Este mes en... International Journal of Urological Nursing
Sumarios de Revistas
Este mes en... International Journal of Urological Nursing:
The importance of medical and nursing care of the open prostatectomy-related vesico-cutaneous fistula
Obstruction of the Foley catheter following open prostatectomy occurs frequently and can lead to the development of vesiculo-cutaneous fistula unless recognized and managed effectively. Vesico-cutaneous fistula reduces the patient's quality of life and increases overall health care costs. In this case report, we explore how ineffective medical and nursing care could lead to the development of vesico-cutaneous fistula and outline what good medical and nursing care should consist of in order to prevent this condition. As far as we know, there is no case report of open prostatectomy-related vesico-cutaneous fistula in the literature to date.
Behaviours of students who have repeated urinary tract infections
To determine the behaviours of students and the variables that have an effect on repeated urinary tract infections (UTIs). A cross-sectional study was implemented on elementary and high school students in Izmir, Turkey. The sample consisted of 318 volunteers from the 6–17 years of age students. Written consent was obtained from parents and institutions. The data were collected through sociodemographic characteristics and a behavioural assessment semi-structured design questionnaire. The data for closed-ended questions were evaluated for frequencies, variance, Chi-square and logistic regression. Content analysis was used for examining the open-ended questions. Students' mean age was 10·28 ± 2·27 (6–15 years of age), 68·2% were females and 70·4% were in elementary school. Of the students, 26·1% avoided using school toilets, 70·4% held urine too long and 30·2% cleaned the perineum from back-to-front. In the prediction of the factors that affect students' behaviours with ages, it was determined that ‘washed the genital area after defecation/urination’, ‘method of cleaning the perineum’, ‘urination status at school’, ‘enuresis’, ‘frequency of changing underwear’ and ‘washing hands before going to the toilet’ increased linearly with age (p < 0·05). Most of the students may have negative perceptions about toilet habits. Students' behaviours are important for improving social well-being. Health professionals and teachers serve a key role in the psychosocial development of students. They can develop individualized health care plans and help parents and students to understand strategies that can prevent UTIs.
Symptom Management for Bladder Cancer in Thailand
Understanding the symptom experiences and management strategies of people with bladder cancer is important for nurses. Awareness of outcomes of the strategies used can enable health care practitioners to provide effective advice to bladder cancer patients. We aimed to examine symptom experiences in patients with each cancer grade; to survey symptom management strategies and outcomes. This study was a cross-sectional survey design. A total of 62 patients receiving care in a northern Thailand university hospital during December 2011 and June 2012 were recruited as subjects. Participants completed a modified questionnaire based on the framework of the symptom management model. Data were analyzed using descriptive statistics. The findings revealed: (i) the three most frequent and severe symptoms in the high grade group were frequent urination, constipation and anxiety; in the low grade group were frequent urination, fatigue and anxiety: (ii) the symptom management strategies revealed correspondence in both groups as follows: for frequent urination strategies were consulting a physician, restricting fluids, using herbs and doing nothing; for constipation strategies were taking a laxative, eating tamarind, eating vegetables/high-fibre fruits and using a suppository; for anxiety strategies were prayer, going to the temple, meditating, talking with family/friends, relaxing, taking up a hobby, resting and consulting a physician; for fatigue strategies were resting, using supplements and consulting a physician: (iii) the outcomes revealed that most of the strategies showed positive outcomes. Positive outcomes could be used as a guide in providing recommendations to patients with bladder cancer and to support further research in this area. Further work is needed to develop interventions that work for specific symptoms.
Marital relationship and health-related quality of life after prostate cancer diagnosis
Prostate cancer has an impact on the health-related quality of life (HRQoL) of patients and their spouses. However, the marital relationship at the time of prostate cancer diagnosis is not well known. The aim of the study was to describe and compare the marital relationship of patients with prostate cancer and their spouses and to identify factors associated with HRQoL at the time of diagnosis. The data of this cross-sectional study were collected with The Marital Questionnaire and RAND-36 Item Health Survey scales after the diagnosis of prostate cancer from 232 patients and 229 spouses at five Finnish central hospitals from October 2013 to January 2016. Patients with prostate cancer rated their dyadic satisfaction better than their spouses. Respectively, spouses reported better dyadic cohesion. The marital relationship of the patients or spouses was not associated with demographic variables of the respondents. In patients, energy, emotional well-being and general health were associated with the marital relationship. In spouses, emotional role functioning, emotional well-being and social functioning were explained by the marital relationship. At the time of diagnosis, the marital relationship of patients with prostate cancer and their spouses was good. However, there were differences in associations between patients' and their spouses' marital relationship and HRQoL. Based on the results of this study, it is useful to take into account the spouses and the marital relationship in the nursing of patients with prostate cancer. The follow-up research on this subject is needed.
An evaluation study examining penile bacterial flora in boys undergoing hypospadias surgery with foreskin reconstruction
Hypospadias surgery with foreskin reconstruction is an increasingly preferred option for the management of this common condition. The objective of this study was to identify the bacterial flora present before and after cleansing of the prepuce as well as 7 d after surgery. Sixty-three boys aged between 12–14 months, with primary distal hypospadias undergoing tubularized incised plate repair, were recruited between October 2013 and April 2014. Microbiological swabs were taken pre- and post-operatively to identify organisms present under their foreskin at the time of surgery and compared with organisms present 7 d post-operatively at the time of dressing removal. A parent reported wound infection tool was used to explore parents' perception and management of their son's wound 4 weeks following surgery. Bacterial colonization of the penis was common. Routine cleansing with an alcoholic chlorhexidine solution reduced bacterial flora in 82% of boys with a positive preoperative swab result. Post-operative colonization of the penis was found in 93% of patients, wound dressing colonization was common. Two parents' reported concerns regarding their son's wound healing. Topical cleansing at the time of surgery is effective in reducing the number of organisms present under the foreskin. Despite recolonization 7 d after surgery, clinical infection remains uncommon. Complication rate 12 months after surgery was very low <2%.
Non-medical prescribing in prostate cancer care: a case study reflection
There are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non-medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence-based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non-medical prescribing.
A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence-based recommendations were integrated into a narrative synthesis.
A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non-medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies.
Non-medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost-effectiveness and a more detailed understanding of how team working and inter-team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.
Nurses experiences discussing sexuality with urinary catheter patients
The aim of this article was to establish registered nurses experiences of discussing sexuality with urinary catheter patients.
A urinary catheter is used to provide drainage for those people who are unable to drain their bladder independently. Urinary catheters can cause issues with sex, sexuality and body image.
This is a qualitative research study using thematic concept analysis to review data. The study used semi-structured interviews that were audio-taped during 2015. Nine community nurses participated in this study.
Four themes emerged: the importance of the nurse–patient relationship, peer support and role models, maintaining professionalism and lack of experience, training and knowledge. The nurses reported barriers that they felt discouraged them from discussing sexuality, such as their own lack of knowledge, discussing sexuality with older people, nurse embarrassment and causing patient embarrassment.
Nurses at all levels were reluctant to discuss issues relating to a patients' sexuality, and they were often uncomfortable doing so. Further training is required for nurses in supporting urinary catheter patients with sexual quality of life. Nursing assessments that allow sexuality to be assessed as part of any holistic nursing assessment are needed in practice. More acknowledgement of older urinary catheter users' sexual quality of life is required by nurses. It is the responsibility of the nurse to address any issues relating to a patients' sexuality with a urinary catheter as part of holistic care.
Effects of stress, dyadic communication and adaptation on prostatectomy patients' quality of life
This study investigates the effects of stress, dyadic communication and dyadic adaptation of patients who received prostatectomy and their spouses on the quality of life (QOL) of patients. A descriptive design was used with 113 prostatectomy couples. Data were collected from December 2012 to February 2014 at a prostate cancer centre in Korea. Stress, dyadic communication, dyadic adaptation and patient QOL were measured with the perceived stress scale, communication pattern questionnaire, Revised Dyadic Adjustment Scale and Functional Assessment of Cancer Treatment-Prostate, respectively. Emotional QOL of patients was negatively affected by stress (β = −0·624, p < 0·001) and mutual avoidance communication (β = −0·050, p = 0·001) of the patients as well as couple cohesion (β = −0·113, p = 0·015). The predictive power (F = 25·895, p < 0·001) was 41·6%. Social QOL of patients was negatively affected by patient stress (β = −0·331, p = 0·010) and positively affected by the constructive communication of the patients (β = 0·034, p = 0·006) and spouses (β = 0·029, p = 0·014) and withdrawal communication of the spouses (β = 0·035, p < 0·001), and the predictive power (F = 11·391, p < 0·001) was 29·7%. Functional QOL of patients was negatively affected by patient stress (β = −0·680, p < 0·001) and positively affected by the patients' assessment of couple cohesion n (β = 0·173, p = 0·007). The predictive power (F = 18·491, p < 0·001) was 25·2%. To improve the QOL of patients who received prostatectomy, a programme needs to be developed to reduce patient stress and improve constructive communication and couple cohesion.
The prevalence of erectile dysfunction in men attending cardiac rehabilitation: an audit in East London
The aim of this study was to ascertain the prevalence of erectile dysfunction (ED), how it is perceived and the percentage seeking treatment for the condition in a population of men with cardiovascular disease (CVD) attending a cardiac rehabilitation programme in East London, UK. One hundred male subjects aged between 30 and 88 years attending a cardiac rehabilitation centre in East London participated in the study. An audit of men attending a cardiac rehabilitation programme was conducted. Participants completed the International Index of Erectile Function (IIEF-5) to ascertain the severity of ED, an adapted ‘bother score’ item from the International Prostate Symptom Score (IPSS) to investigate the extent to which participants were bothered by the symptoms of their ED and questions related to both ED treatment-seeking and beliefs about the impact of cardiac medication on ED. Demographic and clinical data were also collected. The audit was carried out between January and September 2014. Out of 117 male participants, 100 were audited (85·5% uptake). Prevalence of ED in this cohort was 80%, and 38% were suffering with moderate or severe ED. Older men had significantly higher levels of ED, and participants with severe ED were significantly more bothered by their condition. Those of Asian or British Asian descent reported significantly higher levels of ED severity than men from white ethnic backgrounds. Sixty-five percent of men with ED had never spoken to a health care professional (HCP) about the condition, and 35% believed that their medication had a deleterious effect on erectile function. High incidences of ED remain undetected in this patient population. The study stresses the importance for HCPs to discuss ED with patients within primary care and cardiac rehabilitation programmes, which in turn could reduce mortality in those at risk of a future cardiac event as well as facilitate access to ED treatment.
Predictors of prostate cancer screening intention among older men in Jordan
Intention to prostate cancer screening (PCS) is one of the major factors affecting the long-term success of population-based PCS programmes. The aim of this study is to explore strong factors linked to intention to PCS among older Jordanian adults using the Health Belief Model (HBM). Data were obtained from Jordanian older adults, aged 40 years and over, who visited a comprehensive health care centre within a ministry of health. A pilot test was conducted to investigate the internal consistency of the Champion Health Belief Model Scale for PCS and the clarity of survey questions. Sample characteristics and rates of participation in PCS were examined using means and frequencies. Important factors associated with intention to PCS were examined using bivariate correlation and standard multiple linear regression analysis. About 13% of the respondents were adherent to PCS over the prior decade. Four out of the seven HBM-driven factors (perceived susceptibility, benefits and barriers to prostate-specific antigen (PSA) test, and health motivation) were statistically significant. Those with greater levels of susceptibility, benefits of PSA test and health motivation and lower levels of barriers to PSA testing were having more intention to participate in PCS. Family history, presence of urinary symptoms, age and knowledge about prostate cancer significantly predicted the intention to PCS. Intervention programmes, which lower perceived barriers to PSA testing and increase susceptibility, benefits of PSA testing and health motivation, should be developed and implemented.
When is better really better? Individuals' experiences of treatment for OAB with anticholinergic medication
Overactive bladder (OAB) has been found to have a number of psychological consequences, including anxiety, depression and shame. However, there is little research on how drug treatment, which has been found to be effective at reducing physical symptoms, impacts on these psychological effects. This study aimed to examine patients' experiences of anticholinergic treatment for OAB, and the impact of both OAB and its treatment on psychological well-being. A cross-sectional, qualitative interview design with a secondary care outpatient sample was used. The approach was idiographic and sought to understand the detailed complexities and nuances of patient experiences. This small-scale qualitative study found that, even where there had been symptom reduction, patients did not feel ‘better’, and found it difficult to let go of worries and fears around OAB. These findings suggest that a person with OAB may need support even after a ‘successful’ treatment, as OAB continues to be at the centre of patients' lives.
Catheter blockage factors in patients cared for in their own home requiring long-term urinary catheterisation
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.
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