Factors associated with the knowledge of patients and caregivers about clean intermittent urethral catheterization: an integrative review

Benício, Claudia Daniella Avelino Vasconcelos; Rocha, Daniel de Macêdo; Dourado, Giovanna Oliveira Libório; Bezerra, Sandra Marina Gonçalves; Andrade, Elaine Maria Leite Rangel; Nogueira, Lídya Tolstenko

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Sumário

Review Article • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017033703362 copy

Factors associated with the knowledge of patients and caregivers about clean intermittent urethral catheterization: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify the factors associated with the knowledge of patients and caregivers about Clean Intermittent Urethral Catheterization in the literature which hinder or facilitate the procedure.

Method

An integrative review of the literature conducted in the MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS and LILACS databases.

Results

13 primary studies were included in the sample after the peer review. A synthesis of knowledge was performed in two categories: Factors associated with the knowledge of patients and caregivers which hinder the procedure and Factors associated with the knowledge of patients and caregivers which facilitate the procedure. Factors that hinder and facilitate the procedure respectively related to the need of information and negative feelings, use of easy-to-understand language, and application of information leaflets, among others.

Conclusion

There is a shortage of published articles on the subject, and those which were identified had a low level of evidence, therefore requiring greater commitment and effort on the part of health professionals and researchers to use more robust designs.

Intermittent Urethral Catheterization; Patients; Caregivers; Nursing Care; Health Knowledge, Attitudes, Practice; Review

		Controlled descriptors	Uncontrolled descriptors
MESH DECS	P	Patients; Outpatients; Homebound Persons; Caregivers.	Client; Clients; Person, Homebound; Shutln.
	I	Knowledge; Health Knowledge, Attitudes, Practice.	Health Knowledge.
	Co	Urinary Catheters; Catheterization; Intermittent Urethral Catheterization; Urinary Catheterization.	Self-catheterization; Self-catheterism; Intermittent Clean Catheterization; Clean Intermittent Self-catheterization.
List CINAHL	P	Patients; Nursing Home Patients; Outpatients; Ambulatory Care Facilities; Caregivers; Caregiver Support; Caregiver Burden.	Patients; Caregivers; Caregiver Support; Caregiver Burden.
	I	Catheters, Urinary; Suprapubic Catheters; Catheter Care, Suprapubic; Urinary Catheterization, Intermittent; Urinary Catheterization.	Catheters, Urinary; Urinary Catheterization, Intermittent; Urinary Catheters.
	Co	Knowledge; Health Knowledge.	Knowledge; Health Knowledge; Attitudes, Practice.

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Claudia Daniella Avelino Vasconcelos Benício. Universidade Federal do Piauí, Campus Ministro Petrônio Portela, Bairro Ininga. CEP 64049-550 – Teresina, PI, Brazil. cdavb2010@hotmail.com

Search strategy
P	(((((((((“Intermittent Urethral Catheterization”[Mesh]) OR Intermittent Urethral Catheterization [Text Word]) OR Self-catheterization [ Text Word]) OR Self-catheterism [ Text Word]) OR Intermittent Clean Catheterization [Text Word]) OR Clean Intermittent Self-catheterization[ Text Word])
I	((((((((((“Patients”[Mesh]) OR Patients[Text Word]) OR “Outpatients”[Mesh]) OR Outpatients[Text Word]) OR “Homebound Persons”[Mesh]) OR Homebound Persons[Text Word]) OR Client[Text Word]) OR Clients[Text Word]) OR Person, Homebound[Text Word]) OR Shutln [ Text Word])
Co	(((((“Knowledge” [Mesh]) OR Knowledge[Text Word]) OR “Health Knowledge, Attitudes, Practice”[Mesh]) OR Health Knowledge, Attitudes, Practice[Text Word]) OR Health Knowledge[Text Word])
P AND I AND Co
(((((((((“Intermittent Urethral Catheterization”[Mesh]) OR Intermittent Urethral Catheterization [Text Word]) OR Self-catheterization [ Text Word]) OR Self-catheterism [ Text Word]) OR Intermittent Clean Catheterization [Text Word]) OR Clean Intermittent Self-catheterization[ Text Word])) AND ((((((((((“Patients”[Mesh]) OR Patients[Text Word]) OR “Outpatients”[Mesh]) OR Outpatients[Text Word]) OR “Homebound Persons”[Mesh]) OR Homebound Persons[Text Word]) OR Client[Text Word]) OR Clients[Text Word]) OR Person, Homebound[Text Word]) OR Shutln [ Text Word])) AND (((((“Knowledge” [Mesh]) OR Knowledge[Text Word]) OR “Health Knowledge, Attitudes, Practice”[Mesh]) OR Health Knowledge, Attitudes, Practice[Text Word]) OR Health Knowledge[Text Word]))

Category 1: Factors associated with patients’ and caregivers’ knowledge about CIUC which hinder the procedure.
Main author, journal and year	Design / Sample	Type of screening	Factors	LE
Carpenter JS⁽²⁴24. Carpenter JS, Heit M, Rand KL. Development and psychometric properties of a measure of catheter burden with bladder drainage after pelvic reconstructive surgery. Neurourol Urodyn. 2016;36(4):1140-6. DOI: 10.1002/nau.23077⁾, Neurourol. Urodynam. Wiley Periodicals, 2016.	Cross-sectional study/ 178 women with transurethral (108) and suprapubic (70) catheters.	To evaluate the quality of life by the instrument (HRQL) after pelvic reconstructive surgery for bladder drainage.	Embarrassment.	IV
Holland JE⁽²¹21. Holland JE, DeMaso DR, Rosoklija I, Johnson KL, Manning D, Bellows AL, et al. Self-cathing experience journal: Enhancing the patient and family experience in clean intermittent catheterization. J Pediatr Urol. 2015;11(4):187.e1-6. DOI: http://dx.doi.org/10.1016/j.jpurol.2015.03.011 http://dx.doi.org/10.1016/j.jpurol.2015.... ⁾, J Pediatr Urol, 2015.	Transectional study/ Patients and elderly caregivers (25 families).	Applying and evaluating the safety and efficacy of the Self-Cathing Experience Journal.	Potential increase in resilience among those who practice CIC (clean intermittent catheterization) – patients and caregivers.	IV
Ramm D⁽¹⁶16. Ramm D, Kane D. A qualitative study exploring emotional responses female patients learning to perform clean intermittent self-catheterisation. J Clin Nurs. 2011;20(21-22):3152-62. DOI: 10.1111/j.1365-2702.2011.03779.x⁾, Journal of Clinical Nursing, 2011.	Qualitative with phenomenological approach / Women between the ages of 34 and 64 who perform CIUC.	Semi-structured interviews with a convenience sample. The interviews were recorded and transcribed in full. The data were analyzed using the Framework method.	Pain, feeling of loss, lack of knowledge regarding female anatomy, bladder and catheter dysfunction, negative stigma, psychological aversion, embarrassment and coping mechanisms.	IV
Girotti ME⁽¹⁷17. Girotti ME, MacCornick S, Perissé H, Batezini NS, Almeida FG. Determining the variables associated to clean intermittent self-catheterization adherence rate: one-year follow-up study. Int Braz J Urol [Internet]. 2011 [cited 2017 June 26];37(6):766-72. Available from: http://www.brazjurol.com.br/november_december_2011/Girotti_766_772.htm http://www.brazjurol.com.br/november_dec... ⁾, Int Braz J Urol 2011.	Quantitative prospective study/ 60 patients referred to the CISC training program (Clean Intermittent Self Catheterization).	Urodynamic questionnaire, 3-day bladder journal and the WHOQoL-bref. questionnaire	Fear, insecurity and inability to perform the self-catheterization.	IV
Van Achterberg T⁽²⁵25. Van Achterberg T, Holleman G, Cobussen-Boekhorst H, Arts R, Heesakkers J. Adherence to clean intermittent self-catheterization procedures: determinants explored. J Clin Nurs. 2008;17(3):394-402. DOI: 10.1111/j.1365-2702.2006.01893.x⁾, J Clin Nurs, 2008.	Comparative qualitative study / 30 patients.	Identify determinants for patient adherence resulting from pre-structured interviews / content analysis.	Complexity of the procedure, misunderstandings, fears, shame, motivation, quality and continuity of professional care.	IV
McConville A⁽¹⁹19. McConville A. Patients’ experiences of clean intermittent catheterisation. Nurs Times. 2002;98(4):55-6.⁾, Nursing Times Journal Article pictorial research, 2002.	Cross-sectional study / 46 patients, in which the majority (46%) were between 40 and 60 years of age.	Evaluation of the patient’s attitudes through a semi-structured questionnaire with open and closed questions.	Stress and concern when they learn and perform the procedure by themselves.	IV
Category 2: Factors associated with the knowledge of patients and caregivers about CIUC which facilitate the procedure
McConville A⁽¹⁹19. McConville A. Patients’ experiences of clean intermittent catheterisation. Nurs Times. 2002;98(4):55-6.⁾, Nursing Times Journal Article pictorial research, 2002.	Cross-sectional study / 46 patients, in which the majority (46%) were between 40 and 60 years of age.	Evaluation of the patient’s attitudes through a semi-structured questionnaire with open and closed questions.	Guidance on the CIUC using easy-to-understand language, such as leaflets; time they were given for the practical instruction of the procedure and assurance that they could not harm themselves in their practice process.	IV
Chiappe SG⁽²²22. Chiappe SG, Lasserre A, Chartier Kastler E, Falchi A, Blaizeau F, Blanchon T, et al. Use of clean intermittent self-catheterization in France: a survey of patient and GP perspectives. Neurourol Urodyn. 2016;35(4):528-34. DOI: 10.1002/nau.22752⁾, Neurourology Urodynamics, 2015.	Cross-sectional study / 119 French patients.	Questionnaire on the quality of life applied to patients.	Patients’ knowledge about the possibility of CIUC having a positive meaning in the French general clinical practice.	IV
Campos CVS⁽²⁸28. Campos CVS, Silva KL. Cateterismo vesical intermitente realizado pelos cuidadores domiciliares em um serviço de atenção domiciliar. Rev Min Enferm [Internet]. 2013 [citado 2017 jun. 26];17(4):763-70. Disponível em: http://www.reme.org.br/artigo/detalhes/885 http://www.reme.org.br/artigo/detalhes/8... ⁾, REME (Re-vista Mineira de Enfermagem), 2013.	Exploratory descriptive study / six caregivers of users enrolled in the Home Care Service.	The data were obtained through interviews and observation of the catheterization technique during home monitoring of service users.	Hand and urinary meatus hygiene, use of gloves and lubricants, catheter storage and reutilization.	IV
Lopes MAL⁽¹⁸18. Lopes MAL, Lima EDRP. Continuous use of intermittent bladder catheterization - can social support contribute? Rev Latino Am Enfermagem [Internet]. 2014 [cited 2017 June 26];22(3):461-6. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00461 http://www.scielo.br/pdf/rlae/v22n3/0104... ⁾, Revista Latino Americana de Enfermagem, 2014.	Cross-sectional study / 49 patients with spinal cord injury.	Evaluate the continuity of performing CIUC through interview after hospital discharge and its correlation with social support.	Sufficient physical independence to perform the catheterization and proper technique for performing CIUC.	IV
Kessler TM⁽²⁶26. Kessler TM, Ryu G, Burkhard FC. Clean intermittent self-catheterization: a burden for the patient? Neurourol Urodyn. 2009;28(1):18-21. DOI: 10.1002/nau.20610⁾, Neurourol Urodyn, 2009.	Cross-sectional study / 101 patients.	Questionnaire on the quality of life prepared by the researchers based on the Medical Outcomes Study Short Form 12.	Ease of execution and absence of pain in performing the procedure.	IV
Jeon HG⁽²⁷27. Jeon HG, Son H. The effects of centralized intensive education system compared with an individualized ward education system on the acquisition of clean intermittent catheterization in patients with voiding dysfunction. Korean J Urol. 2004;45(2):114-9.⁾, Korean Journal of Urology, 2004.	Prospective randomized study / 122 patients.	After instruction in performing the CIUC, the patients were asked to complete a self-administered questionnaire on the instruction about the procedure.	Understanding the need for CIUC, the cause of its voiding dysfunction, use of CIUC-related images and materials, sufficient guidance on CIUC doubts, overall satisfaction with the education and confidence to perform CIUC after training.	II
Moroóka M⁽²⁰20. Moroóka M, Faro ACM. A técnica limpa do autocateterismo vesical intermitente: descrição do procedimento realizado pelos pacientes com lesão medular. Rev Esc Enferm USP [Internet]. 2002 [citado 2017 jun. 26];36(4):324-31. Disponível em: http://www.scielo.br/pdf/reeusp/v36n4/v36n4a04.pdf http://www.scielo.br/pdf/reeusp/v36n4/v3... ⁾, Rev Esc Enferm USP, 2002.	Qualitative interventional study / 22 patients with traumatic spinal cord injury.	Interview in which the patients described the sequence of the technique and the materials used to carry out the CIUC.	Following criteria for adequately performing the intermittent urethral self-catheterism at home, confirming the assimilation of the received guidelines and the way in which the spinal cord patients structured their procedure.	IV
Azevedo MAJ⁽²³23. Azevedo MAJ, Santa María MLS, Soler LMA. Promovendo o auto-cuidado: treinamento e assistência de enfermagem a pacientes portadores de bexiga neurogênica. Rev Bras Enferm [Internet]. 1990 [citado 2017 jun. 26];43(1-4):52-57. Disponível em: http://www.scielo.br/pdf/reben/v43n1-2-3-4/v43n1-2-3-4a08.pdf http://www.scielo.br/pdf/reben/v43n1-2-3... ⁾, Rev. Bras. Enf., 1990.	Qualitative interventional study / 29 patients.	Urethra re-education of the patients by the nurse after evaluation by the urologist through physical examination, laboratory tests, imaging and urodynamic study.	Evidence of applying the correct technique for self-catheterization and consequent decrease of urinary infections and contaminations.	IV