Investigation of Nursing Knowledge of Catheter Selection following the Introduction of a Catheter Decision Support Tool

Abstract

People living with spinal cord injury or multiple sclerosis are often dependent on some form of catheterisation to manage their urinary incontinence, and this is accompanied by the risk of urinary complications. Nurses’ expertise, based on contemporary evidence about catheter types, purposes and risks, is fundamental to the role nurses play in urinary catheter selection, insertion and care with this client group, and more broadly. Catheter selection choice integrity is influenced by clinical nursing expertise and experience, research evidence, client preference, the availability of appropriate equipment and the capacity of both nurses and clients to use the equipment. Using a quasi-experimental design, this research investigates the extent to which nurses in a speciality context take up and retain complex and technical catheter information to use during catheter selection for clients with neurogenic bladders caused by spinal injury or multiple sclerosis. An education intervention involving a decision support tool is used with pre- and post-intervention testing to determine participant uptake and retention of information. The findings indicate that participants learnt and retained technical information on catheter selection in their practice. However, the findings also indicate that catheter selection knowledge of the registered nurse in this practice context remains a concern, despite improvements detected in catheter selection knowledge following the implementation of tailored education and a decision support tool. Strong correlation was found between uptake and retention of catheter selection knowledge, and overall years of experience as a registered nurse. The evidence also indicates that clinical reasoning and expertise in catheter selection can be quickly learned. The knowledge survey was tested to reveal an intra-class correlation coefficient of 0.89 and a 95% confidence interval of 0.46 to 0.98, thereby indicating extremely robust test–retest reliability, and establishing the survey as a useful component of future research in this field. This research is significant because it builds on earlier work by Dobson, Naidu and Johnson (1996) and Fleming, Day and Glanfield (2000), and extends understanding of the support required by nurses in this context for speciality education delivered in ways that meet their learning needs and support practice development. By revealing the effects of knowledge translation on the use of evidence in everyday practice, this study highlights the need for effective assessment and training to aid clinical reasoning and assist in the use of decision support tools and guidelines to facilitate knowledge translation. This is particularly the case in primary care contexts, where specialist nurses provide both episodic and long-term care and practice in relative isolation from other professionals.