1,721,053 research outputs found
“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care
No full textBackground Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians’ decisions need to be better understood. Objective To explore why clinicians decide to place IUCs in acute medical care. Methods We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used. Results Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals. Conclusions These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.</p
Small study finds that hydrophilic catheters decrease use of antibiotics to treat UTI in people with spinal cord injury who use self-intermittent catheterisation compared with non-coated catheters
No full textInnovating indwelling catheter design to counteract urinary tract infection
No full textBackground and objective: bacteriuria is anticipated in long-term indwelling catheter (IDC) use, and urinary tract infections (UTIs) and related issues are common. Defence mechanisms against infection are undermined by the presence of a Foley catheter, and adjustments to design could influence UTI risk.Methods: we reviewed the various aspects of IDCs and ureteric stent designs to discuss potential impact on UTI risk.Key findings and limitations: design adaptations have focussed on reducing the sump of undrained urine, potential urinary tract trauma, and bacterial adherence. Experimental and computational studies on ureteral stents found an interplay between urine flow, bacterial microcolony formation, and accumulation of encrusting particles. The most critical regions for biofilm and crystal accumulation are associated with low shear stress. The full drainage system is the functioning unit, not just the IDC in isolation. This means reliably keeping the drainage system closed and considering whether a valve is preferred to a collection bag. Other developments may include one-way valves, obstacles to “bacterial swimming”, and ultrasound techniques. Preventing or clearing IDC blockage can exploit access via the lumen or retaining balloon. Progress in computational fluid dynamics, energy delivery, and soft robotics may increase future options. Clinical data on the effectiveness of IDC design features are lacking, which is partly due to reliance on proxy measures and the challenges of undertaking trials.Conclusions and clinical implications: design changes are legitimate lines of development, but are only indirect for UTI prevention. Modifications may be advantageous, but might potentially bring problems in other ways. Education of health care professionals can improve UTIs and should be prioritised.Patient summary: catheters used to help bladder drainage can cause urinary infections, and improvements in design might reduce the risk. Several approaches are described in this review. However, proving that these approaches work is a challenge. Training professionals in the key aspects of catheter care is important
Supporting women with toileting in palliative care: use of the female urinal for bladder management
Full text linkAims and objectives: This study explored whether a female urinal is an acceptable, safe and effective product to meet the toileting requirements of women receiving palliative care on oncology wards in hospital.Background: There is minimal evidence on how urinary incontinence should be managed in women receiving palliative care. Female urinals may present an option. There have been two general reviews of products available but no formal evaluation since 1999.Design: This qualitative interview study used semi-structured interviews.Methods: 11 healthy volunteers, 9 patients and 7 staff members used (or assisted with) a VernaFem (Vernacare) female urinal and subsequently interviewed. Directed content analysis was used to analyse the interviews.Results: User testing confirmed that the VernaFem is an acceptable, safe and effective product. Design improvements were suggested.Conclusions: While unlikely to be suitable for all patients, hospitals should consider offering a female urinal to patients in receipt of palliative care
Intermittent catheterisation after Botulinum toxin injections: the time to reassess our practice
No full textIntroduction Botulinum toxin has become a widely adopted treatment for patients with recalcitrant overactive bladder (OAB) symptoms. Some recommend the institution of clean intermittent self- catheterisation (CISC) if a post void residual exceeds 200 mls post treatment but there is no evidence for this recommendation. The aim of this study was to identify whether abstinence from CISC as a routine strategy for patients with a post void residual (PVR), post intra-detrusor botulinum toxin injections, is associated with any measureable adversity.Methods This was a cohort observation study. Patients with lower urinary tract symptoms (LUTS) attending a medical urology centre were observed pre and post botulinum toxin treatment. Intra-detrusal botulinum toxin injections were administered in the day treatment centre at a medical urology centre in London, United Kingdom. Patients were reviewed at follow up consultations to measure PVR.Results 240 patients were studied; there were 215 women and 25 males. 196 patients (82%) received botulinum toxin injections and were not managed with CISC. 18% were using CISC prior to injections and continued. None of the 196 developed acute retention or significant voiding symptoms. ConclusionsOur study indicates that routine administration of CISC based on an arbitrary PVR volume is unlikely to confer benefit. In order to avoid patients being deterred from botulinum treatment we recommend that CISC be reserved for those who have troublesome voiding symptoms as well as a raised PVR. It is unlikely that CISC, initiated on the basis of an arbitrary PVR volume would benefit the patient
Penile compression clamps: a model of the internal mechanical state of penile soft tissues
No full textManaging incontinence using technology, devices and products: directions for research
No full textBackground: Millions of Americans with incontinence use some type of device or product to manage or collect urine or feces. However, research on their clinical uses, problems requiring nursing care, and patient satisfaction is lacking.Objectives: To review the various products and devices used for incontinence, identify directions for research and development on technology, and outline the ways nurses can influence and participate in those investigations.Methods: Existing literature on incontinence technology, devices, and products was analyzed to generate a plan for future research.Results: Gaps in knowledge exist about the uses, best practices, quality of life factors, and problems associated with catheters, absorbent products, other internal and external devices, and skin care products.Conclusions: Collaboration among public and private sectors would result in greater likelihood of high quality clinical research that has sufficient power and integrity, more efficient use of resources special to each setting, and expedited application of technologies for patient use
Community prevalence of long-term urinary catheters use in England
No full textOBJECTIVES: To calculate the prevalence of long term catheter use in the community in two areas in the south and west of England.SUBJECTS/PATIENTS (OR MATERIALS) AND METHODS: People in England register with general practices to access health care through a National Health Service. Catheters are provided by prescription free of charge. In 2008, patients using urinary catheters for over 3 months were identified, and demographic information collected, from databases of general practices, using catheter prescribing records. The age and sex distributions of people in each practice were obtained from capitation claims. Overall, and age and sex-specific prevalence were calculated separately for each area, and compared.RESULTS: A total of 583 long term catheter users (329 south, 254 west) were identified from 404,328 people registered with practices. The overall population prevalence is similar in both locations (0.146% southern, 0.141% western). Extrapolating for the United Kingdom, this is over 90,000 long term catheter users. Prevalence increases with age (0.732% in over 70 years, 1.224% over 80), especially amongst men. Overall, higher proportions have neurological (vs. non-neurological) reasons (62.9% vs. 37.1%) and use urethral (vs. suprapubic) catheters (59.7% vs. 40.3%). Compared to men, more women tend to use suprapubic (56.4% vs. 29.3%) and have a catheter for neurological reasons (71.8% vs. 56.2%, P?=?0.053).CONCLUSIONS: Previous evidence on prevalence of long term catheter use is sparse, and of variable quality. The strength of this study is utilisation of a reliable source of data (catheter prescriptions) from a large population of patients
Exploring the role of practical nursing wisdom in the care of patients with urinary problems at the end of life: a qualitative interview study
No full textAIMS AND OBJECTIVES: This study examined how nurses understand urinary problems at the end of life, and identified sources of evidence upon which they base their practice through semi-structured qualitative interviews. The aim was to decide whether research or interventions (such as formulation of best practice guidelines) could improve continence care at the end of life.BACKGROUND: There is little evidence in nursing literature to indicate how nurses should manage urinary problems at the end of life. Evidence is particularly lacking regarding the insertion of indwelling urinary catheters.DESIGN: This was an applied qualitative interview study which used the 'guided interview' approach.METHODS: Twelve participants who worked in two hospital wards and one hospice were interviewed about management of patients with urinary problems approaching the end of life. The transcribed interviews were organised using the qualitative analysis software qsr NVivo version 10 (QSR International, Melbourne, Australia). Constant comparison was used to analyse the interviews.RESULTS: The patient and their family were a key concern of all interviewees. Participants focused on processes including: giving care, making decisions, managing uncertainty and assimilating knowledge. These processes are mediated by 'phronesis' or practical wisdom.CONCLUSIONS: Within each of the processes (giving care, making decisions, managing uncertainty and assimilating knowledge), participants approached each patient as an individual, using experience, patient wishes, available resources, clinical knowledge and advice from colleagues to provide care. A generalised set of guidelines on managing urinary problems at the end of life would probably not be useful.RELEVANCE TO CLINICAL PRACTICE: There is uncertainty about what constitutes best practice in specific areas of continence care at the end of life such as indwelling urinary catheter insertion. A careful approach is needed to ensure that the intellectual and moral knowledge that constitutes practical wisdom is shared and developed throughout teams
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