A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder.

Abstract

To establish a care bundle in spinal cord injury patients with neurogenic bladder to avoid upper urinary tract damage and to provide guidance for health care staff in use of nonsurgical and nonpharmacological adjunctive strategies to improve patients' clinical outcomes. Prevention of upper urinary tract damage is critical in the management of spinal cord injury patients with a neurogenic bladder, but there are no authoritative guidelines or high-quality randomized controlled trials. The study was conducted on the basis of Fulbrook and Mooney's seven-step method for care bundle development. The databases PubMed, Embase, Science Citation Index, the Cumulative Index to Nursing and Allied Health Literature, the National Guideline Clearinghouse, the Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, and China Dissertation Database were searched from the date of each database's inception to April 2017. We evaluated the literature according to the Joanna Briggs Institute evidence pre-ranking and grade recommendation system (2014 version). The results were examined using a self-designed data extraction. A three-element cluster including clean intermittent catheterization, bladder function training, and transcutaneous low-frequency pulsed electrical stimulation was formed. The development of this bundle can provide a scientific basis for effective prevention of neurogenic upper urinary tract damage in clinical practice.