Clean Intermittent Self-Catheterisation and the Quality of Life - Assignment Example

Topic: A Critical Analysis on “The Effects of Clean Intermittent Self-Catheterisation on the Quality of Life” Introduction Catheterisation Technique Described Catheterisation technique is the use of intermittent catheterisation, sometimes called IC, in which a thin tube, called catheter is put into the urethra of a male or female who needs to empty his or her bladder. It is done because some people have bladders that cannot hold all of their urine and some are not able to empty their bladders completely. Intermittent catheterisation is done to keep the person from infection and to keep his bladder and kidneys healthy. (Skelly, et.al.2005) Clean intermittent self-catheterisation is a recommended treatment for people suffering urinary voiding difficulties. This paper is a study to describe the experience of people facilitating clean intermittent self-catheterization and its impact on their quality of life. (Shaw, et.al. 2008) The topic is suited for middle to older aged people who suffer from certain illnesses that affect their urinary difficulties and explains further how to cope with the remedy or alleviate their cases and avoids a permanent clean intermittent self-catheterisation (CISC). However, the research included male participants in the two oldest age group and evenly distributed age for the females. The younger males which may be found in the spinal injured group were not included in the study. A qualitative approach was used based on grounded theory. The grounded theory approach incorporates explicit procedures which are evident in that the processes of asking questions and making comparisons are specifically detailed to inform and guide analysis and to facilitate theorizing process. For example, research questions are conducted openly to be able to arrive at a theory that are relevant to the participants rather than form specific hypotheses. (Davidson, 2002) Evaluation The research has been conducted through a qualitative approach that is, using the grounded theory. The Grounded theory was developed by Barney Glaser and Anselm Strauss, both American Sociologists in the late 1960’s. (Gillham 2000). In terms of the relationship between research question and research method, grounded theory starts from a very vague initial question and allows the theory to emerge from the data. So this approach is not about identifying and testing hypotheses. Another issue with the use of grounded theory is that since the theory emerges from the data the nature of the questions asked will determine the answers and therefore the content of the theory developed. Glaser and Strauss (1967) call grounded theory as discovering theory from data. It is argued that much of current research is primarily the verification of theory or the development of theory through logical deduction rather than from the experimental data itself. The roles of the theory are to enable prediction and explanation behaviour, to be usable in practical applications and to guide research on behaviour. Comparative Analysis To build a theory, comparative analysis of different groups or subgroups of people is compared. The theory is then tested and refined by considering it with other comparison groups. Looking at the data the researcher begins to ascertain patterns in the data/behaviour which can lead to general concepts about it. These concepts can then be formed into wider theoretical propositions which can then be evaluated and tested. To enable to generate a theory from the respondents, groups of participants were selected. Although participants were not specifically identified, the first group belonged to the male of oldest age. The next group are females of evenly distributed age. Evidently, the respondents were more of the older age brackets who were highly recommended to take CISC and whose potential to improve their well-being is high. But a proposition was made that younger males should be included in the respondents as this age group has been found in the spinal injured group. Thus, this limits the possibilities and narrows the range of potential theory generation. The research was initially conducted with interviews from people who had actual experience in CISC, basically nurses two of whom were continence nurses. The study displayed limitations too as it used only a small sample. Participants incorporated daily routine. This research method can also be classified as cohort survey which would sample the same class or population every time. Duration of about two years was expected to run in this process. The respondents need time to learn to carry out the procedure of CISC and the sudden impact it will have on their quality of life as having to administer and accept CISC is entirely strange to them. According to Glaser, Barney, and Strauss, the constant comparing of many groups draws the researcher’s attention to their many similarities and differences. Generating hypotheses from the data requires only enough data to suggest the hypothesis, not prove it. During the research the emergent categories will begin to form patterns and interrelations which will ultimately form the core of the emerging theory (p. 40). Theoretical Sampling Researchers often indicate that they use theoretical sampling to choose new participants, to modify interview guides, or to add data sources as a study progresses, but few describe how theoretical sampling is implemented in response to emergent findings. (Draucker 2007) Theoretical sampling is not statistical sampling -- it may only require a few groups to exhaust one category, and many groups to exhaust another. Among the male respondents who carry out CISC, more of them view the procedure for urethral structure rather than to alleviate symptoms. Some participants in a group of women, they refuse group discussion to maintain privacy. Further, older women, difficulties are a result of worries to each of them since they are sensitive to the issues concerning cultural taboos. Building grounded theory requires an interactive process of data collection, coding, analysis, and planning what to study next. The researchers need to be theoretically sensitive as they are collecting and coding data to sense where the data is leading them and what to do next. As this interactive process continues, the researcher may explore the same group more deeply or in different ways, or may seek out new groups. Comparison groups should be selected based on their theoretical relevance to further the development of emerging categories. The credibility of the research can be improved by using multiple comparisons. Noticeably in the sampling, the age and sexual relationships were not addressed in detail though this may have some potential effects on response to CISC such as indirect relationships via lifestyle, level of activity and employment. The topic can be broadening as it concerns more issues that will affect the research study. The two participants who neither experienced great difficulties in carrying our CISC at work was not shown or explained in detail. This could have been included in the positive impact on the quality of life. It could broaden the research discussion while this serves as an evidence of the effects of CISC. Discussion Since the aim of CISC is to improve and stabilise symptoms, users should be encouraged to face it more positively. The positive impacts of results and findings were related to the improvement of the symptom and the avoidance of permanent self-catheterisation. Fairly enough, the participants adapted over a period of time to gradually normalise and incorporate CISC into their daily routine. The negative impacts arose from encountered difficulties including the cultural and psychological problems. Technical difficulties were also a major factor on the negative impact like overcoming the hassles of carrying it out at work, lack of knowledge in employing the techniques and resistance of certain groups because of psychological and cultural reasons. Other factors influencing variations in quality of life impacts were sex, lifestyle, frequency and duration of carrying out self-catheterisation, technical difficulties, type of  catheter, co-morbidities (two or more co-existing medical conditions or disease processes that are additional to an initial diagnosis) and individual predispositions. The mission of this research is to develop techniques that specifically addresses to the needs of men and women to demonstrate a clean technique for intermittent self-catheterisation thereby improving the quality of life. This also provides a teaching aid for health professionals. The findings can also be applied to different health care settings as it serves a channel for ensuring a patient-centred care. Health care professionals like nurses who are encountering or dealing with patients with similar conditions may benefit from this research in ways like: a) implementing therapies, b) teaching the patients the techniques, c) help those who find CISC difficult to adapt, and d) their knowledge in this field will help the patients or respondents in a research design gain security, understanding and confidence in applying CISC. Conclusion The outcome of this paper brings about good results even though it may have to deal with small issues that were not brought up profoundly. It helps health practitioners to deal with proper approach with people using CISC and to better enhance their quality of life by helping them have a positive outlook and result on CISC over a period of time. Instead of considering CISC as a debilitating experience, health professionals especially nurses are responsible to mould the acceptance level of the different respondents in the study. Help the patients gain understanding of every procedure and the nature of their condition rather than deal CISC a hindrance to a better life. Self-catheterisation is performed by many patients who have some form of impaired or absent bladder function. The two major advantages of self-catheterisation are that patient independence is maintained and bladder control is regained. It also allows normal sexual intimacy without the fear of incontinence. It reduces the use of aids and allows the patient to return to work. Sources: Draucker, Claire B. Theoretical Sampling and Category Development in Grounded Theory, Qualitative Health Research. 10 July 2009. [http://qhr.sagepub.com/cgi/content/abstract/17/8/1137] Effect of clean intermittent self-catheterization on quality of life: a qualitative study. Journal of Advanced Nursing, Volume 61, Number 6, Blackwell Publishing, 2008. Glaser, Barney G & Strauss, Anselm L. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, Aldine Publishing Company, 1967. Lippincot Williams & Wilkins. Nursing; perfecting clinical procedures. scitech Book News, 2007. Pilloni S, Krhut J, Mair D, Madersbacher H, Kessler TM. Intermittent catheterisation in older people: a valuable alternative to an indwelling catheter? Age and ageing. 2005. Read More