Patients with indwelling catheters at home are more likely to receive home-visit nursing care. However, the condition of patients with indwelling catheters among those receiving home-visit nursing care, as well as the actual status of catheter management practised by visiting nurses, has not been studied. The aim of this study was to study the condition of long-term indwelling urinary catheter users receiving home-visit nursing care and the status of catheter management by visiting nurses. Thirty visiting nurses with experience in home-visit nursing care for patients with long-term indwelling catheters participated in this study. The questionnaire covered (1) attributes of visiting nurses, (2) the condition of indwelling catheter users, and (3) the state of implementation of catheter management by visiting nurses and difficulties experienced. It was found that patients receiving home-visit nursing care had used indwelling catheters for a prolonged period for both disease management and other reasons, and they developed various abnormal symptoms and complications such as urinary tract infection. A high percentage of visiting nurses implemented all the items of observation, practice, guidance and cooperation in catheter management. Items of catheter management that caused difficulty for visiting nurses included detection of urinary tract infection or other complications, catheter insertion, obtaining catheter replacement supplies, encouraging ingestion of water and cooperation with physicians. This study concludes by throwing light on the condition of long-term indwelling urinary catheter users receiving home-visit nursing care, and the status of catheter management by visiting nurses. Key words: catheter management • home-visit nursing care • long-term indwelling urinary catheter users BACKGROUNDLong-term indwelling urinary catheter users reportedly account for 5·4% of patients at home in Europe. Common underlying diseases in these patients include neurologic disorders and dementia characterized by decreased physical or mental function (Sørbye et al., 2005), and in most cases the reason for using an indwelling catheter is difficulty with urination or urinary incontinence (Zimakoff et al., 1993;Gotoh et al., 2002).
Early urinary catheter removal from patients cared for in their own home is often difficult because of incontinence and care burdens, resulting in long duration of catheterization. Urinary tract infection and catheter blockage are major complications associated with long-term catheterization. Preventing these complications is important for patients who require long-term catheterization in their own home. This study aimed to examine the occurrence characteristics of urinary catheter blockage and to identify the causative factors of catheter blockage in patients cared for in their own home requiring long-term urinary catheterization. The study targeted 154 patients cared for in their own home requiring long-term urinary catheterization. Patient data were collected by questionnaire by the nurse manager. Catheter blockage occurred in 33·8% of patients requiring long-term catheterization within the first 6 months, and the mean frequency in these patients was 3·0, indicating that catheter blockage occurs repeatedly. The following management factors significantly correlated with the frequency of catheter blockage: 'check urine volume', 'check for flexion and distortion of the catheter' and 'check urinary tract infection symptoms' for catheter management by caregivers. Symptoms correlated with catheter blockage included 'cloudiness of the urine', 'decreased urine volume', 'abdominal pain' and 'duration of catheterization'. In the future, we would like to prepare the protocol to help visiting nurses improve their abilities to manage catheter blockage in patients requiring long-term catheterization, by incorporating the findings from this study.
In home‐care patients with urinary catheters (hereafter, ‘catheters’), the indwelling periods are sometimes prolonged and can cause various complications. To educate visiting nurses about long‐term catheter management, we conducted ‘The Long‐term Urinary Catheter Management Training Program for Visiting Nurses’ (hereafter, ‘the training program’). We investigated the efficacy of the training program in the present pilot study. The aim of the study was to verify the efficacy of the training program. Forty‐one participants completed a questionnaire survey before and after the training program. The training program's efficacy was verified on the basis of three indices: satisfaction of learning needs, learning achievement and usefulness for visiting nurses. In the satisfaction of learning needs index, more than 50·0% of training participants answered ‘Yes’ for all program content. The participants answered the same questions about long‐term catheter management before and after the training program to assess their learning achievement. The number of correct answers was significantly higher in the post‐training survey than in the pre‐training survey, and the number of correct answers increased for 75·6% of participants. In the usefulness for visiting nurses index, 50·0% or more participants answered ‘Yes’ for all topics but one. The results of this pilot study indicate that the training program was basically effective in educating a relatively small number of participating visiting nurses about long‐term catheter management from a cognitive perspective. However, ‘number of participants,’ ‘method for examining learning achievement,’ ‘number of goals in the program’ and ‘education method’ require improvement.
Background: We developed a mobile application of the protocol for preventing and managing catheter blockage among long-term indwelling catheter users for visiting nurses. We conducted meetings at four visiting nurse stations in Japan from May to June 2017 to explain the application to visiting nurses. Objective: The purpose of the present study was to clarify issues related to the full-scale use of this protocol application, using data from focus group interviews with visiting nurses. Methods: We conducted focus group interviews with the meeting participants. The focus group interviews were conducted at four different venues. Three focus groups had eight participants, and the fourth had two participants, for a total of 26 study participants. Specifically, the group interviews covered (1) the application’s structure and content; (2) operability; (3) portability; (4) possibilities for use, effects, and expectations; and (5) concerns about use. Results: The results of the group interviews were classified into five categories: possibilities for the use of the mobile application, possibilities for further use of the application by nurses, suggestions for the use of the application by caregivers and nursing care workers, the burden associated with the use of the mobile application, and opinions and desires for improvements in the mobile application. Conclusion: The results suggested that visiting nurses would use the mobile application. However, for full-scale use, it would be necessary to add the ability to use accumulated data, increase the number of learning screens, and take safety management measures for the transmission of medical information.
2010 年 8 月 5 日 受付・2010 年 11 月 15 日 受理) 要 旨 全 12 回から成る"訪問看護師を対象とした感染管理教育プログラム"の 12 回目として『在宅 人工呼吸器感染管理研修会』 を,2 ヶ所の訪問看護ステーション訪問看護師 15 名を対象に開催し, 学習効果を検証した.研修会は,2 ヶ所共に平日の夕方 1 時間で開催した.学習効果検証のため, 在宅人工呼吸器の感染管理に関する知識・技術 34 項目の修得度を研修会前(「事前修得度」)と研修 会後(「事後修得度」)に調査し,変化を分析した.修得度は項目毎に, {全くできない}1 点~{十 分できる}5 点として平均値を算出した.事前と事後修得度の比較には Wilcoxon の順位和検定, 各修得度と訪問看護師属性との比較には,Spearman の順位相関係数を用いた.結果,修得度の全 体平均は,事前修得度 3.1 点から事後修得度 4.1 点に上昇した.項目別修得度は,全項目において 事後に上昇した.参加者個人の事前から事後の修得度は,全項目において「上昇」群の割合が「変 化なし」・「低下」群より高かった.以上より,研修会は学習目標達成に効果があったと評価でき る.今後は,修得度が低かった項目について,学習内容・方法の検討が必要と考える. Key words人工呼吸器,感染管理,訪問看護師,研修会 は じ め に 1990 年に在宅人工呼吸療法が初めて医療保険適用と なった.その後,在宅用人工呼吸器の技術革新と普及, 在院日数短縮化及び在宅医療推進により,在宅人工呼吸 療法を行なう療養者は増加している 1) .在宅人工呼吸療 法が適用になる疾患は,非侵襲的陽圧換気療法では呼吸 器疾患,侵襲的陽圧換気療法では神経疾患の占める割合 が高い.そのため,在宅人工呼吸療法を行なう療養者に は,誤嚥性肺炎の予防,吸引操作に伴う感染予防,人工 呼吸器回路からの細菌侵入防止等,感染管理が重要とな る. 在宅において,訪問看護師は医療専門職として療養 者・家族の感染管理を担っている.2008 年には,在宅 人工呼吸療法を行なう療養者への長時間訪問看護加算が 新設 2) され,訪問看護師は,在宅人工呼吸療法を行なう 療養者・家族への適切な感染管理の実施が期待されてい る. しかし,訪問看護師を対象にした感染管理の実態調査 結果では,標準的予防策及び各ケアを感染防護技術に基 づき適切に実施していた者は約半数であった 3) . そこで筆者らは,訪問看護師が在宅療養者に適切な感 染管理を実践できること,及び家族が感染管理に関する 適切な知識・技術を修得できるよう指導できることをめ ざし,全 12 回からなる"訪問看護師対象の感染管理教 育プログラム"を開発し,必要な知識・技術を修得でき るよう研修会を開催している 4) .今回,研修会の第 12 回として, 『人工呼吸器感染管理研修会』(以下,研修会) を開催し,学習効果を検証したので報告する.なおこれ まで,訪問看護師対象に人工呼吸器に関する感染管理の 知識・技術(以下,知識・技術)の修得度や学習効果を検 証した研究は見当たらない.
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