EXPERIENCES OF PATIENTS LIVING WITH INDWELLING URETHRAL CATHETER IN AJUMAKO ENYAN ESSIAM DISTRICT OF THE CENTRAL REGION OF GHANA

ABSTRACT
This study described the lived experiences of patients living with indwelling urethral catheter in Ajumako Enyan Essiam District of the Central Region of Ghana. The specific objectives were: to explore patients’ experiences related to living with indwelling urethral catheter on patients’ lives; explore the challenges faced by patients who use indwelling urethral catheter; investigate coping strategies utilized by patient’s living with indwelling urethral catheter. A qualitative, phenomenological design was used for the study. Purposive sampling technique was utilized in selecting the participants for the study. Data were collected using semi-structured face to face interviews of ten (10) patients at the emergency unit and at patient’s homes. The interviews were tape recorded with permission from the participants, transcribed verbatim, and analyzed following Colaizzi’s (1978) strategy of descriptive phenomenological data analysis. The analysis revealed both positive and negative experiences which were categorized into Six (6) themes namely: physical impact; psychological impact; social impact; financial impact; coping strategies; information seeking behaviours. Based on findings from this study the researcher is of the view that, nurses should make it a point to counsel patients’ properly, most especially on sexual and emotional needs and also should always make available all needed information (written or verbal) about the catheter to patients as this will help alleviate patients’ frustration and also enable patients to cope with the indwelling urethral catheter.


CHAPTER ONE
INTRODUCTION
Background to the Study
The Urinary catheter as a medical device dates back to 3000 BC (Abdel-Halim, 1990). However, the first balloon-inflated device was used in the 1920s, while the closed drainage system type mainly used these days was developed in the 1950s (Dailly, 2011). The catheter is a slender hollow, flexible tube, made in varying lengths, bores and shapes, and manufactured from either latex or silicone (Lewis, Heitkemper, & Dirksen, 1996; Madigan, 2003).

Urinary catheterization comes in two folds, the intermittent and indwelling catheterization (Dougherty & Lister, 2008). Indwelling catheters are subdivided into two types, Suprapubic and urethral catheterization (European Association of Urology Nurses (EAUN), 2005).

The Indwelling urethral catheter which is the focus of this study has a plethora of functions; as stent, as drainage tube and for diagnostic purposes in the operating room (Rothrock 2003; Smeltzer, Bare, Hinkle, & Cheever, 2010). Though both catheters (intermittent and indwelling) are used to drain the bladder, indwelling catheters are mainly for used in patients with diseases like benign prostate hyperplasia (B.P.H), injury to the spinal cord, urethral strictures, multiple sclerosis, acute or chronic urinary retention, neurogenic bladder dysfunction, and the delivery of medication directly into the bladder (Smeltzer et al., 2010; Turner & Dickens, 2011).

The insertion of the catheter is a sterile procedure and is carried out by either Registered Nurses, Advanced Nurse Practitioners or Doctors. This is done to ensure infections are not introduced into the urinary bladder (Crow, Munhall & Chapman, 1998; Turner et al., 2011; White, Brinson & Glentworth, 2013).

Prinjah and Chapple (2013) reported that about 450,000 people are living with indwelling urinary catheter in the UK and are facing varied challenges. Dellimore, Helyer and Franklin (2013) also posit that over 4 million patients undergo urinary catheterization in the United States and more than 30 million urinary catheters are inserted annually. Documented statistics concerning Africa is however unknown.

Although the use of the indwelling urinary catheter has many physiological and social functions, living with the catheter presents numerous challenges that must be addressed on daily bases. Some of the challenges include: physical problems; such as recurrent urinary tract infections, blockages and leakages and also impaired body image and sexuality (Stickler & Feneley, 2010; Waugh, 2010;Wilde, McDonald, Brasch, McMahon, & Fairbanks, 2013).

Urinary Tract Infection (UTI) is the most frequent of the challenges linked to the urinary catheter (Souza Neto, Oliveira, Kobaz, Silva, Lima, & Maciel, 2008), hence strategies to prevent catheter associated urinary tract infection (CA-UTI) have been emphasized in many countries and hospitals. The current guideline for prevention of CA-UTI recommends the need to minimize duration for catheterization and maintain sterile technique for insertion and keep closed drainage system (Gould, Umscheid, Agarwal, Kuntz, Pegues, & Healthcare Infection Control Practices Advisory Committee (HICPAC, 2010).

Accordingly, each physician should insert catheters only for appropriate indications and leave in place only as long as needed (Lo, Nicolle, Coffin, Gould, Maragakis, Meddings &Yokoe, 2014).

These challenges linked to the indwelling urethral catheters (IUC) are associated with considerable morbidity, prolonged hospitalization, and increased health care expenditure (Talaat, Hafez, Saied, Elfeky, El-Shoubary and Pimentel (2010).

Undocumented observation by the researcher among patients living with indwelling urethral catheters suggest that patients on indwelling catheters always agitate for the removal of the catheter though the disease condition necessitating the use of the catheter persists. Considering everyday problems, they go through as a result of the disability, the researcher was intrigued to investigate further the experiences of persons living with indwelling urethral catheters.

Statement of the Problem
Several studies have been conducted on the experiences of people living with indwelling urinary catheter but most of these researches are either from the UK, (Dailly, 2011; Prinjha & Chapple, 2013; Turner, 2011) or USA (Wilde, 2002; Wilde et al. 2013). Although there is literature on indwelling catheterization in Africa and Ghana, most of the literature concentrated on catheter related Urinary Tract Infections (Adjei & Opoku, 2004; Dougnon et al. 2016; Taiwo, & Aderounmu, 2006), the prevalent bacterium in urinary tract infections (Gyasi-Sarpong, Yenli, Idriss, Arhin, Aboah, Azorliade, Boaitey, & Annan, 2012). Quality of life and prevalence of depressive symptoms among patients on prolonged indwelling urinary catheters (Abiola, et al. 2016) while others focused on the reasons for the prolonged use of indwelling urethral catheters in men (Bello et al., 2013).

However, limited studies focused on patient’s experiences regarding the use of indwelling urinary catheter in particular, and the psychosocial impact of the catheter. Akum (2005) carried out a similar study, her study was limited to the experiences of individuals with Spinal Cord Injury (SCI) who used an indwelling catheter to manage neurogenic bladder dysfunction.

This study however seeks to look at experiences of persons with varied medical conditions such as benign prostate hyperplasia (BPH), urethral strictures, multiple sclerosis, acute or chronic urinary retention, bladder cancer and neurogenic bladder dysfunction using indwelling urethral catheters.

Secondly, WHO (1948) defined Health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Per this definition, patient care should be holistic encompassing the physical, the mental and the social aspect of man but this is usually not the case in the various health facilities in the country. It is for this reason, persons living with IUC were given the opportunity to tell their stories on how they experience living with an indwelling urethral catheter. It is hoped that this study will identify their needs and concerns because personal stories can help health care workers to identify appropriate interventions for the individual patient to improve quality of life. Patients’ experiences from this study will be categorized into psychological, social and physical experiences.

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Item Type: Ghanaian Postgraduate Material  |  Attribute: 112 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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