Exploring the educational, self-monitoring and self-management needs of community dwelling patients living with indwelling urinary catheters: a mixed methods study

Patient Group Patients who meet the criteria will be delivered a bundle of care interventions focused on patients and caregivers designed from the findings of explorative data collected from patient interviews/surveys and the scoping review to optimise self-management of patients with a urinary catheter. These interventions will be underpinned by a pedagogical approach to increase self-efficacy to improve self-management practices, whereby education is one component. Principles of the appreciative inquiry model will be used to partner with patients in supporting change in self-management practices focusing on patient empowerment to maximise adherence to best catheter self-management practices. The utilisation of digital technologies such as email and SMS information sharing and reminders will also be used in this phase to deliver the newly designed bundle of care interventions using ‘Goshare Healthcare’, with resources and functionalities tailored to the needs of these patients. During these six months, patients who are participating will receive the following bundle of care interventions: - The nurse/research team member will provide a 15-20 minutes face to face catheter self-management instructions to patients/carers during their 4-6 weekly routine catheter change appointments - The nurse/research team member will explain and demonstrate to patients regarding how the Goshare platform works and the benefits of using this platform to access information at their convenience as needed. - The nurse will send the relevant information from the care bundle to patient/carer electronically using Goshare digital platform based on their needs. This will help the participant to self-administer the remaining components of catheter self-managment by accessing these information on their personal devices. - Using Goshare, nurses will share information such as patient information sheets/booklets, patient stories, links to credible websites, and the prevention and management strategies for the typical catheter-related problems and how to get further help if required. - Using Goshare, patients will be able to provide their feedback on each content delivered to them and receive further clarification from the research team. - By accessing the Goshare application/web-portal analytics, nurses and research team will monitor the usage of the information sent out, such as how many patients accessed the information and how often they opened each resource. Based on this information, nurses will be able to send reminders to patients to improve patient outcome - Other interventions such as a catheter passport (A booklet containing individualised catheter self-management instructions for each patient) and a facilitated group session for catheter users organised by the research team will be considered based on the exploratory data findings. Nurse group Nurse participants will receive the training 8 weeks prior to patient interventions and the training will help the nurses to upskill their knowledge and deliver interventions to patients. Nurse participants will be provided a bundle of care intervention underpinned by the evidence-based pedagogy using learning encounters known as ‘spaced learning’ characterised by ‘repeated learning over time’ (spaced educational pedagogy). Case-based catheter-related scenarios will be developed as part of the care bundle by clinical and academic experts and will be delivered online using Qstream™. This clinical platform ‘pushes’ clinical questions to participants' email and takes less than 10 minutes to answer, with immediate feedback to responses. This mode of delivery has been shown to boost knowledge retention and at the same time, positively influence entrenched clinical practices. The research team will provide a 20 minute face-to-face or zoom information session to participating nurses to explain the Qstream modules. Six to eight case scenarios with multiple-choice questions will be developed based on the following key areas; - Anatomy and Physiology - Indication for urinary catheter insertion - Common catheter-associated complications and management - Methods for avoiding catheter-associated urinary tract infections - Plan for early removal of IDC and clear documentation - Patient Education Six to eight case scenario questions will be delivered to participants over the course of six weeks, using a standardised QStream algorithm of two questions per delivery, delivered every 2 days. Incorrectly answered questions are repeated after 7 days, while those correctly answered are repeated after 13 days. Retirement of questions occur when there are two consecutive correct answers and a maximum of 3 attempts are given before a question is retired permanently. It is estimated that 10 minutes is required to answer the questions and read supplementary information. While the delivery of QStream questions are delivered using a spaced algorithm, it is received by the participant by push notification of which they have the option to access in their own time. The two-day period in which the next set of questions is delivered will occur once the participant engages and answers the question. The pattern of delivery will therefore be be individualised due to each participant's learning process. There will be instances where participants can finish earlier than the 6 weeks. Upon answering the questions participants will be provided with answers including detail information regarding the topic, references, further readings, and resources. The spaced and repetition of question delivery is aimed to reinforce learning and knowledge retention. By accessing the application/web-portal analytics, the research team can monitor the usage and the performance level of nurses and promote adherence to the interventions by sending reminders. The nurses receiving a bundle of interventions will be upskilled to provide safe, effective catheter self-management strategies to patients living with IDCs and thus, contribute to minimising catheter-associated complications. Nurses provided with the intervention bundle of care will be the same nurses delivering the intervention to patient participants. Nurses participating in the intervention will be delivering the following information to support patients’ self-management and improve their quality of life: - Explain how the catheter works (addressing the information needs of patients), discuss choices of catheters, and drainage system suitable for the patient to adjust their life with the catheter - Address the importance of self-monitoring and self-management in specific aspects, such as fluid management, constipation management, hygiene, and securement of the catheter, and its significance in minimising catheter-related problems. - Demonstrate how to access information via Goshare and share individualised bundle of interventions based on patients’ needs Information materials that will be used in the intervention will be designed specifically for this study from the findings of explorative data and the scoping review except the standard catheter care booklet used in the health district named "Caring for your urinary catheter at home, information for clients and cares".