Purpose/Objectives To evaluate the feasibility and acceptability of a multimodality educational intervention for improving self-efficacy (SE) and self-care in patients with a new urinary diversion (UD). Design Two-arm randomized, controlled trial. Setting Academic medical center in New York. Sample 8 adults diagnosed with bladder cancer requiring UD. Methods A multimodality educational intervention consisting of video, Microsoft PowerPoint® slides, and medical illustrations was developed. SE was assessed pre- and postintervention related to care of the UD. Education scale scores provided evidence for intervention acceptability and assessment of UD self-care skills. Main Research Variables Feasibility, acceptability, results of SE, and self-care scales. Findings Enrollment and retention was 100%. All participants took part in every aspect of the study. No issues were apparent with administration of the study; however, a lack of self-care independence was noted between the study arms. The control group was younger in age than the intervention group. Conclusions A supplemental multimethod educational intervention is acceptable in this population and feasible to integrate into hospital care or into an appropriately powered study. Implications for Nursing A need exists for ongoing postdischarge support and education in this population. Additional studies are needed to determine the best approach for this.
Patients with bladder (urothelial) cancer undergoing urinary diversion (UD) experience physical changes that require important adjustments in their daily lives. This integrative review aims to identify factors that influence adult adaptation to life after cystectomy with the creation of a UD. A review of primary research articles published between 1990 and 2014 was conducted using the PubMed and CINAHL Plus electronic databases. Results of the studies were summarized into 5 categories: (1) individual and family factors, (2) technical aspects related to the individual's ability to care for his or her UD, (3) perioperative nursing care, (4) educational needs, and (5) symptom experience. Bladder cancer patients treated with a cystectomy with a UD have a complex set of needs during postoperative adaptation to their reconstructed urinary system. This integrative review summarizes existing knowledge of factors that affect adaptation to a UD in patients with bladder cancer and may guide future studies. Research on this is limited and more studies are needed.
PURPOSE:The purpose of this study was to investigate the effect of a nurse practitioner-led simulation-based education program on nursing knowledge and confi dence in the care of patients with a cutaneous continent urinary diversion (Indiana pouch) or orthotopic neobladder. DESIGN: Single-group, before-after study. SUBJECTS AND SETTING:The sample comprised 11 RNs practicing at New York Presbyterian Hospital in New York City. Subjects were predominantly female, ethnically diverse, and held a bachelor's degree. About half of the subjects had less than 3 years of experience, and more than half reported prior experience caring for patients with a urinary diversion. METHODS: Participants completed a demographic survey, and a continent urinary diversion confi dence survey and pretest measuring knowledge of nursing care of patients with a urinary diversion. Following baseline data collection, an educational session focused on the irrigation of a continent urinary diversion was made available for participants to review. An onsite simulation experience was scheduled several weeks later. Investigators provided education on proper irrigation of a continent urinary diversion and observed participants' skills when irrigating a continent urinary diversion on a high-fi delity simulated patient mannequin. The simulation intervention was followed by video replay and debrief providing feedback on each participant's performance. At the conclusion of the onsite simulation intervention, participants completed a postintervention confi dence survey and a knowledge posttest related to the care of a continent urinary diversion. The Wilcoxon signed rank test was used to analyze baseline and postintervention changes in nursing knowledge and confi dence. RESULTS: Participants achieved signifi cant improvements in knowledge ( P = .005) and confi dence ( P = .009) following the simulation-based educational intervention. CONCLUSIONS: A nurse practitioner-led simulation-based educational program for RNs caring for patients with continent urinary diversions demonstrates enhanced nursing knowledge and confi dence caring for patients with continent urinary diversions. We anticipate this experience will enhance care we provided to patients undergoing cystectomy and continent cutaneous urinary diversion or orthotopic neobladder construction.
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