is for informational and educational purposes only and is not intended as medical advice. It does not replace consultation with a qualified healthcare professional. Patients should always seek appropriate medical guidance regarding their individual health needs and before making changes to treatment or care.