Caring for catheterized patients: urinary catheter maintenance

This article brings together the evidence and opinions surrounding the ongoing problem of catheter blockage and how to help maintain catheter life. The reasons behind blockage are examined as well as the roles that pH testing and building a comprehensive catheter history, including all aspects of patients' general health, play in caring for the catheterized patient. The use of catheter-maintenance solutions is addressed with discussion on smaller volumes, the use of double instillations and gentle technique for a shorter time of instillation and improvement in catheter-intervention techniques.     

颈外静脉穿刺置管再改良技术的应用

颈外静脉穿刺置管是临床中静脉输液、营养支持及用药的主要途径之一。尤其在抢救各种休克、长期用药、化疗及全肠胃外营养(TPN)中占重要地位[1~3]。颈外静脉的穿刺部位、患者体位的选择和置管技术,是保证输液畅通的关键所在。为了提高颈外静脉穿刺置管技巧,进行有效的输液,本研     

Using smart phone technology to improve daily living skills for individuals with intellectual disabilities

Background

Individuals with intellectual disabilities need continued supports in completing daily living tasks to increase the likelihood of achieving independence. Fortunately, research has shown that assistive technology, and particularly video prompting helps support independent living for individuals with intellectual disabilities.

Aims

This study investigated the efficacy of a highly customizable task analysis smartphone application in assisting three young adults with intellectual disabilities learn how to cook three different multistep recipes.

Materials & Methods

Three young adults with intellectual disabilities enrolled in a four-year postsecondary education program (PSE) participated in a multiple probe design across participants to examine the effect of a Task Analysis app on the participants' completion of three cooking tasks.

Results

In this present study, the use of video prompting to teach a daily living skill resulted in large and meaningful effect size gains of 99%–100% for all three participants, as measured by Tau-U.

Discussion

Video prompting is an effective instructional strategy which allows the user to self-prompt and manage their ability to successfully complete daily living skills. In this current study, video prompting made a substantial difference in the safety of participants.

Conclusion

The use of video prompting can decrease the reliance on others (e.g., teachers and caregivers), improve self-confidence of the user, and improve the user's level of autonomy.     

Simplified urinary immunoassay for 2,4-D: validation and exposure assessment

Urinary monitoring of exposed workers by either analytic chemical methods or radioimmunoassay suggests that urinary levels of 2,4-dichlorophenoxyacetic acid (2,4-D) exceeding 30 ppb are indicative of occupational exposure. However, the current methods do not lend themselves to clinical laboratory use in the rural medical setting. The major goal of this project was to provide medical practitioners who care for members of the agricultural community with a cost-efficient way to conduct exposure assessment. This project used a direct 2,4-D enzyme immunoassay (EIA) and measurement of the ratio between 2,4-D-spiked and non-spiked samples of the same urine to quantify 2,4-D levels. This simplified approach minimizes the effects of non-specific interfering substances in urine and eliminates the need for sample extraction and clean-up. Possible urine co-contaminants (2,4-dichlorophenol and 2,5-dichlorophenol) do not significantly interfere with this immunoassay. Twenty-two forest pesticide applicators who apply and use chlorophenoxy herbicides in their work and 14 comparable control subjects were studied to validate the assay in the occupational setting. Coded urine specimens were examined for levels of 2,4-D by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and compared with immunoassay results from the same specimens. A correlation coefficient of r = 0.982 with a P value of .0001 for a plot of HPLC-MS/MS versus immunoassay demonstrated that the results from these methods were comparable over urinary dose levels ranging from not detectable (<19 ppb) to 1700 ppb 2,4-D, as determined by immunoassay.     

Intraurethral catheter: alternative management for urinary retention in patients with benign prostatic hypertrophy

A polyurethane intraurethral catheter (IUC) was used in 27 patients with benign prostatic hypertrophy who were unfit for surgery, or were awaiting surgery. All of them had previously had a periurethral catheter inserted. The IUC was inserted with a cystoscope under fluoroscopic control. Spontaneous voiding through the IUC resumed in 25 patients (93%) in the immediate postprocedure period. At the end of 6 months follow-up, the peak flow rates and the residual volumes estimated in 22 patients were satisfactory. Immediate complications included incontinence due to distal displacement in 2 patients and hematuria in one patient; long-term complications included mild encrustation of the IUC in 2 patients and calculus formation on the IUC in 1 patient. None of the patients had clinically significant urinary tract infection. The presence of the IUC did not compromise the subsequent transurethral resection of the prostate gland. We recommend the use of an IUC for up to 6 months in patients with urinary retention who are awaiting surgery or are unfit for surgery as an alternative to an indwelling urethral catheter.     

Choosing a urinary catheter for short and long-term use

There are many reasons why patients need a catheter, and the length of time one is needed varies, depending on the condition and how well the patient is. This review looks at the range of catheters available and the advantages and disadvantages for individual patients of the different sorts.     

Helping relationship skills in nurses: the validation of a measurement instrument

Considering the importance of assessing nurses' helping relationship skills, it was necessary to use reliable and context-adapted instruments. Thus, the objective of this study was to assess the psychometric properties of the Helping Relationship Skills Inventory (Inventário de Competências Relacionais de Ajuda, ICRA), by conducting reliability and validity studies to increase the level of confidence or accuracy of the data obtained using this instrument. This quantitative study was conducted on a sample of 690 nurses who worked in six hospitals and eight health centres in Portugal. The results indicate a multidimensional structure of helping relationship skills, divided into four different dimensions (generic, empathetic, communication and contact skills) with a positive correlation between them. Cronbach's alpha for each dimension was higher than .79, showing a good internal consistency of the items within each factor.     

Planning for information technology key skills in nurse education

New recruits to courses in nursing, midwifery and health visiting come from a wide range of educational backgrounds and it is reasonable to expect that this diversity will also be reflected in the range of their experience and competence with information technology (IT). Accommodating such variety can make the planning of appropriate training to enhance and develop their IT skills difficult. In order to explore the likely extent of diversity in IT experience and skills in today's recruits, the project reported here examined the competence, attitudes and previous IT training of two consecutive cohorts of new entrants to a higher diploma programme. The surveys add weight to the view that nurse educators do face a considerable diversity in new students' competence and experience with IT. Further analysis has also shown that subgroups of the cohorts, characterized by their age, gender, education or previous IT training, differed significantly in a 'knowledge of computers' score but not in their attitudes to IT. Arising from the results, the paper argues that, in seeking to develop a consistent level of IT literacy, core IT competence should be identified and all courses should have the clear objective of raising students' confidence in using computers.     

Adherence to evidence-based guidelines for indwelling urinary catheter management: A cross-sectional study

BackgroundUrinary tract infections from indwelling urinary catheters are amongst the most common healthcare acquired infection. Correct adherence to evidence-based guidelines has been shown to reduce these infections. There is limited Australian data on adherence to these guidelines.AimTo examine the prevalence of use of indwelling urinary catheters and identify the rate of adherence to evidence-based guidelines.MethodsA cross-sectional study design using an audit tool was conducted at a major metropolitan teaching hospital (>600 beds) over 2-days in May 2019 in Western Australia.FindingsPrevalence of use of indwelling urinary catheters (n = 67 of 522 patients, 12.8%) was low. There was good compliance with observed catheter care apart from securement of the catheter. There was poor compliance with documenting the planned date for catheter removal and daily perineal/penile hygiene (2.9%–18.6%).DiscussionThe observed care was generally compliant apart from securement. We attributed this to the possible lack of securement devices available on the general wards. Documentation was poorly completed at our centre and commonly reported in the literature. The introduction of prompting documentation using stickers may be useful in overcoming this shortfall in compliance.ConclusionThis audit will allow us to target areas for improvement in catheter care and ensuring accurate and complete documentation. More research is needed in obtaining information around the evidence-based guidelines and relationship to clinical development of catheter associated urinary tract infection.     

Analytical validation of an HPLC assay for urinary albumin

BACKGROUND: Microalbuminuria is the earliest clinical finding for renal disease. Diabetic individuals often produce modified forms of albumin, perhaps due to impaired lysosomal processing, that are undetectable by common immunoassays but accurately measured by HPLC. METHODS: We evaluated the performance of a commercially available, FDA-approved HPLC assay (AusAm Biotechnologies, NY) and compare results to our immunoturbidimetric assay (ITA, Beckman-Coulter, CA) using random urine specimens from 32 nondiabetic and 60 type 1 and 2 diabetic subjects. RESULTS: The HPLC assay was linear to 963 mg/l with a limit of detection of 6.1 mg/l. Within-run and between-run precision was <2% and 7-10%, respectively. Unpreserved urine was stable for at least 3 days at room temperature and 10 days at 4 degrees C. In both diabetic and nondiabetic subjects urinary albumin concentrations were higher by HPLC than by ITA, and many more diabetic and nondiabetic individuals were classified as microalbuminuric by HPLC than by ITA. The HPLC assay showed acceptable performance; however, because urinary albumin concentrations are higher in apparently healthy nondiabetic as well as diabetic subjects, different cutpoints will be necessary to accurately differentiate microalbuminuria. CONCLUSIONS: Prospective studies are necessary to determine whether the HPLC assay can effectively detect microalbuminuria earlier than current assays without a concomitant increase in the false positive rate.     

Best practice in urinary catheterisation and catheter care

In May 2002 a series of 'best practice statements' to encourage a consistent and cohesive approach to care was launched by the former Nursing and Midwifery Practice Development Unit (NMPDU).     

Integrating psychology with interpersonal communication skills in undergraduate nursing education: Addressing the challenges

The inclusion of the social, behavioural and bio-sciences is acknowledged as essential to the development of the art and science of nursing. Nonetheless, the literature highlights on-going debate about the content and delivery of these subject areas in undergraduate nursing education. The bio-sciences and social sciences in particular have received much attention but more recently the inclusion of psychology in nursing curricula is gaining momentum. Studies conducted on nursing students' views of these supporting sciences have also highlighted problems with their understanding, relevance and application to nursing practice.Although broad guidelines are given as to what should be included, no detail is given as to how much detail or at what level these subjects should be taught. Subsequently, approved institutions are responsible for their own course content. This has resulted in inconsistent and varied approaches to integrating the sciences in undergraduate nursing curricula.Following a recent review of the undergraduate nursing curriculum in one university in the Republic of Ireland a decision was made to combine the teaching, learning and assessment of Applied Psychology with Interpersonal Communication skills. This paper will describe the developmental process and evaluation of the integrated module.     

Living with a long-term urinary catheter: older people's experiences

Title. Living with a long‐term urinary catheter: older people’s experiences. Aim. This paper is a report of a study of the experiences of older people living with a long‐term urinary catheter and the development of a substantive theory grounded in their realities. Background. Understanding the user perspective is a prerequisite for involving older people in a collaborative relationship with healthcare professionals which is built around their needs and wishes. Older people’s views and experiences of the complexity of living with a long‐term catheter have not been widely researched. An enhanced understanding of catheter users’ perspectives and an awareness of their needs can be used to improve care. Method. A grounded theory approach was adopted and 20 in‐depth interviews were carried out in England in 2005 and 2006 with 13 older people living at home with long‐term urinary catheters. Findings. The core category ‘all about acceptance’ described older people’s adjustment to living with a long‐term urinary catheter; the two categories ‘at ease’ and ‘uneasy’ reflect the extremes of contentment experienced. Three interlinking categories of ‘trying to understand’, ‘judging catheter performance’ and ‘being aware of the catheter’ shaped older people’s relationships with their catheters and this was mediated by their ‘interaction with others’. The consequences for older people fluctuated along a continuum from ‘engaging actively’ to experiencing ‘downbeat sentiments’. Conclusion. To assist older people to adjust to living with a catheter, healthcare professionals must be sensitive to their life situations and individual needs rather than focusing predominantly on catheter performance and complications.