Long-term suprapubic catheter-related care requirements when living at home : the development of a best practice guide

Whenever possible, indwelling urinary catheter use is restricted because of multiple adverse effects. However, there are numerous health conditions that lead to people requiring the indefinite use of a urinary catheter. In the absence of available or acceptable alternate treatment options, a suprapubic catheter offers an invaluable means of maintaining urinary drainage. However, well-focused, robust evidence-based practice guidance is limited for suprapubic catheter-related care. This study was undertaken to ascertain best practice specific to the healthcare needs of adults living at home with a long-term suprapubic catheter. Guided by the theory of social constructionism, a mixed-methods, two-phased study enabled the integration of experiences and opinions from two groups of experts for the development of a best practice guideline. The first group of experts comprised 10 people living with a suprapubic catheter at home. This group participated in individual semi-structured in-depth interviews. Six overarching themes were generated, each representing an area of healthcare need. The themes provided the question framework for the second phase of the study, a three-round Delphi survey. Twenty-three expert nurses who had provided care to people living with a suprapubic catheter at home participated in the Delphi. The first round elicited the respondents' opinions on specific aspects of suprapubic catheter-related care. Using qualitative content analysis, practice statements were generated and used in subsequent survey rounds. The respondents rated their level of agreement to each statement. The guideline comprises the statements that achieved a consensus of agreement. Through social processes, a comprehensive holistic best practice guideline was developed that strongly promotes self-efficacy. The six elements of the guideline comprise psychological support needs, cystostomy site care, suprapubic catheter replacement, drainage equipment practices, complication avoidance and management, and planning ahead. This thesis contributes a substantial and considerate resource to guide health professionals, promoting standardised care for the optimal wellbeing of people living with a suprapubic catheter at home.