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“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care

“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care
“It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care

Background Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians’ decisions need to be better understood.

Objective To explore why clinicians decide to place IUCs in acute medical care.

Methods We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used.

Results Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals.

Conclusions These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.

2044-5415
444-450
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
Prieto, Jacqui
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277
Murphy, Catherine
b7f2dd56-3a8a-412a-9f6a-bf468ce7f749
Prieto, Jacqui
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Fader, Mandy
c318f942-2ddb-462a-9183-8b678faf7277

Murphy, Catherine, Prieto, Jacqui and Fader, Mandy (2015) “It's easier to stick a tube in”: a qualitative study to understand clinicians’ individual decisions to place urinary catheters in acute medical care. BMJ Quality and Safety, 24 (7), 444-450. (doi:10.1136/bmjqs-2015-004114). (PMID:26065467)

Record type: Article

Abstract

Background Indwelling urinary catheters (IUCs) placed in acute care are a leading cause of healthcare-associated urinary tract infection. Despite initiatives to minimise the placement of IUCs, levels of inappropriate use are still considered unacceptable. IUC practice is difficult to change, and factors influencing clinicians’ decisions need to be better understood.

Objective To explore why clinicians decide to place IUCs in acute medical care.

Methods We conducted a qualitative study in the emergency department and acute medical wards of a 1200+ bed hospital, undertaking 30 retrospective think aloud and 20 semistructured interviews with nurses and physicians who made the decision to place an IUC. A purposive sample and thematic analysis were used.

Results Opinions on when an IUC was warranted varied considerably. Inconsistency in decision-making was caused by differing beliefs on when an IUC was appropriate for each clinical indication. Numerous patient and non-patient factors, including clinical setting, resources, patient age and gender and staff workload, also impacted on each decision. Assessing when the benefit of an IUC outweighed the risk could be problematic due to conflicting goals.

Conclusions These findings help to explain why clinicians sometimes deviate from IUC best practice guidance and resist interventions to modify practice. In order to engage nurses and physicians in change, interventions to reduce IUC use should acknowledge and respond to the complexity and lack of clarity often faced by clinicians making the decision to place an IUC. However, it is equally important that inconsistencies in IUC-related beliefs are recognised, investigated and, where appropriate, challenged.

Full text not available from this repository.

More information

Accepted/In Press date: 30 April 2015
e-pub ahead of print date: 11 June 2015
Published date: July 2015
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 379192
URI: https://eprints.soton.ac.uk/id/eprint/379192
ISSN: 2044-5415
PURE UUID: c8a12aff-47a8-499f-86c6-78d8eaba68f9
ORCID for Jacqui Prieto: ORCID iD orcid.org/0000-0002-5524-6775

Catalogue record

Date deposited: 18 Jul 2015 16:27
Last modified: 06 Jun 2018 12:45

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