Urinary Catheter Users Research Articles

Quality of life and body image of patients with urinary disorders.

to assess the quality of life and body image of men with difficulty urinating and indwelling urinary catheter users, integrating the socio-demographic, economic and morbidity variables. a cross-sectional analytical study with 64 male patients with urinary problems. Three questionnaires were used for data collection: one containing sociodemographic, economic and morbid data, the Medical Outcome Study 36-item short-form health survey to analyze quality of life, and the Body Dysmorphic Examination, which assesses body image. T-test, Mann-Whitney, Pearson, Spearman, Linear Regression and Stepwise were used. quality of life and body image were compromised in both groups, affecting emotional aspects, with a high degree of body dissatisfaction and altered physical and social adversity. changes in patients' quality of life and body image were observed, confirming the need for improvement in care.

Psychometric properties of the Arabic version of the International Consultation on Incontinence Questionnaire on Long‐Term Catheter Quality of Life

To translate the International Consultation on Incontinence Questionnaire (ICIQ) Long-Term Catheter Quality of Life (LTCqol) questionnaire (ICIQ-LTCqol) from English to Arabic and evaluate its psychometric properties. Currently, no tool for Arabic-speaking patients is available to measure the quality of life in patients using long-term urinary catheters. Translation and psychometric assessment of questionnaire. The internal consistency and construct validity of the translated Arabic version of the ICIQ-LTCqol were evaluated in a convenience sample of 141 participants recruited from a hospital in Egypt from April to September 2017. Test-retest reliability was assessed for a sample of 15 participants who completed this version at two time points. Construct validity was assessed by factor analysis. The translated Arabic version of the ICIQ-LTCqol showed satisfactory test-retest reliability and internal consistency, with the Cronbach α = .75. Confirmatory factor analysis confirmed the same two factors ("catheter function" and "lifestyle") structure as found in the English version of the tool supporting the construct validity of the translated questionnaire. This original and significant study allows, for the first time, researchers and clinicians working with Arabic-speaking patients, the opportunity to evaluate the quality of life in long-term urinary catheter users.

A randomized controlled trial on analgesic effect of repeated Quadratus Lumborum block versus continuous epidural analgesia following laparoscopic nephrectomy

BackgroundEpidural analgesia as the effective pain management for abdominal surgery has side effects such as paresthesia, hypotension, hematomas, and impaired motoric of lower limbs. The quadratus lumborum block (QLB) has potential as an abdominal truncal block, however, its analgesic efficacy has never been compared to epidural analgesia on laparoscopic nephrectomy. This prospective randomized controlled study compared the effectiveness of QLB with the epidural analgesia technique in relieving postoperative pain following transperitoneal laparoscopic nephrectomy.MethodsSixty-two patients underwent laparoscopic donor nephrectomy and were randomized to receive QLB (n = 31) or continuous epidural (n = 31). The QLB group received bilateral QLB using 0.25% bupivacaine and the epidural group received 6 ml/h of 0.25% bupivacaine for intraoperative analgesia. As postoperative analgesia, the QLB group received repeated bilateral QLB with the same dose and the epidural group received 6 ml/h of 0.125% bupivacaine for 24 h after surgery completion. The primary outcome was the 24-h cumulative morphine requirement after surgery. The secondary outcome was the postoperative pain scores. Sensory block coverage, hemodynamic changes, Bromage score, postoperative nausea-vomiting (PONV), paresthesia, and duration of urinary catheter usage were recorded and analyzed.ResultThe 24-h cumulative morphine requirement and pain scores after surgery were comparable between the QLB and epidural groups. The coverage of QLB was extended from T9 to L2 and the continuous epidural block was extended from T8 to L3 dermatomes. The mean arterial pressure (MAP) measured at 24 h after surgery was lower in the epidural group (p = 0.001). Bromage score, incidence of PONV, and paresthesia were not significantly different between the two groups. Duration of urinary catheter usage was shorter (p < 0.001) in the QLB group.ConclusionThe repeated QLB had a similar 24-h cumulative morphine requirement, comparable postoperative pain scores and sensory blockade, higher postoperative MAP, a similar degree of motoric block, no difference in the incidence of PONV and paresthesia, and shorter urinary catheter usage, compared to the continuous epidural analgesia following transperitoneal laparoscopic nephrectomy.Trial registrationClinicalTrial.gov NCT03520205 retrospectively registered on May 9th 2018.

Enhanced recovery for gynecological oncology surgery—review

Enhanced recovery after surgery (ERAS) programs initially developed for colorectal surgery two decades ago have revolutionized the management of the surgical patient. By recognizing that the whole peri-operative period, not just the surgery itself, provides opportunities for evidence-based morbidity and length of stay (LoS) reducing interventions to be made, the quality and cost effectiveness of patient care has been improved. By considering and optimising the patients’ pre-operative physical (prehabilitation, carbohydrate loading, avoidance of bowel prep) and psychological (pre-admission education and counselling) condition, they arrive for surgery at a significant advantage. Intra-operatively, using an appropriate balanced anaesthetic technique, combined with minimally invasive surgery where possible, sensible fluid management, and multimodal analgesia continuing into the post-operative period, functional recovery has been shown to be enhanced. The promotion of early ambulation is facilitated by good multimodal analgesia, and reduced usage or earlier removal of abdominal drains and urinary catheters, which in turn reduces the venous thromboembolism (VTE) and post-operative infection risk. Robust discharge pathways including education of patients on discharge, may help to minimise unplanned readmissions. The ERAS principles applied to gynecological oncology surgery have been shown to be effective however the evidence is evolving and hence it is essential the adherence to and effectiveness of these pathways is continually audited.

Observation on the effect of DMAIC in reducing catheter-related urinary tract infection

Objective To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection. Methods A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared. Results Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ2= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ2=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰ (1/3 856) in the observation group and 1.95 ‰ (8/4 098) in the control group, the differences was statistically significant (χ2=5.832, P< 0.05). Conclusions DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections. Key words: Intensive care unit; Indwelling catheter; Nursing care; Catheter-related urinary tract infection; DMAIC

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy.

BackgroundPostoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.ObjectivesThis study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.MethodsA prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.ResultsPatients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).ConclusionsThe three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

Social Determinants of Health in the lives of urinary catheter users.

To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

MODIFICATION OF URINARY CATHETERS USING ANTIMICROBIALS FROM STREPTOMYCES SP. ABK 07 FOR URINARY TRACT INFECTION RESISTANCE

Objective: The main aim of this study is to prevent biofilm formation by impregnating an antimicrobial on urinary catheter.Methods: Catheter segments were immersed in the antimicrobial compound for impregnation. After 2 h, the segments were removed, sterilized and dried after which mechanical and antimicrobial properties of the catheter segments were determined. The shelf life of the impregnated segments was also ascertained as well as anti-biofilm assay. Spectral analysis (UV &amp; FTIR) was also performed.Results: Impregnation was achieved by immersing catheter segments in antimicrobial compound ensuring it does not affect the catheter texture. The impregnated antimicrobial catheters were able to prevent colonization by common uropathogens Escherichia coli, Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella, and Candida albicans for up to 12 weeks. Antibiotic impregnation of the catheters did not affect the mechanical properties and did not render it as unfit for insertion. The antimicrobial-impregnated catheter offers a means of reducing biofilm formation and subsequently reducing the infection in long-term urinary catheter users. Spectral analysis was done by UV-Vis and FTIR.Conclusion: Antibiotic impregnation of the catheters did not affect the mechanical properties and did not render it as unfit for insertion. The antimicrobial impregnated catheter offers a means of reducing biofilm formation and subsequently reducing the infection in long-term urinary catheter users.

Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters.

To describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess healthcare use for treating catheter problems. Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. Secondary data analysis was conducted from a sample in a randomised clinical trial, using data from the entire sample of 202 persons over 12months' participation. Descriptive statistics were used to characterise the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of catheter-related urinary tract infection and blockage. Catheter-related urinary tract infection was marginally associated with catheter blockage. Problems reported at least once per person in the 12months were as follows: catheter-related urinary tract infection 57%, blockage 34%, accidental dislodgment 28%, sediment 87%, leakage (bypassing) 67%, bladder spasms 59%, kinks/twists 42% and catheter pain 49%. Regression analysis demonstrated that bladder spasms were significantly related to catheter-related urinary tract infection and sediment amount, and catheter leakages were marginally significantly and positively related to catheter-related urinary tract infection. Frequencies of higher levels of sediment and catheter leakage were significantly associated with higher levels of blockage, and being female was associated with fewer blockages. Persons who need help with eating (more disabled) were also more likely to have blockages. Catheter-related urinary tract infection and blockage appear to be related and both are associated with additional healthcare expenditures. More research is needed to better understand how to prevent adverse catheter outcomes and patterns of problems in subgroups. Nurses can develop care management strategies to identify catheter blockage prior to its occurrence by tracking the amount of sediment and frequency of leakage. Bladder spasms could be an early warning of catheter-related urinary tract infection.

Feasibility of a Web-Based Self-management Intervention for Intermittent Urinary Catheter Users With Spinal Cord Injury.

The purpose of this study was to evaluate the feasibility of a new Web-based intermittent catheter self-management intervention. We tested the acceptability and usability of intervention components, which included multiple Web-based materials (an online urinary diary adapted for mobile phone use and an educational booklet), 3 phone calls with a nurse, and a peer-led discussion forum. Thirty adults with spinal cord injury using intermittent catheterization for bladder drainage were enrolled; 26 participants received the nurses' phone-based consultations. Preliminary effectiveness of new self-efficacy and self-management scales were evaluated using baseline and 3-month online surveys. Participants' perceived value of the intervention components, self-management changes, and suggestions were assessed with data from the 3-month surveys, followed by brief tape-recorded interviews. Several catheter practices improved somewhat over 3 months. The frequency of catheterizations every 4 to 6 hours increased from 71% to 77%. Self-management of neurogenic bladder dysfunction increased significantly (P = .032); participant comments indicated that fluid intake was the biggest change. Catheter-related self-efficacy and quality-of-life scores increased but not significantly. The frequency of urinary tract infection and pain did not change significantly. For feasibility, intervention components, with the exception of the forum, were rated highly by the majority of participants for usefulness, satisfaction (desired information), and Web-based usability. Further testing of this intervention is recommended in a multisite randomized clinical trial.

Prevention and control of catheter-associated urinary tract infections - implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in nursing homes for the elderly in Frankfurt am Main, Germany.

Introduction: Urinary tract infections range among the most frequent infections not only in hospital patients but also in residents of long-term care facilities for the elderly. Urinary catheters are the greatest risk factor for urinary tract infections. In the guidance paper on the “prevention of infections in nursing homes” (2005) as well as in the updated recommendations for the “prevention and control of catheter-associated urinary tract infections” (2015), the Commission for Hospital Hygiene and Infection Prevention (KRINKO) has recommended adequate preventive measures. In 2015, the implementation of these KRINKO recommendations was investigated.Method: All of Frankfurt’s 40 nursing homes were evaluated using a checklist based on the KRINKO recommendations. The evaluation included assessing the availability of operating instructions, appropriate indications for the placement of catheters etc. Age, sex and duration of catheterization, as well as current and previous infections within the past 6 months were documented for every resident with a catheter.Results: In 35 (87.5%) of the nursing homes, operating instructions for the handling of urinary tract catheters were available. The decision as to whether a catheter is indicated is made by physicians, while its placement is often delegated to the nursing service. Typically, silicon catheters are used. In three-quarters of the nursing homes, regular intervals of 4–6 weeks for changing catheters were reported. On the respective survey day, 7.3% of the residents were catheterized. On the survey day, 3.6% (4.2%) and in the previous 6 months a total of 28% (28.9%) of the residents had a urinary tract infection (prevalence of antibiotic therapy in parentheses). Ciprofloxacin was used most often followed by cefuroxime and cotrimoxazole.Discussion: In the current evaluation, fewer nursing home residents were catheterized than in previous years and the rate of urinary tract infections was low. This indicates an increasingly cautious and apparently appropriate usage of urinary tract catheters. Also, the prevalence of antibiotic therapy was low for residents with urinary tract catheters (4.2%). However, broad spectrum antibiotics are still preferentially administered (particularly quinolones), which may favor the high rate of colonization with ESBL-producing bacteria and 3MRGN. Given this background, a coordinated approach including resistance-based antibiotic stewardship appears increasingly important in nursing homes and other health care facilities.

Rise and fall of KPC-producing Klebsiella pneumoniae in New York City.

The study objective was to examine the epidemiological trends of KPC-producing Klebsiella pneumoniae in New York City medical centres. Single patient isolates of K. pneumoniae were collected from nine medical centres in New York City during a 3 month period from 2013 to 2014. Isolates were tested for the presence of blaKPC. Results were compared with similar surveillance studies conducted in 2006 and 2009. Infection control data, including utilization of medical devices, were analysed at a subset of hospitals. There was a progressive decline in the percentage of K. pneumoniae harbouring blaKPC from 2006 to 2013-14. For the nine hospitals that participated in all three surveillance studies, the percentages of isolates with blaKPC fell from 36% in 2006 to 25% in 2009 to 13% in 2013-14. Seven of the nine hospitals had marked declines in isolates with blaKPC, while two hospitals continued to struggle with this pathogen. These two hospitals were smaller and had longer lengths of patient stay. Device utilization rates were obtained from two hospitals that successfully controlled the spread of KPC-producing K. pneumoniae; both had ∼20%-25% reduction in the usage of urinary catheters. Changes in antibiotic usage at one hospital could not explain the decline in these pathogens. Over the past decade there has been a steady decline in KPC-producing K. pneumoniae in most New York City hospitals. The reason for the decline is probably multifactorial, involving a reduction in device (catheter) utilization and possibly an improvement in infection control practices.

Nurses experiences discussing sexuality with urinary catheter patients

ABSTRACTThe 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.

A nurse‐driven process for timely removal of urinary catheters

ABSTRACTCatheter‐associated urinary tract infection (CAUTI) comprises 30–40% of all health care‐acquired infections, and 70–80% of these infections are related with use of indwelling urinary catheters. This quality improvement (QI) project was initiated to evaluate the effectiveness of a nurse‐driven urinary catheter removal process in reducing the duration of urinary catheter usage in a general medical ward in Singapore. A pre‐ and post‐study design was adopted. The pre‐implementation data included urinary catheter utilization ratio and CAUTI rates. Over a 6‐months period, nurses used a nurse‐driven urinary catheter removal process to improve rates of timely removal of catheter. Data collected included nurses' compliance with the process and clinical outcomes, such as urinary catheter utilization ratio and CAUTI rates before and after implementation. Compliance with the use of the nurse‐driven process by staff was 89%. The urinary catheter utilization ratio revealed a raise from 0·12 before implementation to 0·18 after implementation. However, CAUTI rates decreased from 4 to 0 per 1000 catheter‐days, indicating a marginally significant difference between the pre and post‐implementation rates (p = 0.06), using Fisher's exact test. The nurse‐driven process decision support tool for optimizing appropriate catheter usage had the potential of reducing a patient's risk of acquiring CAUTI.

Testing a Model of Self-Management of Fluid Intake in Community-Residing Long-term Indwelling Urinary Catheter Users

Urinary tract infection and blockage are serious and recurrent challenges for people with long-term indwelling catheters, and these catheter problems cause worry and anxiety when they disrupt normal daily activities. The goal was to determine whether urinary catheter-related self-management behaviors focusing on fluid intake would mediate fluid intake-related self-efficacy toward decreasing catheter-associated urinary tract infection (CAUTI) and/or catheter blockage. The sample involved data collected from 180 adult community-living, long-term indwelling urinary catheter users. The authors tested a model of fluid intake self-management related to fluid intake self-efficacy for key outcomes of CAUTI and blockage. To account for the large number of zeros in both outcomes, a zero-inflated negative binomial (ZINB) structural equation model was tested. Structurally, fluid intake self-efficacy was positively associated with fluid intake self-management, suggesting that higher fluid intake self-efficacy predicts more (higher) fluid intake self-management; however, fluid intake self-management was not associated with either the frequency of CAUTIs or the presence or absence of CAUTI. Fluid intake self-efficacy was positively related to fluid intake self-management, and fluid intake self-management predicted less frequency of catheter blockage, but neither fluid intake self-efficacy nor fluid intake self-management predicted the presence or absence of blockage. Further research is needed to better understand determinants of CAUTI in long-term catheter users and factors which might influence or prevent its occurrence. Increased confidence (self-efficacy) and self-management behaviors to promote fluid intake could be of value to long-term urinary catheter users to decrease catheter blockage.

Exploring the information needs of people living with a long-term indwelling urinary catheter: a qualitative study.

To explore the information needs of long-term indwelling urinary catheter users, the consequences for patients of inadequate information and how these needs could be met. Previous studies have drawn attention to the lack of information given to indwelling catheter users and how users would benefit from more. Little is known about the varied and detailed information needs of long-term indwelling catheter users. A qualitative interpretative approach was used, combining thematic analysis with constant comparison. A diverse sample of people living in the community with a catheter for 3months or longer was recruited. Interviews were conducted using a narrative approach. Thirty-six interviews were conducted in England, Wales and Scotland between 2011-2013. Participants ranged in age from 22-96years. After having a catheter fitted they wanted more technical information about it and information to help prevent catheter-related physical problems (infection, blockage, leaking), on sexual activity and the siting of catheters and about managing a social life with a catheter. In its absence, patients sometimes experimented with the catheter, learning to live with it through trial and error, used the Internet to find out more, or contacted other patients or organizations. Research has consistently shown that indwelling catheter users need to be given more information but some patients still feel poorly informed. Nurses are in a good position to find out what people know, what they need, and to ensure that patients have contact phone numbers for further information and details of reliable websites and support organizations.

High Serum Prostate Specific Antigen as A Risk Factor for Moderate-Severe Prostate Inflammation in Patient with Benign Prostatic Hyperplasia

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common degenerative disease found in men. Theories have been delivered to elucidate etiology, one of them is the theory of inflammation, and PSA is considered as one of risk factor for prostate inflammation. Undetected chronic inflammation could be a problem in BPH due to the obstructive and irritative symptoms it causes. Assessing risk factor could provide a better treatment outcome. Methods: A retrospective case control study in Sanglah Hospital, Indonesia. 70 men with BPH who underwent TURP in 2014, prostate inflammation is evaluated histologically from prostate specimens by one pathologist to avoid subjectivity. Those without inflammations and with mild inflammations are categorized as control group (n=35), and those with moderate and severe inflammations are categorized as case group (n=35). Preoperative total serum PSA retrieved from medical record Results: Median PSA is higher in case group, 2,83 compared to 14,12, with odd ratio 1,18 (p<0,001). Multivariate analysis is done for high PSA, bacteriuria, duration of urinary catheter insertion, and obesity, and still high PSA is the independent risk factor (adjusted OR=14,6 p<0,001). Conclusion: PSA is a risk factor for moderatesevere prostate inflammation in men with BPH. Bacteriuria, urinary catheter usage, and obesity did not differ significantly as risk factors for moderate-severe prostate inflammation.

Development of a Web-Based Self-management Intervention for Intermittent Urinary Catheter Users With Spinal Cord Injury.

While Web-based interventions have proliferated recently, information in the literature is often lacking about how the intervention was developed. In response to that gap, this is a report of the development of a Web-based self-management intervention for intermittent urinary catheter users and pretesting with four adults with spinal cord injury living in the community. Two Web sites were created, one for recruitment and the other for the intervention itself. The intervention involved developing new Web-based technology, including an interactive urinary diary (with fluid intake/urine output and a journal), extensive catheter products information, three intervention nurse phone call consultations, and user-community discussion forums. Study participants completed an online survey and were interviewed twice about the enrollment process and their perceptions of their involvement in the intervention. Suggestions from the pretesting participants were used to revise the Web site applications prior to the next stage of research (a feasibility study). Numerous recommendations and comments were received related to content, interactivity of components, and usability. This article provides a description of how the Web sites were developed (including the technology and software programs used), issues encountered and what was done to address them, and how the Web-based intervention was modified for improvements.

A Hybrid Process Fidelity Assessment in a Home-Based Randomized Clinical Trial

A process fidelity assessment was conducted as a nested study within a home-based randomized clinical trial teaching self-management to 101 long-term indwelling urinary catheter users in the treatment group. Our hybrid model combined external assessments (outside observations and tape recordings) with internal evaluation methods (through study nurse forms and notes) for a comprehensive process fidelity assessment. Barriers, patient-related issues, and nurse perspectives were identified demonstrating the complexity in home care intervention research. The complementary and synergistic approaches provided in-depth information about the context of the delivery and the impact of the intervention on study outcomes.

Self-care management questionnaire for long-term indwelling urinary catheter users.

Self-management is believed to be an important behavioral capacity in people with chronic illness, and self-efficacy is an important component contributing to self-management. Two new and related measures for urinary catheter self-efficacy (C-SE) and self-management (C-SMG) were developed based on existing tools and tested for psychometrics for use in a randomized clinical trial (RCT) teaching urinary catheter self-management. The instruments were evaluated at baseline (intake face to face interview) with 202 persons and with 158 of the same individuals 6 months later by telephone interviews. Exploratory factor analysis was conducted in an iterative process related to items' theoretical and statistical appropriateness. To assess construct validity and goodness of fit for model testing, confirmatory factor analysis was conducted with the samples at intake and 6 months. Also, bivariate analyses were conducted of the measures in relation to each other. Both scales were modified reducing the items to 13 in each, with four factors in C-SE and three factors in C-SMG. Reliability testing (Cronbach's alpha) was viewed as satisfactory for both scales, though some of the subscale (factors) reliabilities were lower in the self-management measure. Confirmatory factor analysis was adequate. Correlation of the two instruments (r = 0.25, P < 001) suggests that they are related scales. With a change in the C-SMG scale from 3- to 5-level responses and subsequent testing, both new scales are appropriate for use separately or together as a questionnaire related to catheter self-care management in intervention research with long-term indwelling urinary catheter users. Neurourol. Urodynam. 35:492-496, 2016. © 2015 Wiley Periodicals, Inc.