Living with a long-term urinary catheter - Essay Example

? LIVING WITH A LONG-TERM URINARY CATHETER By Presented to The objective of this paper is to critique my chosen research, “Living with a long-term urinary catheter: older people experiences”(Godfrey H. 2008). INTRODUCTION This essay will focus on the research process in familiarities of aged people coping with a permanent urinary catheter. This particular subject was chosen because I am interested in it. Throughout my Health Care Assistant experience I was involved in looking after patients with urinary catheters. My role was to ensure cleanliness, catheter function, monitoring output and emptying catheter bag. As a Trainee Assistant Practitioner (TAP) female catheterisation is one of my competencies. This has made me more aware about patient perception and psychological feelings when living with a long-term catheter (Godfrey, 2008, p. 181). I work in Highcare Unit where I look after patients with varying ages and sex. Some of them are quite reluctant to having a catheter. Other patients view it as an embarrassment and consider discussion about the device undignified. In critiquing the research regarding a patient's personal experiences, it enables me to relate, understand and empathise with the patient's situation and predicament. This enables me to give support, advice and information not only with the physical side implications but also the psychological impact in living with a long-term catheter. I think that being able to understand patients' perspectives about living with long term urinary catheters, enables healthcare professionals to sympathize and understand with what the patient is experiencing. It is obvious that research needs to be carried out and compare. This way the study will develop strong and valid evidence based research and implement the conclusions into practice that can assist these patients (Godfrey, 2008, p. 180). CRITIQUE RESEARCH: UTILISING EVIDENCE BASED CARE In the 1990's at McMaster University in Ontario, Canada, developments were made regarding Evidence Based Practice (EBP) movement, which underpinned the Research and Development Strategy in the UK in 1991. Factors like the rise in the cost of healthcare, unnecessary intervention and variations in healthcare, influenced the EBP movement in the UK (Parahoo 2006). EBP advocates the best available evidence should be used when making clinical decisions, to improve the effectiveness, efficiency and health outcomes for patients (Kings College London 2009). Its origins date back to the mid-19th century, when concerns were raised because healthcare interventions were not being proven or evaluated (Lloyd et al 2007). Since the 1970's the term proof-based medical care has increased with the advancement of being capable of having a right to entry to a variety of data. Other aspects that have brought about the usage of EBP medical care comprise of; adjusting of communal anticipations, governmental consensus, cost stresses and expertise responsibility (Hammer Collinsonsn2005, cited by Cutcliffe W. & J. Ward M, 2004). EBP is an approach where healthcare professionals are able to use current evidence and research to back up. This support provides an accurate reason for their care they provide for patients. EBP is highly significant to me because it enables me to offer the best recent physical healthcare I can deliver for my patients. It also makes it possible for me to use proof to aid my understanding and comprehend the reasons behind my decision along with the performance of definite facets of medical practice that I am responsible for. There are many reasons why EBP is specifically relevant to engage in as a part of a nurses' role. Nurses need to make more informed judgements as part of a multi-disciplinary team. This initiative increases the number of complex healthcare decisions that need to be made. The Department of Health's (DOH) directives of best evidence collectively highlight the reason for EBP’s momentous nature. This questioning is accompanied by further cognitive research behind its requirements for implementing medical research of aged people with urinary catheters to ensure the best outcomes for the patients (EBNP 2003). It has importance that is outlined specifically regarding the nurses role, in the Nursing and Midwifery Councils (NMC) Code of Conduct. Within the code it specifies; “You must deliver care based on the best available evidence or best practice” (NMC 2008). Within the society at present there is an expectation that the NHS should deliver a high quality of care within the care provisions. This expectation was recognised in the White Paper Our Health, Our Care, Our Say (DOH 2006). This White Paper could result in a radical sustained shift because of the way the NHS delivers its services. As a result, it becomes more personalised to the service users. This White Paper will in effect, change the way that healthcare professionals work. Healthcare professionals will be needed to make effective clinical decisions that have more of an evidence based approach. There are many resources that are used as evidence as well as research; these include journal articles, reports, expert opinion, policies, anecdotal evidence, professional consensus and audits. It is implied that research is the strongest form of evidence (Dale 2005). The hierarchy of evidence is used to interpret the strength and the validity of research,. (Evans 2002). As evidence is graded lower on the hierarchy, the changes of reaching unbiased, reliable and accurate findings decreases (Lloyd et al 2007). METHODOLOGY In critiquing this research I will use The Critical Appraisal Skills Programme (CASP) tool; 10 questions to help you make sense of qualitative research (CASP 2006). It is a qualitative piece of research, studying the experiences of the adult participants, who live with long term urinary catheters (Godfrey, 2008, p. 183). A grounded theory approach was adopted, with 20 in depth interviews carried out with a sample of 13 adult patients. The grounded theory originally developed by Glaser and Strauss in the 1960's and interviews are classic examples of qualitative approaches ( Research methods knowledge base 2006). Interviews were carried out in two phases, the second phase was to saturate categories and refine the developing theories, through theoretical sampling (Charmaz 2006). Participants over 60 years of age with long term urinary catheter were selected via district nurses within the Primary Care Trust. All participants were sent an information sheet and letter of invitation (Godfrey, 2008, p. 185). DATA ANALYSIS Data gathering was conducted through thorough interrogations while indoors. Interview guides provided themes and prompts to facilitate discussion about thoughts and behaviour. The first phase consisted of 12 interviews and a further 8 were carried out to refine developing ideas. The information were digitally recorded and transcribed vebatim (exact word and comment) by the researcher (Godfrey, 2008, p. 185). A research journal was kept as well as memos for future reference. Theoretical saturation was achieved after the interview. The study was approved by the University and health ethics committee. The participants were encourage to ask the district nurses for further information if needed, and the researcher offered clarity at times, to direct queries. Information guides were given and explained. Written consent were given by the participants before the interviews began. Data was analysed through the constant comparative method, which is typically used to develop a grounded theory. Open, selective coding and axial was carried out so that the categories and core categories could be conceptualised. DISCUSSION To make an effective clinical decision will take time, in (Rycroft- Malone 2004, Cohen et al 2002) research they highlighted that time will always be seen as the barrier as healthcare professionals just do not have the time as they are always too busy. I believe that this is a culture within the nursing profession and this is one reason why new evidence is not implemented into practice. Also lack of education for staff, lack of motivation, lack of interest and compliance from the staff and team members was a hindrance experienced by the staff involved in this research (Godfrey, 2008, p. 185). The applicable assumption brought about through this research is based on the truths and familiarities of elder people living with a catheter. Aged people’s acceptance of a livelihood with permanent catheter is outlined by a figure of interrelated aspects and varies alongside a range between being comfortable or edgy. The three criteria used in the research, “trying to understand”, “judging catheter performance” and “being aware of physical manifestations” outlined the aged person’s affiliation with their catheter. This approach was interceded by the excellence of their interrelations with other people. Involvement with the law made it more likely for the aged person to be comfortable to take part in the research. At the same time, the subjects endured informal feelings brought about by the uncomfortable reception of life with an unavoidable catheter. The main criterion used by Godfrey was “all about acceptance.” The ethical aspect used in the study did not manage to describe the change that aged people has to go through to live with a permanent urinary catheter (Godfrey, 2008, p. 186). Criteria of being comfortable and uncomfortable were the only aspect of the research methodology that that managed to reflect the extreme nature of the satisfaction experienced. Three interlinking criteria of attempting to comprehend, judging the catheter performance and being aware of the catheter outlined the aged people’s affiliations with their doctors, and surroundings’ interrelations as well. The effects for aged people living with the catheter increased from active lifestyles to going through deep and informal feelings. The opening part of the research was a practical study aimed at comprehending the lived familiarities of aged patients with the indwelling urinary catheter. This part was carried out using the matrix technique. Acting as a quantitative method of research, Godfrey utilized the power of this technique for analysts of this study to view the extent at which he was concerned for these people (Godfrey, 2008, p. 186). Swaying from a qualitative research, this method was advantageous because it was ordered and made from disorders coming from many records. These flaws can be viewed throughout the entire study. The study’s methodology had several barriers because of the lack of consideration of quality outlined in its methodology. Describing the lives lived by aged patients was necessary and only researches of people aged over 18 years could be included in the study. From this part of the study, synthesizing the biomedical data in published records had to be carried out through reading, examining and concluding the periodicals. The research claims that there was no barrier in putting these records as part of the data section of the research. Simultaneously, there was a prodigious limitation to obtaining records that reflected on aged people who lived with permanent urinary catheters. Under such circumstances, Godfrey did not find it easy to reject the fact that most information was found to be associated with the coordination of the urinary catheter. From the books and journals used, documents that were printed on the lived experienced of the aged people included in Godfrey’s study were only relevant to the overall objective of the study (Godfrey, 2008, p. 187). However, the aged patients with permanent urinary catheters were from the United States and the study. This made the study define how it is to cope with the urinary catheter and other bodily equipment. The participants used in the study obtained skills and adaptation from living with their devices continuously. A mixed sentiment was created concerning the means by which the catheter was perceived by the aged patients. It was also discovered that there was an effect of mobility on the functioning of the catheter. The emancipatory methodology deployed in Godfrey’s research was utilized in recruiting the members to accomplish purposeful sampling, and selection size was suitable with regard to the analyzed information (Godfrey, 2008, p. 188). This analyzed data defined the phenomenological definitive, and the hermeneutic phenomenological methodology. This is because the purposive selection technique is employing members grounded in the data required. Therefore, the aged patients who were permanent users of the indwelling urinary catheter were not regarded in the articles obtained and used in the study. The moral code of respect for autonomy, non-maleficence, beneficiary and justice was taken in to regard because the study engaged human subjects. The participants of the study had a right to confidentiality, inform agreement, and their liberated will to take part in the study was respected. Therefore, Godfrey’s research stands legitimate in comparison with other quantitative studies carried out on permanent use of indwelling urinary catheters amongst aged people. The subjects of the research were also told of their liberty to become involved in the study, and pull out from the study at will. Authorization from the institutional review board of the state had been obtained, making the study legitimate and free of ethical and constitutional violations. A qualitative research technique was deployed through an interview between Godfrey and the participants of the research (Godfrey, 2008, p. 188). This methodology was an approach to getting knowledge and makes the study ideal through evasion of barriers. The experiences of the subjects with permanent and indwelling urinary catheter offered an insight of the subjects’ endurance in all varieties. Nevertheless, this technique had limitations like posing threats towards the aged patients’ time answering inquiries that were inapplicable to the study’s objectives. The latent content analytic methodology was deployed in the understanding of the interrogated writing that was an appropriate approach. This is because the writing may have included the numerous descriptions making trust value increase if the person reading the analyzed data was in search of substitute interpretations. The study managed to discover that the patients could have simply been obtained through the utilization of quantitative methodologies. Interviews were not able to acquire a thorough understanding of the subjects used in the study. Godfrey makes it clear that urinary catheterization is a process that is frequently administered to aged people. Nurses are required to provide healthcare to patients in hospital, and in their respective residences (Godfrey, 2008, p. 18). This means that nurses have to cater to catheterized patients in their daily caring operations. At the same time, they have remarkably had little effort made to research the ethical and medical aspects of developing catheterization. A number of reasons have been thought out by Godfrey in his research. Certain aspects of nursing case like coping with physical care, feces, and sexuality might make the researcher feel uneasy. Communal norms might also play a part in preventing debates concerning the theme. Godfrey articulated his surprise on how regular nurses asked him the reason behind the research into the catheter healthcare. Conveying the discomfort brought about by the topic through amusement and pessimistic facial articulations referred t the research as abhorrently unethical. However, nurses involved in the emancipatory methodology of the research did not want to get involved in answering questions regarding the urinary catheter care. This is because they believed it may be a reaction to the humiliation of doing filthy work. An ethical explanation can be found in the appendix of the research that clarifies on the issue of this nature of physical healthcare (Godfrey, 2008, p. 188). This hinders the development and related practical knowledge as nurses find it hard to talk about such patients and their line of profession. As part of the results obtained, the common place for the technology utilized by the practitioner administering the urinary catheter may have not been realized by the effort of the nurses towards the subjects of the study. For a patient living with a permanent urinary device to change his or her lifestyle, there has to be a deeper intervention. This intervention requires the assistance of nurses, doctors, family, friends and researchers. The responsiveness of the subjects included in this study can be contrasted with the effect of the colostomy of the urinary device discovered through Godfrey’s study. There are support groups for aged patients forced to endure life-long livelihoods with indwelling urinary catheterization and none existed prior to such studies. The study subjects defined their familiarities of living with permanent urinary catheter revealed that there were lots of communication gaps amid the study with healthcare experts. This is because they were not able articulate their sentiments regarding their sickness. Living with the catheter was considered as significant when it was viewed as a gadget that helped the aged patient in urinating. At the same time, the device was discovered to be as unhelpful because it prevented the individual from having sexual intercourse. This is because of a decline in taking part in the activity as a result of sense of loss in self-respect. Subjects had to change to living with the urinary catheter due to their physical conditions. Subjects involved in the study majorly articulated their shame of urine leakage when in a gathering. CONCLUSION By critiquing this research it has given me a solid foundation in understanding evidence based practice and research (Godfrey, 2008, p. 189). It has given me clarification on how to find and evaluate research and the importance of it being used in practice. This will enable me to implement evidence based care and provide the best care for the individual patients in my care. As a Trainee Assistant Practitioner and ualified Assistant Practitioner, I will continue to do so in the future. The applicable assumption presented in Godfrey’s research proposes that aged people’s understanding and change to life with an indwelling catheter is sophisticated. This understanding is not simply associated with the performance of the catheter or complications brought about by its usage. The confrontation for healthcare experts is to take part in accomplishing the significant needs of the aged people undergoing urinary problems. Living with the urinary catheter can be a challenging livelihood. However, the methodologies and experiences brought about by this study have highlighted the fact that assistance from analysts and caregivers can make these people adapt to such a lifestyle. Ethical issues experienced by caregivers towards such patients and individuals living with urinary difficulties have to be brought out in the open. Concealing sentiments of shame and fear have simply proven to be unhelpful to the subjects (Godfrey, 2008, p. 189). REFERENCES Beauchamp, T.L. and Childress, J. F. 2001. Principles of biomedical ethics. London: Oxford University Press Cottenden A, Bliss D, Foder M,. 2005. Management with continence products. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. 3rd International Consultation on Continence. International Continence Society. 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