Graduation Date

Spring 5-9-2020

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Paula S. Schulz

Second Advisor

Lani Zimmerman

Third Advisor

Mary H. Wilde

Fourth Advisor

Kevin A. Kupzyk

Abstract

Many individuals with adult neurogenic lower urinary tract disorder require long-term urinary catheterization for bladder management. The daily use of urinary catheterization increases the risk for chronic complications including catheter associated urinary tract infections. Previous studies have used self-management interventions to reduce chronic complications in the community setting. However, there are limited intervention studies focused on reducing chronic complications after discharge from a rehabilitation hospital. The purpose of this dissertation study is to examine the feasibility and impact of a self-management intervention on individuals after leaving rehabilitation hospital for home within the community.

This dissertation comprises two studies, the first examined the feasibility of using a three day self-monitoring intervention in a rehabilitation hospital. This study looked at the use of a urinary diary and catheter journal to promote self-monitoring. Participants were asked to use two formats (paper and online) for three consecutive days. Evaluation was done to determine feasibility of enrollment, data collection, and acceptability of the intervention. We found that it was feasible to enroll patients in this setting, and the paper format was the preferred method for documenting information on the urinary diary and catheter journal. Participants also identified increased awareness related to fluid intake and urine output from using the self-monitoring intervention.

The second study was completed over twelve weeks and examined the impact of an intervention on urinary catheter quality of life and urinary catheter self-management. The study v also examined self-management intervention components including knowledge, self-monitoring, self-efficacy, and patient activation by groups (intervention and standard care) at baseline and twelve weeks. The intervention study found small changes in measurements from baseline to 12 weeks. There were no statistical differences between intervention and control groups on any outcomes.

The final manuscript in the dissertation describes use of healthcare resources and catheter related problems for all participants who completed the twelve-week study. Overall, 58% of the participants self-reported having a urinary tract infection and had unplanned physician visits within the 12 weeks after discharge. Indwelling catheter users also had a higher rate of self reported urinary tract infections and use of healthcare resources compared to clean intermittent catheter users.

The findings of this study begin to address the gap to identify self-management strategies for better long-term bladder management in individuals living with adult neurogenic lower urinary tract disorders. Future research is needed to develop and test self-management strategies to enhance individual bladder self-management and prevent chronic complications. Nurses have an essential role in helping individuals develop individualized strategies that can be implemented into their daily routine contributing to a conceivable decrease in CAUTI and other urinary complications.

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