The University of Southampton
University of Southampton Institutional Repository

Why do clinicians place indwelling urinary catheters with patients in acute medical care?

Why do clinicians place indwelling urinary catheters with patients in acute medical care?
Why do clinicians place indwelling urinary catheters with patients in acute medical care?
Background: Indwelling urinary catheters (IUCs) placed for short-term use in hospital frequently become long-term catheters, increasing the potential for infections, trauma and other complications. Current research has focused on the prompt removal of IUCs in place, with no published review of interventions to reduce the initial placement. Furthermore, little is known about why clinicians place IUCs in acute medical care. Without this knowledge, the effectiveness of strategies aimed at reducing IUC use is likely to be sub-optimal.

Aim: To understand why clinicians decide to place IUCs in acute medical care.

Methods: (1) A systematic review of interventions to minimise the initial placement of urinary catheters in acute care. (2) A qualitative study in the A&E department and acute medical wards of a 1200+ bed hospital. Clinicians who made the decision to place an IUC were asked to participate in a retrospective think aloud interview describing how they came to the decision, later participating in a semi-structured interview to discuss their wider experiences of making the decision to place an IUC. A purposive sample and thematic analysis were used.

Results: (1) Eight (six uncontrolled) studies met the inclusion criteria for the systematic review, using a variety of interventions including clinician education and introduction of guidelines to reduce IUC use. Although seven demonstrated a reduction in the initial use of IUCs post-intervention (relative risk 0.19 – 0.86), the impact of individual interventions was unclear. Notably, each study provided a list of reasons considered to provide justifications for IUC use, with substantial variation between the lists. (2) 30 retrospective think aloud interviews and 20 semi-structured interviews were undertaken. Clinicians were influenced by cues taken from three groups; individual beliefs (e.g. on the clinical indication or IUC-associated risks), patient factors (e.g. age or gender) and organisational factors (e.g. resources or policy). Many spectrums of belief were found (e.g. varying opinions on using IUCs to protect skin from urinary incontinence).

Conclusions: This work establishes that understanding of interventions to reduce the initial placement of IUCs is poor and there is a lack of agreement on when the benefits of IUC use outweigh the risks. Clinical reasoning in this area is frequently inconsistent and IUC placement decisions vary widely, indicating that there is considerable scope for a reduction in use.
Murphy, Catherine
9cb9fc47-8fb4-4005-8e18-9d01ea62ff2c
Murphy, Catherine
9cb9fc47-8fb4-4005-8e18-9d01ea62ff2c
Fader, Miranda
c318f942-2ddb-462a-9183-8b678faf7277
Prieto, Jacqueline
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc

Murphy, Catherine (2014) Why do clinicians place indwelling urinary catheters with patients in acute medical care? University of Southampton, Faculty of Health Sciences, Doctoral Thesis, 292pp.

Record type: Thesis (Doctoral)

Abstract

Background: Indwelling urinary catheters (IUCs) placed for short-term use in hospital frequently become long-term catheters, increasing the potential for infections, trauma and other complications. Current research has focused on the prompt removal of IUCs in place, with no published review of interventions to reduce the initial placement. Furthermore, little is known about why clinicians place IUCs in acute medical care. Without this knowledge, the effectiveness of strategies aimed at reducing IUC use is likely to be sub-optimal.

Aim: To understand why clinicians decide to place IUCs in acute medical care.

Methods: (1) A systematic review of interventions to minimise the initial placement of urinary catheters in acute care. (2) A qualitative study in the A&E department and acute medical wards of a 1200+ bed hospital. Clinicians who made the decision to place an IUC were asked to participate in a retrospective think aloud interview describing how they came to the decision, later participating in a semi-structured interview to discuss their wider experiences of making the decision to place an IUC. A purposive sample and thematic analysis were used.

Results: (1) Eight (six uncontrolled) studies met the inclusion criteria for the systematic review, using a variety of interventions including clinician education and introduction of guidelines to reduce IUC use. Although seven demonstrated a reduction in the initial use of IUCs post-intervention (relative risk 0.19 – 0.86), the impact of individual interventions was unclear. Notably, each study provided a list of reasons considered to provide justifications for IUC use, with substantial variation between the lists. (2) 30 retrospective think aloud interviews and 20 semi-structured interviews were undertaken. Clinicians were influenced by cues taken from three groups; individual beliefs (e.g. on the clinical indication or IUC-associated risks), patient factors (e.g. age or gender) and organisational factors (e.g. resources or policy). Many spectrums of belief were found (e.g. varying opinions on using IUCs to protect skin from urinary incontinence).

Conclusions: This work establishes that understanding of interventions to reduce the initial placement of IUCs is poor and there is a lack of agreement on when the benefits of IUC use outweigh the risks. Clinical reasoning in this area is frequently inconsistent and IUC placement decisions vary widely, indicating that there is considerable scope for a reduction in use.

PDF
Final Thesis.pdf - Other
Download (2MB)

More information

Published date: June 2014
Organisations: University of Southampton, Faculty of Health Sciences

Identifiers

Local EPrints ID: 369975
URI: http://eprints.soton.ac.uk/id/eprint/369975
PURE UUID: 50da85ad-d5f1-404a-a29d-eb9e478bb2c9
ORCID for Jacqueline Prieto: ORCID iD orcid.org/0000-0002-5524-6775

Catalogue record

Date deposited: 24 Oct 2014 15:52
Last modified: 06 Jun 2018 12:45

Export record

Contributors

Author: Catherine Murphy
Thesis advisor: Miranda Fader
Thesis advisor: Jacqueline Prieto ORCID iD

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×