Indwelling Catheter Usage Intervention

The article entitled “Self-Management Intervention for Long-Term Indwelling Urinary Catheter Users” by Wilde, McMahon, McDonald and Chen (2015) is a credible quantitative study that focuses on infection stemming from catheter use. Specifically, the study examines self-management approaches for home-patients. The article is well-written, concise, grammatically correct, and avoids the use of slang or common jargon. It is very well laid out and organized with headings and subheadings used to divide the text into easily readable sections. The authors of the study have university and/or professional nursing backgrounds, which indicates a high degree of knowledge in this particular field of catheter studies: Wilde and McMahon are professors at the School of Nursing at the University of Rochester, Chen is a professor in the School of Social Work at the University of North Carolina at Chapel Hill, and McDonald is a professor at the Center for Home Care Policy and Research at the Visiting Nurse Service of New York. Their combined backgrounds are appropriate for addressing the needs of patients engaged in catheter self-management methods. As Grove, Gray and Burns (2015) point out, it is helpful to know the qualifications of the authors of a study in order to assess their credibility. Additionally, the title is clear, of a sufficient length (Coughlan, Cronin and Ryan (2007) state that the title should be between 10 and 15 words—this one is 8 unless one counts the hyphenated words separately, in which case it is 10), and the title states the main idea of the paper without ambiguity. The abstract offers a clear overview of the study and identifies the research problem, the sample, the methodology used, the findings that were made and the recommendations that were given.
The purpose of the study is clearly understood and the research problem is identified explicitly. The purpose of the study was specifically to determine how effective self-management intervention is in terms of preventing catheter-related urinary tract infections, blockages and accidental dislodgement. A secondary purpose was also identified, namely the quality of care associated with infection, blockage and accidental dislodgement as well as the degree of catheter-related quality of life. The research report follows the steps of the research process in a logical manner and these steps naturally flow from one to the other. The links between the research compiled in the literature review and the present study are effectively clear and suitable. It is evident from a gap in the literature that there was a need for this study.
The literature review was also logically organized and offered a balanced critical analysis of the literature. The literature was mostly of recent origin and mainly from primary sources and of an empirical nature. The literature discussed the history of catheter-usage, the problems associated with long-term indwelling catheters, and the use of self-management intervention.
A theoretical framework was not clearly identified as guiding the study and no conceptual framework was explicitly described. A framework could arguably be determined by examining the nature of the study but the researchers did not specifically identify one themselves. The aim of the study was, however, clearly identified and the research questions were made evident. They were clearly stated and reflected the information presented in the literature review.
The sample was clearly identified. The sample consisted of 202 adult long-term urinary catheter users. The sample was split between a control group which received usual care and the test group which received the self-management intervention. The sample was selected by using baseline data from hospital patient records and participants were contacted to be participants in the study. The sample was probable and the method was a randomized clinical trial. The sample size was suitable for early stage research but for more extensive research, a larger sample will be needed in the future. Inclusion/exclusion criteria was based on baseline data.
Ethical considerations were also not clearly defined, so it is unknown whether or not the participants were fully informed about the nature of the research. It is assumed that autonomy and confidentiality was guaranteed since there is no depiction of individual participants in an identifiable way; however, this guarantee is not stated in the text. Likewise, it is not known if the participants were protected from harm; the results of the intervention are described and this is the only mention of outcomes. It is also not stated as to whether ethical permission was granted for the study.
Terms are defined sufficiently throughout the study. However, it is assumed that the reader of the study is sufficiently versed in technical terminology and thus will not need terms such as catheter or blockage defined for them. Terms that were defined included particular interventions that were used in the past when treating catheter-related infections and other problems.
The methodology was clearly identified as random clinical trial and the data gathering instrument was also clearly identified: face-to-face home interview followed by phone interviews every two months. The interviews were conducted for an entire year to track the outcomes of the intervention and measure them against the outcomes of the control group. The researchers achieved triangulation by ensuring that the control group received separate intervention care than the test group.
The data gathering instrument was appropriate as it enabled the participants to do self-management and self-monitoring (though one limitation of the study is that the participants might not always be exact in their monitoring or recording of incidences). The data gathering instrument/method was adequately described and was suitable to the purpose of the study. The instrument was developed by identifying the problem areas associated with long-term indwelling catheter usage and formulating questions to ask based on those problem areas, which were ascertained via the literature review and analysis of what other researchers have found. There was no indication of a pilot study being conducted in order to verify the validity of the instrument.
Data and statistical analysis were conducted and described. The researchers used standard data cleaning procedures to screen for error and potential univariate and multivariate outliers. The data analysis also included intention to treat analysis using SAS 9.3, which is widely accepted measurement device in the industry. The analysis methods were suitable and appropriate to the study’s purpose and to the data obtained through the instrument. All of the sample participated and the findings were found to be significant in some areas for a portion of the year, but not for the whole year. For example, there was a significant decrease in blockages among the test intervention group during the first 6 months, with p = .02, but this difference did not last over the entire year. There was no significance difference between the control group and the intervention group in terms of infection and dislodgment. Thus, the results have modest value but could be used to do a more exact study in the future.
The findings were linked back to the literature review in a minimal way, but there was some linkage. The research questions were discussed and the findings were described in a way that showed consideration for the research questions. The findings showed by comparing baseline rates that both the control group and the intervention group improved over the 12 month period. Thus, the study found that the self-management intervention was not any more effective than the usual treatment for patients with long-term indwelling catheters. However, the findings did suggest that an initial improvement could be made through self-management with respected to preventing blockages. This finding was significant and was discussed in terms of the literature evaluated earlier in the study.
The strengths and limitations of the study were identified and discussed and the self-monitoring method along with the sample size was described as a limitation that could be off-set by future research. The generalizability of the study was not discussed in great detail but a recommendation for future research was made with respect to examining a simplified intervention using a self-monitoring calendar with the intake of optimal and consistent fluids so as to see the impact of this intervention and how patients might benefit from it. The strength of the study was viewed as its focus on the outcomes of the self-management intervention. References of all journals and books used in the study were placed at the end of the study and everything that was cited received a reference.
In conclusion, the researchers used strategies to enhance the trustworthiness of the study such as randomization and blinding of the sample and they identified the design of the study clearly, described their research questions, clearly described the measures used along with the method of data analysis employed. The study’s quantitative approach produced significant results for a portion of the study’s duration and the recommendations were suitably developed based on the data produced by the study in full.

References

Coughlan, M., Cronin, P., Ryan, F. (2007). Step-by-step guide to critiquing research.
Part 1: quantitative research. British Journal of Nursing, 16(11), 658-663
Grove, S.K., Gray, J. R., Burns, N. (2015). Understanding Nursing Research Building
an Evidence-based practice. St. Louis, MO: Elsevier Saunders.
Wilde, M. et al. (2015). Self-management intervention for long-term indwelling urinary
catheter users. Nursing Research, 64(1): 24-34.