This article summarises a publication by Karen Logan, Nurse Consultant at The Grange University Hospital in UK. It highlights key challenges faced by men using IC and explores strategies on how to overcome them. The findings are also relevant to women using IC.
Historically, indwelling and suprapubic catheters were the primary methods for managing voiding dysfunction, but these methods were linked to recurrent urinary tract infections (UTIs), urosepsis, bladder stones, and distal urethral damage in men.
IC has many positive aspects
Intermittent catheterisation (IC) is considered the gold standard in bladder management because it is associated with less complications and because it also allows for more independence. K.Logan's literature review highlights that IC not only alleviates the discomfort of a full bladder but also reduces UTI rates. Users report feeling empowered and more in control of their bladder, enabling participation in physical activities and enhancing their overall sense of independence. Men with prior experience using indwelling catheters expressed a preference for IC, citing a reduced sense of disability.
The stigma associated with IC, given its intimate nature, can be mitigated by nurses with excellent communication skills, facilitating better information exchange and outcomes. In addition, comprehensive instruction from experienced nurses enhances therapy adherence and long-term bladder health.
How IC impacts users' quality of life
Quality of life (QoL) has become an important indicator of the success or failure of a particular treatment. The insight that IC may be the only way forward for an extended period of time, or even a lifetime, can be frightening and can impact QoL.
As users begin to use IC, it will initially influence their social life, sexuality and intimacy as well as work and family life.
The initial learning and adjustment phase is particularly challenging, both physically and psychologically, affecting QoL negatively during this period. However, over time, IC demonstrates superiority over indwelling catheters, providing freedom from urine bags, fixation straps, and clothing restrictions.
IC is not devoid of challenges
IC is not devoid of challenges. Common factors identified as having a negative effect on quality of life (QoL) include lifestyle, as well as the frequency and duration of performing IC. Moreover, the process is further complicated if the individual experiences difficulties with catheterisation or has other coexisting medical conditions. Notably, it was observed that men tend to be less receptive and more intimidated by the catheter compared to women.
The author also found that adherence to IC is linked to strategies of proactive acceptance rather than denial and avoidance. While some men adapted to IC more readily than others, acceptance levels varied, influenced by personality traits or innate tendencies. The adjustment period can range from days to several years, encompassing both psychological and technical aspects.
Overcoming barriers to IC
The barriers to learning and initiating IC, including fear, embarrassment, privacy concerns, environmental challenges (such as difficulties in public restrooms), limited manual dexterity, and catheter insertion issues, are well-documented. These barriers often coincide with adherence problems, particularly environmental ones. Difficulty finding appropriate public facilities for IC contributes to significant stress and avoidance behaviours among many men.
To prevent UTIs and other complications, regular and consistent IC, as per guidelines, is crucial. Yet, a previous study indicated only 76% of users adhere to the recommended practices.
Barriers to adherence are linked; men facing insertion or removal difficulties often endure pain and occasional bleeding. Physical issues, like spasms during catheter removal, impede adherence. Thus, the catheter's ease of use is vital for pain-free catheterisation, influencing both the visual appeal of the catheter and men's acceptance and regular performance of IC.
Role of nursing knowledge in IC
Developing a follow-up plan after the teaching session is considered best practice and essential to prevent lapses in the treatment program. However, this is dependent on access to, and time spent in the clinic with the nurse. The limitations in staffing and diminishing resources imposed by cost efficiencies can compromise the time allocated for teaching and reviewing IC. Innovative approaches and individualised follow-up plans are needed to ensure continuous support.
Many users report follow-up care as insufficient. Studies showed for instance that people were unsure if they could contact health professionals after the teaching appointment when experiencing problems or needing advice.
A follow-up plan is not only important to support and aid adherence but also because circumstances, lifestyle, physical and cognitive abilities change over time, due to disease progression and ageing. IC users often have active and social lives during a long period of time, also at an older age and nurses need an understanding of the entire IC experience throughout life.
Previous studies suggested that follow-up care needs to be improved to re-evaluate the catheterisation technique and to help integrate IC into daily activities. Specialist education for both nurses and IC users could help overcome barriers and improve long-term bladder health.
This training may be delivered in- house by nurses or specialists who are already highly skilled and experienced and/or by manufacturers who make and sell catheters.
Access to useful and practical teaching aids and service user information literature is important. Such material should be available in a range of online and paper formats. EAUN (Vahr et al, 2024) states that best practice involves the use of a wide range of visual and written aids as useful adjuncts to the verbal and practical teaching session.
"Refresher sessions and ongoing education will be necessary for nurses to maintain competence in running clinics for teaching and follow up of IC to result in a good experience and outcome for IC users".
Conclusion
Men learning and living with IC encounter numerous challenges and barriers. Proper follow-up care is vital for incorporating IC into daily routines and ensuring long-term adherence. Providing nurses with access to specialised training and education is crucial for them to acquire and retain the expertise needed in catheter selection and the skills necessary not only for instructing IC but also for facilitating its adoption into day-to-day life.