Changing a urethral or suprapubic catheter: the patient's perspective

Understanding the patient's perspective in any area of health care is now recognised as being crucial to good practice, but little is known about patients' views on living with an indwelling urinary catheter. In this study, 36 people living with either a urethral or suprapubic catheter across the UK were interviewed. After thematic analysis, the authors interpreted what they learned. Many issues were raised, including the need to know who was responsible for changing the catheter, the importance of continuity of care, 24-hour access to services, and good hygiene. Patients valued nurses with training and experience, with plenty of time, who took care and who listened to what mattered to the patient. The patient's perspective is important at all levels, not only when designing and planning an integrated continence service, but also in delivering services in the community.

An alternative model of prescribing stoma appliances

The NHS is challenged with making efficiency savings of pounds 20 billion by 2015. In order to achieve a target of this magnitude, commissioners, clinicians and patients are required to work together to evaluate current service delivery and explore all options which have the potential to increase efficiency. This article describes the significant service redesign work undertaken in Rotherham by commissioners, clinicians and patients which has improved the way in which prescriptions are issued to patients requiring stoma products. The project has achieved impressive financial savings and, importantly, has improved patient experience. The project illustrates how new ways of working can significantly contribute to the pounds 20 billion savings target, avoiding cuts in service provision while simultaneously improving the quality of service provided to patients.

OptiLube Active. The role of lubricants in urinary catheterisation

Catheterisation is necessary for many patients but places them at risk of developing uncomfortable and potentially lethal infections. Catheter insertion can also be painful. It is essential that all staff who perform the procedure have a clear understanding of the measures they should implement to reduce discomfort, trauma and the risk of infection to the patient. The need for staff to be trained and competent and to use an aseptic technique when undertaking the procedure are core principles for practice. Guidance advises that lubricating gels are used in all patients undergoing urethral catheterisation to minimise the risk of urethral trauma and associated infection. Gels containing a local anaesthetic make the procedure less uncomfortable, but must be applied correctly to be effective. This article will consider the actions of these gels and the potential benefits and risks associated with each, focusing on use of OptiLube Active with case studies.

Key considerations of intermittent catheterisation

Intermittent catheterisation provides a safe and effective alternative to indwelling catheterisation for patients who require bladder drainage. It can be undertaken by health professionals in a variety of clinical settings for a range of clinical indications, and increasingly by patients themselves who use it as a long-term bladder management technique. The relative simplicity of the technique comes with the potential for health professionals to underestimate the skills required when considering a regimen of intermittent catheterisation and, perhaps more importantly, to underestimate the impact it may have on individual patients. The aim of this article is to consider intermittent catheterisation, its indications as a bladder management technique, and the potential psychological impact it may have on the patient, as well as how this may influence concordance.

Promoting patient safety in continence care

Continence care is a fundamental component of nursing. Good quality continence care supports patient dignity and improves quality of life significantly. However, as with all aspects of health care, patients face a number of risks during the delivery of continence care and, perhaps more importantly, are at risk of harm when care is not given to the required standard. This article focuses on essential elements of continence care and explores pertinent risks to patient safety, which may occur if care is not individualised or delivered appropriately.

Selecting the right urinary leg bag drainage system for patient needs

There are many clinical reasons why a patient may require indwelling urinary catheterization. Selecting the most appropriate closed drainage system to be used in conjunction with an indwelling catheter is essential to reducing the patient's risk of developing catheter-associated urinary tract infection (CAUTI). Leg bags are one of the options available, however, evidence suggests patients may find these products problematic during daily activity. Careful assessment of patients' needs when selecting a leg bag enables the nurse to identify the individual's specific product needs, thereby reducing the risk of difficulties for the patient during daily use. This article focuses on key areas for consideration when selecting a leg bag.

Redesigning a continence prescription service to improve patient safety and experience

A review of prescribing practice for continence related products revealed shortcomings in the service that patients were receiving. This led to it being radically redesigned, with the continence service being responsible for prescriptions. The new service model also includes telephone triage before prescriptions are issued. Patient feedback on the new model has been extremely positive. This project won the 2009 Nursing Times continence award.

Improving service provision for patients who are prescribed continence products

It is estimated that 14 million people experience problems with bladder control and 6.5 million people have a bowel control problem (Bladder and Bowel Foundation, 2008). Many will rely on continence products to manage their problem and as such require products which ensure user dignity and discretion is maintained. Locally, an ever-increasing spend on prescribed continence products promoted a review of current service delivery. The combined results of a clinical audit and patient satisfaction survey highlighted areas in which service delivery needed immediate improvement. Significant service re-design has been undertaken with prescribing responsibility for continence-related products being transferred from GP practices to specialist nurses working within the continence service. Improvements in clinical care have been achieved and cost savings have been re-invested in the service.

Principles of aseptic technique in urinary catheterisation

Most nurses are aware of the importance of aseptic technique but some may be unsure about applying the technique during urinary catheterisation. This article explains the principles of aseptic technique and their application to the procedure of urinary catheterisation. The article was originally published in Nursing Standard in 2006, volume 21, number 8, pages 49-56.

A UK consensus on the management of the bladder in multiple sclerosis

Bladder symptoms in multiple sclerosis (MS) are common and distressing but also highly amenable to treatment. A meeting of stakeholders involved in patients' continence care, including neurologists, urologists, primary care, MS nurses and nursing groups was recently convened to formulate a UK consensus for management. National Institute for Health and Clinical Excellence (NICE) criteria were used for producing recommendations based on a review of the literature and expert opinion. It was agreed that in the majority of cases, successful management could be based on a simple algorithm which includes using reagent sticks to test for urine infection and measurement of the post micturition residual urine volume. This is in contrast with published guidelines from other countries which recommend cystometry. Throughout the course of their disease, patients should be offered appropriate management options for treatment of incontinence, the mainstay of which is antimuscarinic medications, in combination, if necessary, with clean intermittent self-catheterisation. The evidence for other measures, including physiotherapy, alternative strategies aimed at improving bladder emptying, other medications and detrusor injections of botulinum toxin A was reviewed. The management of urinary tract infections as well as the bladder problems as part of severe disability were discussed and recommendations agreed.

Continence specialists use of quality of life information in routine practice: a national survey of practitioners

OBJECTIVES

To survey continence specialists (CSs) about their assessment practice including their use of quality of life (QoL) information, perceived barriers, benefits and training needs.

METHODS

Cross-sectional national postal survey of 624 practicing CSs in the UK. The questionnaire included open and closed questions relating to assessment practice.

RESULTS

Completed questionnaires were returned by 299 (49%) CSs. Although 80% routinely assessed QoL, fewer than 54% demonstrated awareness of published questionnaires. The majority used structured questions (41%) many of which were non-standardised single items (26%) or locally developed questionnaires (19%). Only 22% used standardised patient-completed questionnaires such as the King's Health Questionnaire and the Incontinence Quality of Life questionnaire. Perceived assessment barriers included the availability of appropriate questionnaires, patient disability, limited guidance, resources and time. Of those routinely assessing QoL, 77% wanted more support; the most useful media cited being the internet, followed by professional guidance and training courses.

CONCLUSION

Although QoL measurement is highly valued, there was wide variation in assessment practice with few adopting standardised approaches. Most CSs require greater guidance and support that takes account of their diverse needs. Familiar assessment barriers exist which the use of web-based information, in association with professional guidance might help overcome. Clear mechanisms are required to direct standardised and appropriate assessment practice.

Intermittent catheterisation: using a reflective framework

Intermittent catheterisation is a safe and acceptable method of bladder emptying, however, the impact it has on a patient's quality of life may not be fully appreciated by those involved in teaching the procedure. Reflection after an event allows practitioners to critically examine the experience from the nursing and patient perspective and respond to it in relation to current theory, literature and research.