Este mes en... International Journal of Urological Nursing
Sumarios de Revistas
Este mes en... International Journal of Urological Nursing:
Management and implementation of intermittent catheterization in neurogenic lower urinary tract dysfunction
As a considerable heterogeneity in the procedure of intermittent catheterization (IC) was identified by a questionnaire survey conducted in hospitals and institutions for the treatment of patients with spinal cord injury in 2010, it became necessary to standardize the IC procedure (i.e. self-catheterization and assisted catheterization). These guidelines were developed within a structured consensus process (e.g. several consensus conferences and nominal group process) by members of the working group on neuro-urology and the working group on nursing of the German-speaking Medical Society of Paraplegia and were published as guidelines of the German Society of Urology (DGU). The guidelines developer group was a multiprofessional group. Firstly, the indications for IC are presented and concepts such as sterile, aseptic and hygienic catheterization are defined. The materials necessary for the IC are presented in detail. The disinfection and catheterization techniques are described and a detailed explanation of the potential complications and their management is given. Finally, the legal aspects and issues of eligibility of catheter materials are discussed. The purpose of this consensus is to contribute to the standardization of IC. It should remove uncertainty and offer assistance to users (i.e. patients, staff and care providers). A particular focus is placed on practical instructions for carrying out the IC. The intention is to support the realization of IC in various settings (e.g. hospital, rehabilitation, long-term care institutions and home-based care). A wide implementation of the guidelines should lead to a reduction of the risks and complications of IC.
Frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life
What is the frequency of urinary incontinence in Turkish women and how does it affect their quality of life? The aim of this study is to determine the frequency of urinary incontinence among Turkish women, effective factors and its effect on quality of life. Urinary incontinence, a health problem that is commonly seen among women, leads to primarily social and hygienic problems, and affects the physiological, psychological and economic aspects of individuals who are effected. This cross-sectional study was conducted in the gynaecological outpatient clinics of a Turkish hospital, between 01 August 2014 and 26 December 2014. The population of the study consisted of 155 women aged 19 and over who applied to the gynaecology outpatient clinics for reasons other than pregnancy. The entire population was included in the study without selecting a sample. The data were collected by using a 16-question questionnaire and King's Health Questionnaire (KHQ). A total of 67·7% of the women were found to suffer from urinary incontinence problem. A significant correlation was found between the age groups and incontinence problems. While pollakiuria was observed more in the age group of 20–29 years (37·3%), urge incontinence (35·6%), stress incontinence (36·2%), and enuresis nocturna (31·6%) were observed more in the age group of 30–39 years. Quality of life of women with bladder problems was significantly impaired. When the women with stress incontinence were compared with women who suffered from other incontinence problems, all sub-scale mean scores obtained by the women with stress incontinence from KHQ were higher and the quality of life of these women was seriously impaired.
The impact of oral nutrition in patients after radical cystectomy: an overview
Nutritional status is considered a significant factor determining the post-operative outcomes after RC. The aim of this literature review is to describe the impact of early oral nutrition on functional outcomes in patients underwent cystectomy. Usually, these patients are not fed orally until the return of gastrointestinal function, because early oral nutrition is often perceived as detrimental for the anastomosis integrity and is believed to cause nausea and vomiting. This phase of nutritional deprivation may vary from a few days to a few weeks, depending on the return of bowel movements. In clinical practice, patients are fed on a substitutive nutritional support based on the use of total parenteral nutrition or enteral nutrition, which have not demonstrated positive effects on bowel function recovery time, infection complication rates or length of hospital stay. The early introduction of oral feeding seems to allow early mobilization and to lead to an improvement of post-operative outcomes: bowel functions, pain, complications, patient's comfort and length of hospital stay. The early implementation of oral diet after cystectomy is associated with an improvement of considered outcomes, allowing an early recovery of patient's general conditions and reducing length of hospital stay.
Evaluation of a multidisciplinary allied health prostate cancer clinic
Prostate cancer is the most common male cancer, with increasingly longer survival, and many treatment options for advanced disease. Men with prostate cancer report a high level of unmet supportive care needs. To evaluate unmet needs of a small cohort of Australian men with advanced prostate cancer, and their partners, and to assess the impact of attendance at a multidisciplinary allied health clinic on meeting these needs. Fifty patients were referred to the clinic by their treating specialists. Prior to their clinic consultations patients and partners completed study questionnaires to determine their unmet needs, prostate cancer and treatment related quality of life, levels of anxiety and depression, exercise patterns and prostate cancer-related functional status. Questionnaires were completed again 1 month post-clinic attendance, and pre-and post-clinic scores were compared. Patients reported unmet needs in several domains including psychological and sexuality needs. These showed a small reduction when assessed post-clinic. Partners also reported needs in the psychological and emotional, and information domains. Thirty-two percent of patients reported clinical levels of distress when assessed pre-clinic attendance, reduced to 8% reporting the same level of distress 1 month post-clinic. The identified high levels of unmet needs and levels of distress of this group of patients and partners highlights the necessity for additional resources to assist these men. A multidisciplinary allied health care prostate clinic as described here may further assist in the comprehensive care of these men and their partners.
Voiding diary: proposal and assessment of a tool
Can voiding diary be a primary tool to assess urinary symptoms, being accessible and easier to fit into patients' lives and their family or caregiver? The nursing care to neurogenic bladder patients reveals the daily need for standardized patient assessment tools that support the treatment process. The aim of this study is to propose and assess a voiding diary for use with intermittent bladder catheter users and their caregivers. Voiding diary is important tool for patients and their caregivers to use to help both parties understand the functioning of the urinary tract and identify urinary symptoms. Research developed at a Rehabilitation Center of a university hospital. After characterizing the population, the voiding diary was constructed based on the literature review and then subject to expert face and content validation. Each participant received a diary, a graded plastic flask and a data collection instrument, between June and October 2013. The data were analysed using descriptive statistics. Among the 44 (100.0%) participants, 28 (63.6%) were caregivers and 16 (36.4%) patients. The best assessed items regarding the diary were ‘Importance of the tool,’, ‘Explanation of the orientations’ and ‘Clarity of the Figures.’ The good adherence level to the tool was highlighted, as well as the importance of appropriate orientations before completing the diary.
Identifying reasons, gaps and prevalence of diaper usage in an acute hospital
Are diaper usage overused in acute hospital settings? Are there ways to avoid unnecessary diaper usage? This study aimed to identify the prevalence of diaper usage and the reasons of using diaper as well as to suggest strategies to avoid unnecessary use of diaper. Diaper is widely used for patients in hospitals worldwide but is seldom to be report its prevalence. Some patients with medical issues need to use diaper but some who do not have those problems are still given a diaper to wear once admitted. This is a cross-sectional prevalence survey study from 24 wards covering 3 major departments between 19 and 26 October 2016. Data were sourced from different means such as documents and interviewing patients/relative, nursing and nursing supporting staff. The study was approved by cluster general manager (nursing) who supported the study to improve patient care. The overall prevalence rate of diaper usage during admission was 37·9%. The top four reasons of diaper usage in all departments were faecal/urinary incontinence, poor patient condition, confusion and poor mobilization which accounted for 38, 15, 10 and 8% respectively. A total of 53 patients of those who had not used diapers before admission but were given diapers to wear, reported reasons as having poor mobilization and lower limb weakness. This is the first study ever to explore the prevalence and reasons of diaper usage in Hong Kong. Different reasons to use diapers after admission but patients did not use diaper upon admission could be identified in various department. A clinical guideline on proper use of diaper that identified some gaps of the prevailing practice and possible solutions was suggested to improve clinical practice.
The use of chewing gum for postoperative ileus prevention in patients undergoing radical cystectomy
Does the postoperative use of chewing gum in patients undergoing radical cystectomy (RC) facilitate intestinal motility recovery, reduce intestinal recanalization times and decrease length of stay? Postoperative ileus is a temporary impairment of intestinal motility and a frequent complication after RC. It is characterized by abdominal distention and absence of bowel functions, with symptoms including nausea, vomiting, pain and cramps. This results in an increase in length of stay, patient discomfort and costs. Different studies investigated the efficacy of chewing gum use, as a form of simulated feeding, in accelerating the resolution of ileus after several abdominal surgical procedures. Considering the lack of specific studies, some other conducted in similar abdominal procedures were included in this literature review. Despite the diversity of type of surgery, all considered studies show for patients who received chewing gum, a significant reduction in the time of first flatus and faeces, a reduction in the time of first bowel movements; not all included studies instead have found a significant decreasing in morbidity and length of stay. The chewing gum use seems to be a simple and inexpensive way to enhance recovery of bowel function, although it is probably still a little known procedure. It is possible recommending the administration of chewing gum in patients after cystectomy, monitoring the effectiveness, upon the recognition of possible conditions that might contraindicate its use.
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%.
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.
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.
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.
Health-related quality of life in prostate cancer patients' – treatment comparisons
Active surveillance (AS) as treatment option for prostate cancer (PCa) has been systematically offered from Vestfold Hospital Trust since 2009. This option proposes delay or avoidance of radical treatment and its troublesome side effects especially urinary leakage and erectile dysfunction. The aim is to compare urinary problems, sexual dysfunction and health-related quality of life (HRQOL) between Norwegian PCa patients undergoing radical retropubic prostatectomy (RRP) and AS. A cross-sectional study of 330 PCa patients diagnosed between 2010 and 2014 at Vestfold Hospital Trust was performed, including 150 in an AS group and 180 in a RRP group. HRQOL was assessed using the SF-12 questionnaire. Sexual and urinary function was assessed through excerpts from The Expanded Prostate Cancer Index-50 Question (EPIC-50). Continuous data was analysed with t-tests, while categorical data was analysed with χ2-tests. In addition, linear regression analysis was performed. No difference in HRQOL was observed between the two groups despite significant differences in urinary leakage and sexual function. The AS group had a significantly lower proportion of men with a Physical Component Score (PCS) ≤ 40. We did not find the same pattern for Mental Component Score (MCS). The difference in PCS was not significant after adjustment for treatment, age, relationship and other independent variables. The findings are important for nurses informing PCa patients eligible for AS. The majority of men adjust with their disease and report good HRQOL, despite urinary leakage and erectile dysfunction after RRP compared with nontreated men on AS.
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.
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.
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