Perceived usefulness of the nurse-patient therapeutic relationship in the rehabilitation journey of people with urinary incontinence: A mixed-method study.

INTRODUCTION: Despite various studies on the impact of incontinence on patients' lives, the existing literature has not investigated the contribution of nursing care during rehabilitation in terms of quality of life. Fewer data, therefore, exist on the characteristics and perceived impact of the therapeutic relationship as part of the rehabilitation program. AIMS: To investigate the characteristics of the nurse-patient therapeutic relationship and its impact throughout the rehabilitation program; to describe the levels of patient burden on everyday activities. MATERIALS AND METHODS: A monocentric, retrospective, multimethod descriptive study was conducted in the nurse-led continence clinic of a major teaching hospital in Northern Italy. A phenomenological approach with semistructured interviews was adopted after 6 weeks of rehabilitation, following the method of phenomenological enquiry by Giorgi. The short form 12 questionnaire was administered upon admission of patients to the clinic, after 6 weeks, and during the last consultation to investigate the impact of urinary incontinence (UI) on daily activities and physical and psychological quality of life. RESULTS: Ninety-one adult patients of both genders presenting for nonneurogenic nonpostpartum UI were consecutively enrolled. Physical scores (PCS-12) and MCS-12 scores significantly increased over time. Psychological scores showed great variability upon admission, which was reduced halfway through the rehabilitation program. The thematic analysis highlighted four categories based on data saturation: the impact of UI on daily activities, strategies to face the problem, feelings, and the role of nurses. CONCLUSIONS: This mixed-method investigation suggests the importance of therapeutic nursing relationships, clinical expertise, and rehabilitative skills. Quality of life is arguably related to the positive results of the rehabilitation program but also to the environment, patients perceive in terms of support, honesty, and trust.

Living with and without an intestinal stoma: Factors that promote psychological well-being and self-care: A cross-sectional study.

AIMS: This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self-care in stoma patients in the future. DESIGN: A cross-sectional and comparative study design was employed. METHODS: Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well-being. RESULTS: Of 278 participants aged 18-68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one-fifth experienced problems with stoma management. Psychological well-being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly).

Patient preferences and willingness to pay for innovations in intermittent self-catheters.

BACKGROUND: Intermittent catheterization is the gold standard for bladder management in Europe in people with spinal cord injuries. The aim of the present study was to identify and investigate individuals' preferences regarding intermittent self-catheterization (ISC) devices and furthermore investigate the willingness to pay for attributes in ISC devices in the UK, France, and the Netherlands. METHODS: A discrete choice experiment survey was conducted to evaluate the patients' perceived value of catheter features. Attributes were selected based upon a literature review of the most important characteristics of catheters and the survey was developed and validated with input from patients and medical experts. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log) odds ratios of preference for attributes. Willingness to pay was estimated for all levels of the attributes. RESULTS: Two-hundred and eighty-three participants completed the questionnaire and were included in data analysis. Risk of infection had the highest odds ratios as preferred important attribute for all three countries followed by ease of insertion. "Pre-coated catheters" was found to be valued as the most preferred coating technology across all countries. Out of pocket cost was a significant influence on patients' choice. CONCLUSION: Users of ISC perceive the value of convenience (size of catheter), ease of insertion, and reduced risk of infection as the most important features attached to an intermittent catheter. These results are applicable both for the "classic" ISC user as well as for another broad group of catheter dependent individuals.

Development and psychometric validation of the intermittent self-catheterization questionnaire.

BACKGROUND: Intermittent catheterization, often performed by the users themselves and known as intermittent self-catheterization (ISC), has become the gold standard treatment for people with chronic urinary retention. To date, there are no validated patient-reported outcome measures for individuals who rely on ISC that focus on ISC-related quality of life and can help health care professionals and catheter users to optimize long-term ISC care. OBJECTIVE: The objective of this study was to develop and validate a patient-reported outcome measure, the Intermittent Self-Catheterization Questionnaire (ISC-Q), which evaluates aspects of quality of life specific to the needs of individuals performing ISC. METHODS: This study was divided into 2 phases. The first phase focused on the development of the ISC-Q using 20 interviews and a review of selected literature. In addition, 10 interviews with UK and French individuals who performed ISC were conducted to ensure face and content validity of the ISC-Q. In the second phase of the study, the ISC-Q was administered online in the United Kingdom, France, and Germany to 306 individuals with neurologic urinary retention (including spinal cord injury, multiple sclerosis, and spina bifida), who performed ISC for at least 6 months, and were aged 18 to 85 years. Item reduction, reliability, and validity testing were performed to determine the psychometric properties of the ISC-Q. Responsiveness and minimum important differences were also examined. RESULTS: The initial phase of the study led to the development of a 4-domain instrument focusing on ease of use, convenience, discreetness, and psychological well-being. Various item reduction techniques were used that resulted in the removal of 3 items from the ISC-Q; there were 24 items in the final version. The conceptual framework of the ISC-Q was confirmed with a four-factor solution of the subscales. The ISC-Q was psychometrically robust, with excellent internal consistency, adequate test-retest reliability, and good validity (convergent and known groups validity). Overall, the responsiveness results show the ISC-Q to be sensitive to change, and the total ISC-Q minimum important difference estimates ranged from 4.94 to 8.73. CONCLUSION: The findings illustrate the ISC-Q to be a valid and reliable outcome measure that evaluated aspects of ISC-related quality of life.

Developing an innovative approach to tackling men's health issues.

Men are notoriously reluctant to seek health advice, particularly if it involves urological problems. A multidisciplinary team in Northern Ireland came up with some innovative initiatives to address some major health issues facing men in their community, involving meetings in a pub and a mosque, and a men's health roadshow.

Can quality-of-life measures help in the care of urology patients?

Measuring a patient's quality of life aims to help practitioners concentrate on individuals' needs. But there are disagreements on how quality of life is defined and measured. Focusing on men with prostate cancer, this paper considers the problems of finding out what patients are really experiencing, and how nurses can help improve things.