Self-Management Intervention for Long-Term Indwelling Urinary Catheter Users

Abstract

Background People using long-term indwelling urinary catheters experience multiple recurrent catheter problems. Self-management approaches are needed to avoid catheter-related problems. Objectives The aim was to determine effectiveness of a self-management intervention in prevention of adverse outcomes (catheter-related urinary tract infection, blockage, and accidental dislodgement). Healthcare treatment associated with the adverse outcomes and catheter-related quality of life was also studied. Method A randomized clinical trial was conducted. The intervention involved learning catheter-related self-monitoring and self-management skills during home visits by a study nurse (twice during the first month and at four months—with a phone call at two months). The control group received usual care. Data were collected during an initial face-to-face home interview followed by bimonthly phone interviews. A total of 202 adult long-term urinary catheter users participated. Participants were randomized to treatment or control groups following collection of baseline data. Generalized estimating equations (GEE) were used for the analysis of treatment effect. Results In the intervention group, there was a significant decrease in reported blockage in the first six months (p = .02), but the effect did not persist. There were no significant effects for catheter-related urinary tract infection or dislodgment. Comparison of baseline rates of adverse outcomes with subsequent periods suggested that both groups improved over 12 months. Discussion A simple–to–use catheter problems calendar and the bimonthly interviews might have functioned as a modest self-monitoring intervention for persons in the control group. A simplified intervention using a self-monitoring calendar is suggested—with optimal and consistent fluid intake likely to add value.

Testing a Model of Self-Management of Fluid Intake in Community-Residing Long-term Indwelling Urinary Catheter Users

“…Results of the trial indicate that the presence or absence of blockage decreased significantly in the first six months in the experimental group, but this result was not sustained over 12 months of the study; there was no group effect on CAUTI (Wilde et al, 2015a). Therefore, the present analysis for the structural equation model (SEM) involved testing a subsample ( N = 180) taken from the full sample (see below in “Methods”), specifically examining relationships during the second six months of the study.…”

“…The research took place in the homes of study participants who lived in the community, with an initial home visit interview and bimonthly assessments for 12 months. At baseline, the groups were not significantly different by age, sex, type of catheter (43% suprapubic, 57% urethral), catheter or balloon size, or length of use (Wilde et al, 2015a). The researchers present a full description of the sample of 202 persons elsewhere (Wilde et al, 2013a).…”

“…In this report, we used a structural equation model to test direct and indirect (via fluid intake self-management) effects of fluid intake self-efficacy on two of the most frequent and persisting catheter-related problems: catheter-associated urinary tract infection (CAUTI) and catheter blockage. Data were obtained as part of a randomized clinical trial designed to test the impacts on health outcomes of a self-management intervention with indwelling urinary catheter users (Wilde et al, 2015a). …”

Successful recruitment methods in the community for a two-site clinical trial

“…The randomized clinical trial was a test of a new self-management intervention for persons with long-term indwelling urinary catheters based on a pilot study of self-monitoring of urine flow in a similar population (Wilde & Dougherty, 2006; Wilde & Brasch, 2008; Wilde & Brasch, 2008). The study took place from 2008–2012 with a sample of 202 persons (103 males, 99 females), with equal numbers in the experimental and control groups.…”

A qualitative study exploring the value of a catheter passport

“…Inadequate support on discharge from hospital means that patient's physical and practical needs are often unmet. In addition psychological support for patients who may experience difficulty adjusting to altered body image and sexual expression is not adequately addressed (Prinjha & Chapple, 2013;Fowler et al, 2014;Godfrey, 2008;Kralik et al, 2007;Wilde, 2003Wilde, & 2015Sweeney et al, 2007).…”