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Objectives: The Mitrofanoff principle has been extensively evaluated in terms of associated morbidity and mortality. However, there is limited literature specifically addressing quality of life (QoL), particularly concerning the laparoscopic procedure. The aim of this study was to assess the impact of laparoscopic appendicovesicostomy (LA) on QoL by using a specific questionnaire targeted at patients and their families., Materials and Methods: This observational and descriptive study involved patients who underwent LA between May 2018 and December 2023. A survey consisting of 29 questions, organized into three sections was used: satisfaction with the surgery, outcomes, and current continence status. Responses were graded according to the Likert scale (1-5) (1 = strongly disagree, 5 = strongly agree)., Results: Of the 29 contacted families, 24 (82.8%) responded. The average age was 12.3 years (SD 4.4), with 75.9% being male. The primary indication for surgery was pain during urethral catheterization (69%). Mean postoperative follow-up was 36.5 months. Regarding satisfaction with surgery: overall satisfaction,hospitalization duration and pain control was rated with a score of 5 by 66.7%, 58.3% and 58.3%, respectively. In terms of outcomes: 54.2% rated aesthetic results with a score of 5, and 83.3% rated improvement in QoL with a score of 4 or 5. Concerning current continence status, 66.6% were very satisfied with the results and reported total absence of leakages or on a very specific occasion (score of 4 or 5)., Conclusions: This study supports the improvement in perceived QoL among patients requiring an LA. Overall satisfaction with the procedure and outcomes related to continence were perceived as very good by both patients and their families.

Background: Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure., Aim: The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI., Design: This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data., Methods: A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis., Results: Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'., Conclusion: It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance., (© 2024 The Authors. International Journal of Nursing Practice published by John Wiley & Sons Australia, Ltd.)

Aim: To develop and test the psychometric properties of an expanded catheter self-management scale for patients with in-dwelling urinary catheters., Design: A cross-sectional validation study. Despite the utility of the original 13-item catheter self-management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self-management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self-management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self-management., Methods: A total of 101 adult community-dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23-item expanded catheter self-management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales., Results: The 23-item expanded catheter self-management scale yielded a 5-factor solution, labelled as: (i) self-monitoring of catheter function, (ii) proactive, help-seeking behaviour function, (iii) bowel self-care function, (iv) hygiene-related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self-management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self-management scale and catheter-related problems., Conclusion: The 5-factor structure provided a comprehensive assessment of key aspects of urinary catheter self-management essential to reduce the likelihood of catheter-related hospital presentations., Implications: The expanded catheter self-management scale can be used to assess and monitor effective patient-centred interventions for optimal self-management to prevent catheter-related problems and improve the quality of life of patients., Impact: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter. The findings of this study show the correlation between catheter self-management skills and catheter-related problems. The expanded catheter self-management scale (E-CSM) assists with analysing the self-management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients., Reporting Method: STROBE checklist was used to report all aspects of this study comprehensively and accurately., Patient or Public Contribution: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co-designing interventions. This paper reports the psychometric analysis of the expanded catheter self-management scale (E-CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ-IDC Study' (Alex et al. in Collegian, 29:405-413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objectives: Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study., Methods: Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study. In part 1, subjects underwent a semistructured interview to elicit their opinions regarding 2 methods of bladder filling: intravenous fluid or transurethral catheter. The summation of subject statements was then narrowed down to a final Q set of 25 statements. In part 2, a second sample of subjects independently arranged this Q set according to their own agreement or disagreement with each statement. Principal components analysis was conducted to examine factors or collections of statements representing a shared viewpoint and to describe commonalities., Results: Part 1 was completed with 9 subjects, and part 2 with 26 subjects. Factors revealed from the Q-sort data included acceptance of tests deemed medically necessary, desire for parental involvement, and a wish to minimize discomfort. Most adolescents aligned with 1 of these 3 factors., Conclusions: Adolescent female patients varied in their attitudes and opinions regarding intravenous catheter hydration and Foley catheter placement for transabdominal ultrasound. Knowledge of adolescent viewpoints may help better inform practitioner-patient communication for this procedure.

Purpose: The aim of this study was to identify themes related to barriers and facilitators to the integration of intermittent catheterization (IC) in the daily lives or persons using the form of bladder evacuation., Design: Descriptive, qualitative study., Subjects and Setting: A purposive sample of 25 adults from 5 countries (United States, United Kingdom, Germany, France, and the Netherlands) was assembled. All participants had used IC as their primary method of bladder emptying for at least 1 year and, in that time, had used as least 2 different IC products., Methods: Guided telephone interviews with each participant were conducted by professional staff fluent in each participant's local language as well as trained in qualitative data collection. Interviews were digitally recorded and subsequently transcribed verbatim into English for analysis. We used ATLAS.ti qualitative analysis software (version 7.5.11) to assist with data organization and identification of major themes. Descriptive statistics (eg, mean, standard deviation, or frequency) were used to characterize the sample in terms of sociodemographic and clinical characteristics as collected during the interview., Results: Analysis revealed 9 main themes around individuals' lived experiences of IC: initial fear, urinary tract infection, pain/discomfort, independence, choice, community, life quality, resilience, and acceptance., Discussion: Our results indicate that IC is perceived as a burden by some, but not all, users. The challenge, and opportunity, is to learn more about what has gone right for those who have adapted and to leverage the clinical, practical, psychological, and social factors that enable individuals to integrate IC into the rhythm of their daily lives.

Background: Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices., Methods: As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral., Results: Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other., Conclusions: Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs., (Published by Elsevier Inc.)

Objective: To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration., Design: A randomized controlled trial with a cross-sectional anonymous online survey and focus group., Setting: Ten wards in an Australian hospital., Participants: All hospitalized patients with a urinary catheter., Intervention: An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters., Outcomes: Catheterization duration and perceptions of nurses about the ease of use., Methods: A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group., Results: In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9-6.2) and 5.08 days (95% CI, 4.6-5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91-1.14; P = .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44-5.56) to 3.84 days (95% CI, 3.47-4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified., Conclusion: The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

Objectives: Bladder drainage can be achieved by clean intermittent self-catheterization (CISC), transurethral indwelling catheterization (TIC), or with a suprapubic tube (SPT). The primary objective of this study was to determine patient preference for catheter type in the management of potential voiding dysfunction after pelvic organ prolapse (POP) surgery., Methods: Between 2012 and 2016, patients scheduled for POP surgery were recruited into the study. Before surgery, patients were informed of the potential for postoperative voiding dysfunction and the catheter choices were discussed. Each patient's choice was recorded along with baseline information, surgery performed, and perioperative details. After surgery, voiding dysfunction, length of catheter use, scores on a catheter satisfaction questionnaire, as well as uroflowmetry and urine culture testing were assessed., Results: Of those recruited to the study (N = 150), 6.7% chose CISC, 7.3% chose TIC, and 86% chose SPT. Catheter satisfaction score 1 week after surgery was significantly better for SPT compared with CISC and TIC (P = 0.005). In addition, at week 1, 33% of CISC, 25% of TIC, and 13% of SPT had a PVR of more than 30% (P = 0.002) on uroflowmetry, and 33% of CISC, 50% of TIC, and 24% of SPT had a positive urine culture (P = 0.05)., Conclusions: This study has shown that patients prefer SPT over CISC and TIC for management of voiding dysfunction after POP surgery. Use of SPT showed better satisfaction rates, better uroflowmetry results, and lower infection rates 1 week after surgery. Patient preference is an important factor in this decision and can help facilitate a clinical approach.

Background: Recurrent urinary tract infections are a commonly reported problem in people who use clean intermittent self-catheterisation. Yet there is a lack of knowledge regarding both the impact on people's lives, the use of prophylactic anti-biotics and perceptions of patients on their use., Aims: To explore the views and experiences of adults who use clean intermittent self-catheterisation for long-term bladder conditions, with a focus on urinary tract infection experience and prophylactic antibiotic use., Design: A qualitative descriptive study., Methods: Twenty-six semi-structured qualitative interviews were conducted with individuals recruited from the ANTIC Trial (Antibiotic treatment for intermittent bladder catheterisation: A randomised controlled trial of once daily prophylaxis). Participants were intermittent self-catheter users aged 18 years or older. Interviews took place between August 2015 and January 2016. Transcript data were analysed thematically., Findings: Three overarching topics were revealed with corresponding themes: the experiences of intermittent self-catheterisation and urinary tract infections (normalisation, perceived burden); attitudes towards antibiotics for urinary tract infection treatment (nonchalant attitudes, ambivalence towards antibiotic resistance); and experiences of low-dose prophylaxis antibiotics (habitual behaviour and supportive accountability)., Conclusion: The emotional and practical burden of catheter use and urinary tract infection was considerable. Beliefs pertaining to antibiotic use were based on utility, gravity of need and perceived efficacy. These opinions were often influenced by clinician recommendations., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: This study aimed to examine and map the scientific evidences regarding quality of life in neurogenic bladder patients and consequently their caregivers by means of a scoping review., Design: This is a scoping review proposal of the Joanna Briggs Institute., Methods: It was conducted to examine and map the scientific evidences about quality of life (QoL) in neurogenic bladder patients and their caregivers, to identify the meanings attributed to QoL and its relation with intermittent urinary catheterization. The following guiding question was: "What scientific evidence has been produced on the QoL of neurogenic bladder patients using intermittent urinary catheterization and their caregivers?" A total of 2945 research studies were identified using The Cochrane Library, CINAHL, LILACS, Academic Search Premier (via EBSCO platform), PubMed, SCOPUS, the platforms Web of Science, the b-on and Gray Literature. The keywords established were patient, intermittent urinary catheterization, neurogenic urinary bladder, quality of life and caregiver., Results: From 2,945 studies, 13 studies were selected. Most of the selected studies that analyzed variables related to the patients' QoL were regarding the urinary catheterization technique, assessment of urinary incontinence, individual perceptions of the procedure and experiences with urinary catheter in childhood and adult life. The meanings attributed to QoL, when compared to adult and child individuals with normal bladder functioning, presented lower QoL scores. Concerning caregivers, the QoL of caregivers of children using intermittent urinary catheterization demonstrated low scores., Linking Evidence to Action: The QoL of patient's who use intermittent urinary catheterization can be determined by improvement of urinary symptoms and self-confidence. Research related to QoL of patients who use urinary catheter indicates the importance of adequate professional support and appropriate health public policies., (© 2017 Sigma Theta Tau International.)

Introduction and Hypothesis: To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery., Methods: This was a prospective study of all eligible women who were scheduled to undergo reconstructive surgery requiring bladder drainage during the study period November 2013 to March 2015. Women who did not undergo the planned procedure(s) or did not require bladder drainage were excluded. The primary outcome was patient-reported quality of life using catheter-specific instruments including the Catheter-related Quality of Life (CIQOL) instrument, and a modified version of the Intermittent Self-Catheterization Questionnaire (ISC-Q), designed to evaluate aspects of catheter-related quality of life and satisfaction specific to the needs of the individual., Results: A total of 178 women were analyzed, 108 in the transurethral catheter group and 70 in the suprapubic group. Women with suprapubic bladder drainage had higher quality of life and satisfaction scores than women with transurethral bladder drainage as measured by the ISC-Q (68.31 ± 16.87 vs. 54.04 ± 16.95, mean difference 14.27, 95 % CI 9.15 - 19.39). There was no difference in quality of life by the CIQOL. After regression analysis, women with suprapubic bladder drainage were more satisfied with their catheter-specific needs despite longer duration of catheter use, more concurrent continence surgery, and higher trait anxiety., Conclusions: Differences in catheter-specific quality of life and patient satisfaction scores favoring suprapubic bladder drainage support its continued use in appropriately selected women for treatment of temporary postoperative urinary retention after reconstructive pelvic surgery.

Aims and Objectives: This study reports about the experiences of 11 patients in the Netherlands who use intermittent self-catheterisation to manage their symptoms. The aim of the study was to get insight in underlying barriers and facilitators for patients dealing with intermittent catheterisation in everyday life., Background: Studies show that intermittent catheterisation has an impact on everyday life. A positive effect does not guarantee that patients maintain catheterisation over a longer period of time. After the implementation of a guideline, a quantitative study was performed to determine successful intermittent catheterisation. The patients of this study had previously taken part in this quantitative study., Design: This is a qualitative multicentre study using semistructured in-depth interviews with 11 patients between March-May 2013., Methods: Inclusion criteria included patients of a quantitative study (n = 124) with a variety of diagnoses referred to the outpatient clinic. Those who received instruction from the researcher and who at start of the study performed catheterisation ≤3 months were excluded. Of the total number that met the inclusion criteria, every fourth patient was invited to participate in an interview. Patients were asked about the introducing of intermittent catheterisation, the incorporation into everyday life, the progress after the instruction and guidance perceived, the cause of the bladder problem and the motivation to start intermittent catheterisation., Results: Eleven interviews were performed (six males/five females). All patients described the instruction and follow-up care as positive. Barriers were the preparation before the handling, which is more difficult than the catheterisation itself, and the fact that patients felt constrained by the need to plan convenient times to catheterise themselves., Conclusion: This study shows that patients who perform catheterisation are satisfied about the instruction and follow-up care. Important barriers in everyday life are the preparation and the need to plan convenient times., Relevance to Clinical Practice: Interviewing patients gave important additional information about dealing with intermittent catheterisation in everyday life. Prescribers and teachers of intermittent catheterisation must realise that they often have to high expectations of patients when it comes to being flexible in frequency of catheterisation. It is important to realise that patients experience barriers of which healthcare workers are not always aware of, such as the preparation before the handling and feeling constrained by the need to plan convenient times to catheterise. The outcome of this study can be used to improve the content of patient information brochures and guidelines for intermittent catheterisation., (© 2016 John Wiley & Sons Ltd.)

Objective: The purpose of this study was to compare catheter-related pain and quality-of-life scores between 2 catheters used after failed voiding trials following urogynecologic surgery., Methods: Women failing an inpatient voiding trial requiring short-term catheterization after urogynecologic surgery were randomized to receive either a standard FC or a patient-controlled VC. Subjects completed a 6-item, visual analog scale-based postoperative questionnaire (POQ) and an outpatient voiding trial 3 to 7 days after surgery. Baseline demographic, surgical data, and results of the outpatient voiding trial were recorded. The primary outcome was the difference in mean score for catheter-related pain on the POQ, based on intent to treat. Secondary outcomes included between-group differences in means for individual POQ items and a calculated composite satisfaction score. The statistician was blinded to group assignment., Results: Forty-nine subjects were randomized to FC (n = 24) and VC (n = 25). Two subjects, one in each group, were excluded from the primary analysis because of missing data. Mean age was 60.6 (SD, 12.5) years. Baseline characteristics were similar. Valve catheter users had a lower median catheter-related pain score (1.25 vs 2.3), but not significantly (P = 0.153). Valve catheter users had significantly lower median scores for frustration (1.2 vs 3.8; P = 0.018) and limitation on social activities (0 vs 7.6; P < 0.001). Mean composite satisfaction score was statistically significantly lower for the VC group (2.23 [SD, 1.83] vs 3.62 [SD, 1.95]; P < 0.01), suggesting greater satisfaction., Conclusions: Valve catheter and FC users report similar catheter-related pain. Valve catheter users scored better in overall satisfaction, frustration, and limitations on social activities.

Aims: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria. In this paper, we describe the development of the ICIQ-Long Term Catheter quality of life (ICIQ-LTCqol), one of the modules of the ICIQ series, an international project to standardise assessment of lower pelvic dysfunction: www.iciq.net., Methods: In-depth interviews were conducted with 27 catheter-users and 4 informal carers and cognitive debriefing with a further 31 catheter-users and clinical experts to evaluate clarity and comprehensiveness. The draft 44 item questionnaire was then sent by post to 893 long-term catheter-users; the 370 completed questionnaires were used to test content validity, test re-test reliability and internal consistency (Cronbach α coefficient). Factor analysis alongside expert opinion was used to formulate the final questionnaire of 16 items. This was then sent by post to another 438 long-term catheter-users to evaluate domain scores., Results: The final questionnaire consists of two scored domains: catheter function and concern (9 items) and lifestyle impact (3 items) and four standalone items, relating to pads, pain, sexual activity and bladder spasm. Levels of missing data are good (mean 3.6%) with moderate to good agreement and acceptable internal consistency (Cronbach's alpha 0.76 and 0.74 for each domain respectively), suggesting acceptability and stability of the questionnaire., Conclusion: The ICIQ-LTCqol is a psychometrically robust self-report questionnaire for the clinical assessment and evaluation of health related quality of life for long-term catheter users., (© 2015 Wiley Periodicals, Inc.)

Background: Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs., Methods: In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants., Results: All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement., Conclusions: Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.

The design of the Foley catheter has not changed since 1937. Scientists interested in medical technology tend to focus on state-of-the-art designs for newsworthy specialties rather than the more mundane technologies of daily life. We interviewed 36 people living with a long-term urinary catheter in the United Kingdom, who described limitations of the current catheter design, including infections and complications and consequences for social life and relationships, and their perceptions of whose responsibility it was to improve the design. All took steps to hide the urine bag, but the need to use a catheter and urine bag had, for some, a very detrimental effect on social life and relationships. People living with long-term catheters are relatively isolated at home and dealing with many different underlying health problems, undermining opportunities to speak with a collective patient voice. Qualitative health researchers could act as a conduit to help stimulate new designs., (© The Author(s) 2015.)

Unlabelled: Indwelling urinary catheters (IUCs) are placed frequently in older adults in the emergency department (ED). Though often a critical intervention, IUCs carry significant risks. Our objective was to examine current knowledge, attitudes, and practice of emergency nurses and other providers regarding IUC placement and management in older adults., Methods: We surveyed ED providers at a large, urban, academic medical center. We developed questionnaires using items from previously validated instruments and questions created for this study. We also assessed providers' management of 25 unique clinical scenarios, each representing an established appropriate or inappropriate indication for IUC placement., Results: 129 ED providers participated: 43 nurses and 86 other providers. Ninety-one percent of nurses and 87% of other providers reported comfort with appropriate indications for IUC placement. Despite this, on the clinical vignettes, nurses correctly identified the appropriate approach for IUC placement in only 40% of cases and other providers in only 37%. Practice varied widely between individual providers, with the nurse participants reporting appropriate practice in 16%-64% of clinical scenarios and other providers in 8%-68%. Few nurses or other providers reported reassessing their patients for IUC removal at transfer to the hospital (28% of nurses and 7% of other providers), admission (24% and 14%), or shift change (14% and 8%)., Discussion: Although emergency nurses and other providers report comfort with appropriate indications for IUC placement, reported practice patterns showed inconsistencies with established guidelines. Wide practice variation exists between individual providers. Moreover, nurses and other providers infrequently consider IUC removal after placement., (Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To explore why men and women decide to have a suprapubic catheter, how the decision is made, and to compare people's experiences of suprapubic and transurethral catheterization for long-term bladder drainage., Design: Narrative interviews followed by thematic analysis., Subjects and Setting: Thirty-six long-term catheter users living in England, Wales, or Scotland were interviewed. The sample included men and women from various socioeconomic backgrounds, with a wide range of conditions. They were aged 22 to 96 years (M = 57 years)., Methods: Interviews lasted between 1 and 3 hours; they were audiotaped and fully transcribed for analysis. A qualitative interpretive approach was taken, combining thematic analysis with constant comparison., Results: Some respondents were satisfied with or preferred a urethral catheter; others preferred a suprapubic catheter because they perceived that suprapubic catheters led to fewer infections, were more hygienic, more comfortable, improved self-image, allowed a sense of control, and were better suited for sexual relations. Participants also mentioned the decision-making process, including how the decision was made to have a suprapubic catheter and where to insert the catheter at a particular point in the abdomen. Even with a suprapubic catheter, some worried about sex or were put off sexual intimacy because of the catheter., Conclusion: Our findings suggest that patients should be better informed before a suprapubic catheter is inserted and that issues such as sex should be raised in consultations when appropriate.

Background: Urinary retention is a common complication following hospital care, which can result in overdistension of the bladder and, at worst, chronic bladder damage and persistent micturition difficulties., Objectives: The purpose of this study was to explore patients' experiences of micturition problems after bladder distension and their effects on the patients' everyday lives., Methods: The Swedish Patient Insurance LÖF was used to identify patients from January 2007 to June 2010 who have reported micturition problems after hospital care and have had their injuries classified as avoidable bladder damage due to overdistension. Narrative interviews were conducted with 20 volunteers and analyzed by qualitative content analysis., Results: The micturition problems affected everyday life through constraints (dependence on disposables and access to toilets, clothing restrictions, limitations on social life and career), suffering (pain, infections, impaired sex life, leakage), and concerns for the future (fear of worsening symptoms and fear of losing control with age). Aspects related to having been harmed by the healthcare system were the harm could have been avoided (lack of knowledge, insufficient routines, mistrust), obstacles to overcome when reporting an injury (difficulties in obtaining knowledge about the possibility of reporting an injury, ambivalence toward reporting their healthcare providers), and a wish to improve care (raise awareness, prevent harm to others)., Discussion: Bladder distension is a healthcare-related injury that can cause suffering and practical, emotional, and psychosocial problems with a great impact on the life of the person affected and anxiety for the future. The healthcare system must, therefore, raise awareness and improve preventive routines.

Background: An indwelling urinary catheter can solve the problem of incontinence and may be life-saving in individuals with retention, but it can cause problems such as infection and may have a negative impact on body image, sex, and sexuality., Aim: To explore the individual's perceptions of how a long-term urinary catheter can affect body image, sex, and sexuality; and to help GPs to discuss the subject in consultations., Design and Setting: Qualitative study of a diverse sample of individuals living with a long-term urinary catheter. Interviews took place all over the UK, usually in the individuals' homes., Method: Narrative interviews were audiorecorded, transcribed, and analysed thematically, using the constant comparative method., Results: Some individuals said that sex was not an important part of their lives because of old age, illness, or the catheter. Others talked about how their catheter and their disability affected their sexual self-esteem, feelings of masculinity or femininity, and how the catheter caused pain, discomfort, or unexpected symptoms during sex. Many noted the lack of information on the subject and also said that health professionals were reluctant to talk about sex. For a minority a catheter was not a major problem in relation to sex., Conclusion: Some individuals using a urinary catheter would benefit from information on how to have a sexual relationship with a catheter in place and a chance to discuss the subject with their doctors. GPs need to be aware that sex may matter to a person with a catheter and how illness, disability, and a catheter may affect sexuality., (© British Journal of General Practice 2014.)

Background: There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored., Setting: Community-based survey from Norway., Methods: An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire., Results: A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life., Conclusions: The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.

Background: Involving patients in decision making about their care requires expert knowledge and understanding of patients' perspectives. Knowledge comes from several sources and experience; however, the self-testing of products by health professionals who teach clean intermittent self-catheterisation (CISC) has not been investigated., Aim: This study aimed to assess the impact of self-testing on catheter evaluation by continence nurses., Methods: Sixteen continence nurses self-tested two catheters and completed a questionnaire on their opinions about the catheter, routine self-testing and whether the study would make them change their usual practice., Results: Almost half of the participants found self-testing intermittent catheters a useful experience and some of those who did not routinely self-test said they would do so in future., Conclusion: Self-testing intermittent catheters can provide useful knowledge to those who teach CISC.

Purpose: We assessed patient perceptions of regular intermittent self-dilation in men with urethral stricture., Materials and Methods: We constructed and distributed a visual analog questionnaire to evaluate intermittent self-dilation via catheterization by men referred for urethral stricture management at a total of 4 institutions. Items assessed included patient duration, frequency, difficulty and pain associated with intermittent self-dilation as well as interference of intermittent self-dilation with daily activity. The primary outcome was patient perceived quality of life. Multivariate analysis was performed to assess factors that affected this outcome., Results: Included in the study were 85 patients with a median age of 68 years, a median of 3.0 years on intermittent self-dilation and a median frequency of 1 dilation per day. On a 1 to 10 scale the median intermittent self-dilation difficulty was 5.0 ± 2.7, the median pain score was 3.0 ± 2.7 and median interference with daily life was 2.0 ± 1.3. Overall quality of life in patients with stricture was poor (median score 7.0 ± 2.6 with poor quality of life defined as 7 or greater). On univariate analysis younger age (p <0.01), interference (p = 0.03), pain (p <0.01) and difficulty performing intermittent self-dilation (p = 0.03) correlated with poor quality of life in a statistically significant manner. On multivariate analysis only difficulty catheterizing (p <0.01) and younger age (p = 0.05) were statistically significant predictors. Patients with stricture involving the posterior urethra had a statistically significant increase in difficulty and decrease in quality of life (each p = 0.04)., Conclusions: Most patients with urethral stricture who are on intermittent self-dilation rate difficulty and pain as moderate, and inconvenience as low but report poor quality of life., (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Despite 450,000 people in the U.K. using long-term catheters, there is very little information available about the experience. This study aimed to gain an understanding of patients' perspectives of living with an indwelling urinary catheter.

In a nonrandomized prospective study, significant decreases in patient anxiety with home urinary catheter management and in length of stay were reported when patients attended the preoperative prostatectomy class with standard postoperative education versus standard postoperative education.

This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health., (Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Background: Intermittent catheterization, often performed by the users themselves and known as intermittent self-catheterization (ISC), has become the gold standard treatment for people with chronic urinary retention. To date, there are no validated patient-reported outcome measures for individuals who rely on ISC that focus on ISC-related quality of life and can help health care professionals and catheter users to optimize long-term ISC care., Objective: The objective of this study was to develop and validate a patient-reported outcome measure, the Intermittent Self-Catheterization Questionnaire (ISC-Q), which evaluates aspects of quality of life specific to the needs of individuals performing ISC., Methods: This study was divided into 2 phases. The first phase focused on the development of the ISC-Q using 20 interviews and a review of selected literature. In addition, 10 interviews with UK and French individuals who performed ISC were conducted to ensure face and content validity of the ISC-Q. In the second phase of the study, the ISC-Q was administered online in the United Kingdom, France, and Germany to 306 individuals with neurologic urinary retention (including spinal cord injury, multiple sclerosis, and spina bifida), who performed ISC for at least 6 months, and were aged 18 to 85 years. Item reduction, reliability, and validity testing were performed to determine the psychometric properties of the ISC-Q. Responsiveness and minimum important differences were also examined., Results: The initial phase of the study led to the development of a 4-domain instrument focusing on ease of use, convenience, discreetness, and psychological well-being. Various item reduction techniques were used that resulted in the removal of 3 items from the ISC-Q; there were 24 items in the final version. The conceptual framework of the ISC-Q was confirmed with a four-factor solution of the subscales. The ISC-Q was psychometrically robust, with excellent internal consistency, adequate test-retest reliability, and good validity (convergent and known groups validity). Overall, the responsiveness results show the ISC-Q to be sensitive to change, and the total ISC-Q minimum important difference estimates ranged from 4.94 to 8.73., Conclusion: The findings illustrate the ISC-Q to be a valid and reliable outcome measure that evaluated aspects of ISC-related quality of life., (Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.)

Purpose/objectives: To investigate the lived experience of prostate cancer from a patient perspective., Research Approach: Descriptive, qualitative., Setting: Community setting., Participants: 10 men with prostate cancer aged 62-70 years., Methodologic Approach: A hermeneutic phenomenologic method using semistructured, open-ended questions addressing the lived experience., Data Synthesis: Phenomenology of praxis proposed by van Manen guided the data analysis and transformed personal experiences into disciplinary understanding., Findings: The use of van Manen's method of inquiry and analysis has contributed to the findings of the study by providing a way to explore the meaning of the lived experiences in an attempt to understand living with prostate cancer. Several themes were identified: living in the unknown, yearning to understand and know, struggling with unreliability of body, bearing the diagnosis of cancer, shifting priorities in the gap, and feeling comfort in the presence of others., Conclusions: Oncology nurses can use van Manen's four fundamental existentials-lived space (spatiality), lived body (corporeality), lived time (temporality), and lived other (relationality)-to understand the lived experience of prostate cancer. Nurses have many opportunities to impact the lives of men diagnosed with prostate cancer, including diagnosis, management of physical integrity, management of psychosocial integrity, and providing education., Interpretation: Nurses may encourage men to describe their diagnosis story and illness experience to better understand the meaning of the prostate cancer experience and to provide appropriate nursing care.

Together with comprehension and therapy of neurogenic failure of the storage function of the urinary bladder, intermittent catheterization as a pressure-free voiding method without residual urine, represents a major principle of therapy in lower urinary tract dysfunction. Aseptic intermittent catheterization is recommended in Germany and Europe and seems to be acceptable even in long-term application with low complication rates. It is a precondition that patients are seen for clinical and urodynamic reevaluation at risk-adapted time intervals. The major focus is on early recognition and avoidance of threatening complications. The most important preventive measures are the motivation and compliance of the well-educated patient and the use of careful catheterization techniques with individually optimized catheters.Although aseptic intermittent catheterization has been used effectively for many years there is still a lack of randomized controlled studies for some important questions of details and an optimal catheter has still to be defined. Furthermore, valid conclusions based on well-conducted studies on the self-estimated quality of life of patients with intermittent catheterization, especially those with catheterization by attendant, are urgently needed. Intermittent catheterization is never a ready-made solution but always an individually tailored treatment for patients with lower urinary tract dysfunction.

The aim of this study was to clarify why a homecare patient had an anxiety and the type of difficulties while having an intermittent self-catheterization at home. We used a questionnaire survey to conduct an oral interview for 25 homecare patients, who regularly had an intermittent self-catheterization. The survey results were codified into single phrase units of meaning, and then separated into categories. The results revealed that 70 to 80% of patients who had an intermittent self catheterization in their own homes experienced an anxiety and encountered difficulties during the process. The findings emphasized the importance of providing a sort of support for homecare patients when they have an intermittent self-catheterization for the first time, as well as the importance of providing continued support until the patients are comfortable with the procedure. For a future support, these patients' anxiety need to be reduced and difficulties related to an intermittent self catheterization resolved during an outpatient visit.

Aim: The aim of this study was to evaluate which neurological impairments on discharge from rehabilitation services are associated with a worse outcome in terms of health related-quality of life (HRQoL) one year after stroke., Methods: We enrolled 528 first-time stroke patients in a multicenter observational study involving 18 Italian inpatients rehabilitation centers. Neurological impairment-related factors, socio-demographic and general clinical variables and process indicators were considered independent variables at discharge. Outcome was represented by the following dependent variables of HRQoL: EuroQoL-5D questionnaire (5D-EQoL) and its derived index (Eq-Index) and a Visual Analogue Score (QoL-VAS)., Results: The strongest predictors of lower HRQoL were an incomplete limbs motor recovery. An incomplete lower limb motor recovery was associated with a lower HRQoL only in the "mobility" domains, whereas a incomplete upper limb motor recovery could predict a lower HRQoL in all domains except "mobility". Regarding cognitive impairments, the presence of neglect at discharge was associated with a lower HRQoL in "self-care", "pain-discomfort" and "anxiety-depression". Female gender, presence of urinary catheter seemed to exert a much lesser role in predicting HRQoL., Conclusion: The results of this study suggest that upper limb motor impairments may have a detrimental impact on the patient's perceived HRQoL one year after stroke.

Aims: To develop and assess the measurement properties of a catheter-related quality of life (C-IQoL) instrument designed to support research with persons using long-term urinary catheter users who use indwelling urethral or suprapubic catheters permanently., Methods: Testing was conducted in two small studies for psychometric qualities of reliability (internal consistency and test-retest) and factor analysis. The initial instrument, which was modified after each study, was based on an International Continence Society (ICS) validated generic incontinence quality of life tool. ICS guidelines were used to develop content, including using descriptive and qualitative literature as well as and subjective/objective measures. Literature included content areas related to sexuality, embarrassment, and everyday catheter management., Results: A three-factor solution of subscales (management, interpersonal, and psychosocial) was created. The final instrument contains 22 items. Reliabilities were all satisfactory., Conclusions: Quality of life continence instruments need to be device-specific to address appropriate and critical issues in randomized trials. For further development of a valid and reliable measure, continued collaboration is needed among researchers working with this population., (© 2010 Wiley-Liss, Inc.)

Purpose: The purpose of this study was to propose a systematic teaching and learning strategy for Brazilian caregivers of children with neurogenic bladder dysfunction(NBD), by using an illustrated booklet written in Portuguese., Design: Descriptive study., Subjects and Setting: Caregivers of children requiring clean intermittent catheterization (CIC) were approached when attending the pediatric urology outpatient clinic of Hospital de Base in Sao Jose do Rio Preto city, Brazil., Methods: After educational sessions, a supervised procedure was done, with the child's caregiver observing the technique., Results: Twenty-three caregivers of children with NBD provided feedback on a CIC teaching booklet. The children were all cared for at the pediatric urology outpatient clinic of a teaching hospital in Sao Jose do Rio Preto city, Brazil. The booklet was evaluated as "excellent" concerning organization and the quality of the illustrations by the majority of the caregivers. All caregivers stated that they had developed the ability to perform CIC successfully; 61% evaluated their learning process as "excellent," whereas 39% evaluated it as "good.", Conclusion: The booklet successfully reached the goals and now is implemented in orientations about CIC.

Up to 100% of patients treated with epidural analgesia can experience urinary retention, which may be related to dermatomal level of the epidural block, epidural medication, and surgical procedure. This study was designed to identify the incidence of urinary retention in patients who receive thoracic patient-controlled epidural analgesia (TPCEA) after thoracotomy. Forty-nine patients were enrolled and received epidural infusion of ropivacaine 0.2% or mixture of bupivacaine 0.1% with hydromorphone 0.015 mg/mL. Epidural catheter placement level was verified by chest X-rays. Indwelling urinary catheters were removed between 12 and 48 h after surgery when no longer required for fluid monitoring. Four hours later, patients were assessed for urinary retention using bladder ultrasound. Residual bladder volume was recorded, and urinary retention was defined as an inability to void or a bladder volume of greater than 600 mL at 4 h. Twenty-four hours after the catheter removal, patients completed a questionnaire to assess their perception of the indwelling catheter before and after its removal. Five participants (approximately 10%) with epidural catheters between T3 and T5 with bupivacaine/hydromorphone epidural solution were recatheterized. No association was established between catheter level, drug type, infusion rate, and urinary retention. Although 76% of patients did not report any physical discomfort with the indwelling urinary catheter, 66% felt relief after its removal and 18% did not ambulate with the inserted urinary catheter. The incidence of postoperative urine retention was low (10%), indicating that unless required for other purposes, indwelling urinary catheters may be removed between 12 and 48 h after surgery while receiving TPCEA.

Many people in the community have a urinary catheter that is routinely changed by a community nurse. People with urinary catheters can experience a number of problems including catheter blockages. A blocked catheter causes great distress and inconvenience to the person and places a strain on the resources of community nursing organizations because of the need for unscheduled visits to change the catheter. A procedure that enabled catheter changes to be planned before they blocked would reduce patient distress and better assist community nursing organizations with resource management. The planned catheter change approach is a procedure that community nurses can use to better plan urinary catheter changes to minimize complications. In this article the author presents the outcomes from the implementation of a planned approach to catheter care in a home nursing service in Melbourne, Australia.

Aim: To assess patients' perception of clean intermittent self-catheterization (CISC) for voiding dysfunction., Patients and Methods: A total of 101 patients performing CISC because of voiding dysfunction were invited to participate in this questionnaire survey. The response rate was 91% (92/101)., Results: The mean time over which CISC was performed was 5 years (standard deviation (SD) +/- 6.3) and the mean frequency of CISC per day was three times (SD +/- 2). Almost 80% (72/92) of the patients perceived CISC as easy or very easy and CISC did not interfere at all or interfered a little bit with work or other regular daily activities in more than 80% (76/92). Almost 90% (80/92) reported no or minimal pain while performing CISC. This did not interfere at all or interfered a little bit with work or other regular daily activities in almost 90% (80/92). Quality of life improved considerably due to CISC in more than 60% (56/92) and 12% (11/92) complained of a deterioration. In multivariable analysis, severe pain performing CISC (odds ratio 20.9, 95% confidence interval 1.7-259.9, P = 0.018) was the only factor that predicted poor quality of life., Conclusions: The majority of patients considered CISC to be an easy and painless procedure which did not interfere with daily activities. Consequently, quality of life improved in more than 60% of the patients. Therefore, CISC does not appear to be a burden for the patient and, from a patient's perspective, can be recommended., ((c) 2008 Wiley-Liss, Inc.)

Self-monitoring of urine flow may be beneficial in preventing catheter-related problems. An intervention was pilot tested using a single group design with 11 individuals over 6 months. Feasibility of the intervention, performance of new measures (awareness, self-monitoring, and self- management of urine flow), and health outcomes were assessed. The intervention was well received by participants, none of whom withdrew voluntarily from the study. All data were collected at intake, and bimonthly at 2, 4, and 6 months. Nine of 11 participants reported that the intervention had helped them to pay attention to fluid intake. Episodes of UTI decreased over the course of the intervention, with the greatest drop between 2 and 4 months., ((c) 2008 Wiley Periodicals, Inc.)

Spina bifida (SB) is a neural tube defect that causes many physical and mental disabilities. Bowel and bladder incontinence is the disability seen most often in these students that requires the school nurse's attention. Clean intermittent catheterization (CIC) provides the student with SB a vehicle to reach a satisfactory level of continence, helps build self-esteem, and allows the student greater independence. The school nurse assists the student with SB with CIC in the school setting and reinforces the importance of correct technique with the student, family, and other personnel caring for the student. The success of a continence management program at school is dependent on all these individuals working together with the common goal of maintaining normal renal function, gaining urinary continence, and promoting independence of the student.

The aim of this study was to identify characteristics of children requiring sedation for urodynamics. Findings suggest children between the ages of 3 and 7 are more likely to require sedation for urodynamics when compared to other age groups.

Objective: To determine the applicability, acceptance, and compliance of the option of clean intermittent catheterization CIC when needed by patients in our society., Methods: We retrospectively reviewed the files of all patients for whom CIC was conducted at King Khalid University Hospital and Security Forces Hospital, Riyadh, Saudi Arabia, between 1998, and 2006. We considered primary pathology, indication of CIC, age at CIC initiation, and who administered the CIC. We also documented the acceptance and compliance levels of the procedure by the patient over time., Results: We included 280 patients, of which 118 (42%) were female and 162 (58%) were male in this study. The main pathology was myelodysplasia in 196 (70%) patients, posterior urethral valve in 52 (18.6%) patients, and non-neuropathic bladder sphincter dysfunction in 32 (11.4%) patients. The mean age was 6.49 +/- 4.25 years. Two hundred and fifty-seven (91.7%) families and their children accepted the idea of CIC, and 248 (88.6%) continued with the CIC program. Mothers were responsible for carrying out the procedure in 204 (72.9%) patients. However, in 76 (27.1%) cases, the patient was doing the procedure independently and the average age for a child to master the technique was 8 years. During the last 3 years, an urotherapist took over the educational services and performed outpatient education instead of our previous inpatient education., Conclusion: Clean intermittent catheterization is an appropriate method of treatment for our group of patients. They showed excellent acceptance of and compliance with the procedure, however, we suggest that for complete success, proper education, teaching, and follow-up should be conducted.

It is important that pediatric nurses know that the methods they use are reliable and the most appropriate for the child's security and well being. In-out catheterization is a sterile invasive method to obtain a urine sample in young children. To confirm this as a reliable method, a study of medical records from 61 children ages 0 to 24 months with suspected urinary tract infections (UTIs) was performed. Each child had produced both a urine sample from an adhesive bag and a urine sample from in-out catheterization. Dipsticks were taken from both samples; and the methods were compared with kappa analysis. Cultures were obtained from the catheter urine. UTI was verified as a growth in the catheter urine in 32 out of 61 children. Catheterized samples of urine with 3+ or 4+ of leucocytes all had a growth of bacteria in the culture. This examination of medical records showed that in-out catheterization is a reliable method to use to confirm UTIs in children 0 to 24 months.

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.

Aim: This paper is a report of a study to describe the experience of people carrying out clean intermittent self-catheterization and the impact on their quality of life., Background: Clean intermittent self-catheterization is a recommended treatment for people experiencing urinary voiding difficulties. The majority of the literature to date has focused on biomedical issues such as complication rates and use of different catheters., Method: A qualitative approach was used based on grounded theory. Fifteen users (eight men and seven women) of intermittent self-catheterization took part in semi-structured interviews during 2006. Ages ranged from 33 to 81 years (median 65 years). Reasons for self-catheterization included multiple sclerosis, urethral stricture and high residual volumes. Thematic analysis was used to develop hypotheses about the causes and consequences of the core category 'quality of life'., Findings: The core category consisted of two subcategories of positive and negative impacts. Positive impacts were related to improvement in lower urinary tract symptoms, whereas the negative impacts resulted from the practical difficulties encountered, and the psychological and cultural context of worry and stigma. The factors influencing variations in quality of life impacts were sex, lifestyle, frequency and duration of carrying out self-catheterization, technical difficulties, type of catheter, co-morbidities and individual predispositions., Conclusion: The model has the potential to help professionals to identify the factors likely to influence response to clean intermittent self-catheterization, and could be used as a tool to help identify those who may have difficulty complying with the treatment or to aid advice-giving on situations that may cause difficulties.

Aims & Objectives: The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self-catheterization (CISC) procedures in adults., Background: Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature., Methods: Relevant factors were explored in two studies. The first study (n = 10) addressed mastery and short-term adherence, whereas the second study (n = 20) addressed long-term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure., Results: A list of 16 determinants of mastery and short-term adherence and a list of 12 determinants of long-term adherence was found. Most of these determinants were found in both older (>or=65 years of age) and younger patients. However, five determinants of mastery and short-term adherence and six determinants of long-term adherence were specific to patients under the age of 65., Conclusion: Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence., Relevance to Clinical Practice: Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.