Experience of training in ISC V1.0
Research type
Research Study
Full title
A Phenomenological study into the experience of training to perform Intermittent Self Catheterisation from the perspective of the patient and the nurse.
IRAS ID
237530
Contact name
Marion Haskin
Contact email
Sponsor organisation
University of Northumbria at Newcastle
Duration of Study in the UK
0 years, 11 months, 4 days
Research summary
Summary of Research
Intermittent self-catheterisation (ISC) is a technique where an individual is trained to use a catheter (small hollow tube) to drain their bladder which does not empty independently. The individual may need to perform this technique once or up to several times a day. This requires commitment to regularly perform the technique for optimal bladder drainage in cases of partial or complete urinary retention. Conditions that can require ISC are neurogenic bladder (where retention is caused by the nerves to the bladder not functioning as well or at all), by medical treatments such as Botulinum toxin injection (paralyses the bladder nerves causing a retention of urine), urological (bladder outflow obstruction e.g. enlarged prostate gland) and gynaecological conditions ( e.g. pelvic organ prolapse following childbirth).
ISC is deemed as the 'gold standard' treatment (NICE, 2012 a, b) and over the past four decades ISC has been instigated and taught in the hospital setting. Evidence has identified that whilst many individuals trained in this technique manage well, some however struggle from a psychological, social and practical perspective as ISC impacts upon every aspect of their daily living (Logan et al, 2007; Ramm and Kane, 2011). Current limited evidence has highlighted that living with ISC requires individuals to develop coping strategies, however for some coping strategies do not develop, leading to ineffective practice of ISC which can lead to ill health and the increased risk of urine infections. Despite ISC being recognised as a treatment method since 1972 it is acknowledged that nurses who train individuals to perform ISC have been trained and are competent in the technique (NHS England, 2015; RCN, 2012; Loveday 2014). There are currently no studies that examine the experience of the nurse in providing ISC training for the individual and this is a significant gap in the literature. With the intention of improving patient-centred care these experiences need to be explored in order to understand what they go through when undertaking ISC training.
There are two parts to the study – 1. Observation of ISC training 2. Interviews. The patient participants and nurse participants will be identified within two NHS Trusts and approached about taking part in the study. This study is part of a five-year part-time PhD research project due to be completed in May 2024.Summary of Results
The purpose of this research was to study the experience of patients and nurses during a clinic visit where the patient would be shown how to do Intermittent Self Catheterisation (ISC). There is not a lot of research looking at what happens when the patient is being taught how to catheterise by the nurse and there is no research on the nurses’ experience.
Intermittent Self Catheterisation is a technique that uses a hollow tube (catheter) passed up the water pipe (urethra) to drain urine that cannot be passed out of the bladder (where urine is stored) naturally. The catheter is not left in the bladder, once the bladder is empty, it is removed and disposed of straight afterwards.
9 nurses and 25 patients from two hospitals in the Northeast of England took part in the study. The participants (people taking part in the study) were male and female, aged between 22 and 82 years. Patients had a range of bladder conditions that meant they needed to learn how to drain their bladder using an intermittent catheter (catheter that is not left in the bladder).
The researcher watched and made notes about what was happening during the whole training appointment. They also watched and followed the nurse around clinic to see what they did during their shift. After the clinic visit the researcher arranged to meet with the patient and nurse on their own to interview them about what they had just experienced. Interviews could take place in a room in the clinic, on university premises, at their home or online via Zoom, Skype or Microsoft Teams. All patients chose to be interviewed in their own homes and the nurses preferred to be interviewed in the clinic.
This research has found that the relationship the nurse makes with the patient is very important to the patient. Patients value the knowledge, experience and support that they are given by the nurse during their training appointment. They like a nurse that is caring, compassionate, calm, kind, has a good sense of humour, and that maintains their privacy and dignity whilst they are trying a very personal and embarrassing skill. It is easier for the patient if the nurse uses words that are familiar to them when explaining parts of their body e.g. water pipe instead of urethra.
When coming to the hospital, some patients do not know what their appointment is for as the letter does not tell them. This can cause the patient to be scared about what to expect or shocked when they do find out why they are there. Some patients may be told beforehand by the nurse, consultant or receive a booklet about ISC, so are better prepared.Many patients find the thought of ISC scary as they worry that they are going to hurt themselves or cause damage pushing the tube up their ‘water pipe’ (urethra). They are also embarrassed at the thought of letting the nurse see ‘down below’ as it is a private and personal. For some patients who have been sexually assaulted the thought of what they will need to do may make them very upset and re-live their experience. Some patients see the chance to learn to catheterise as a positive experience as it gives them the chance to take control of their bladder problems which have previously affected their quality of life.
The time allocated for the appointment is important as it allows the patient to have as many attempts at trying ISC as they need. It is important that the patient is able to put the catheter in themselves as they will ned to be able to do it on their own when they get home. It also allows the patient to get to know the nurse and feel comfortable enough to ask any questions they may have before they are discharged home.Nurses build up their experience of teaching ISC over many years. There are different ways that nurses learn e.g. trial and error, observing another nurse teach a patient, self-learning and training courses. Their aim is to ensure that they are as prepared as possible to support and educate the patient during their appointment. The nurse will prepare their diary so they can plan their workload for that day. Patients can be taught ISC in either the clinic room, treatment room or toilet. This area is always checked and cleaned prior to the patient going into the room. They will prepare themselves by reading patient notes and see if they need to use a particular type of catheter for that person. If a patient has a poor grip the nurse may use a catheter that has a sleeve to help the patient to hold or grip the catheter more easily.
It is very common for the nurse to be interrupted by their colleagues when with a patient which can disrupt the flow of the training and unsettle the patient. Nurses are skilled at showing the patient what they need to do whilst talking through each step of the process. Sometimes nurses have extra work that is added to their workload that they had not expected to do. They want to make sure that this does not change the care that they provide to the patient due to time pressure. Providing patient care whilst juggling administrative tasks is challenging and something the nurse needs to be good at.
Nurses find it stressful, mentally and emotionally draining when trying to teach a patient who has been sexually assaulted. They feel that they are abusing the patient again and often they have not had the training to support the patient or themselves in these situations. Each step of the training appointment the nurse gives the patient advice, guidance and the opportunity to ask questions. There are many skills that the nurse needs to be good at e.g. good teacher, good communicator, listen to the patient, explain things clearly, use simple language, show empathy, know urology, and create a space that is safe and private.
The research has shown that patients need information about what is going to happen during their appointment. They need to be given information booklets explaining what ISC is and what they will be expected to do. The appointment letter needs to tell them exactly what their appointment is for rather than a general letter for that department. Patients would like more time during their appointment to make sure they have time to practice the ISC technique, especially female patients where the ‘water pipe’ can be tricky to find. If the nurse puts the catheter in because the patient is struggling to find the ‘waterpipe’, the patient will not be able to manage when they get home. This causes the patient to be very upset that they could not manage, but the nurse did manage. They would like a more honest approach from the nurse in that they may fail when they try to reduce the pressure that they feel to manage ISC on their first try.
Nurses want patients to receive information about ISC much sooner in their bladder management journey. They would like to have more time to teach patients so they can tailor the training to the persons needs and not worry about how long it takes. Nurses would also like to have the time to train other nurses how to teach ISC to patients. They would like to create a pathway (step by step) plan of care for patients who need to catheterise. Included in this pathway would be training other health care providers e.g. accident and emergency, community about what ISC is and how they can support patients needing to learn this technique, before they reach the nurse.
This research has shown that overall, patients have a good ISC training experience with the nurse. Nurses strive to give the patients a supportive clinic and learning environment to help them to succeed at ISC. The study has also highlighted areas for improvement in relation to information the patient receives before their appointment, the time allocated for the appointment, the importance of the patient being able to insert the catheter on their own and the management of care from other health care providers.
The research has demonstrated the everyday that challenges the nurse faces in managing their patient workload alongside interruptions, unexpected work and limited time for appointments. It has highlighted that there is a need for extra education and training of nurses especially when caring for patients who have been sexually assaulted to make sure that the nurse is supported and skilled.
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
21/NW/0077
Date of REC Opinion
11 May 2021
REC opinion
Further Information Favourable Opinion