Self-Management of Urine Flow in Long-term Urinary Catheter Users

长期导尿管使用者的尿流自我管理

基本信息

批准号：
7877869
负责人：
MARY H WILDE
金额：
$ 45.03万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-24 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7877869
关键词：
Accident and Emergency department Adverse event Area Attention Awareness Bacteriuria Behavior Caring Categories Catheter Management Catheters Centers for Disease Control and Prevention (U.S.)Chronic Chronic Disease Clinic Visits Clinical Research Clinical Trials Design Cognitive Data Discipline of Nursing Educational Intervention Educational process of instructing Effectiveness Effectiveness of Interventions Esthesia Extravasation Feedback Goals Guidelines Health Health Care Costs Health Status Healthcare Home Care Agencies Home Nursing Care Home environment Home visitation Hospitalization Hour House Call Incontinence Individual International Intervention Intervention Studies Knowledge Lead Learning Life Long-Term Care Measurement Measures Mediating Medicine Modeling Monitor National Institute of Nursing Research New York Nurses Nursing Services Outcome Participant Patients Pattern Population Prevention Process Publishing Quality of life Randomized Randomized Clinical Trials Recruitment Activity Recurrence Reporting Research Research Personnel Self Care Self Efficacy Self Management Self Perception Sepsis Severities Site Study models Symptoms Telephone Testing Time Training Universities Update Urethra Urinary tract infection Urine Visit Visiting Nurse Work arm base behavior change comparison group cost effective design effective intervention evidence base experience follow-up group intervention health care service utilization implantable device improved innovation prevent programs public health relevance social social cognitive theory standard of care tool urinary

项目摘要

DESCRIPTION (provided by applicant): Urinary catheter users (estimated at 148,000 in home care agencies the U.S.) commonly experience adverse health effects, such as urinary tract infection (UTI), blockage, dislodgement, and leakage, leading to poor quality of life indicators. Catheter-related problems often require health care utilization resulting in increased health care costs. Self-management of urine flow is an essential part of self-care for people with long-term urinary catheters and may lead to prevention or reduction of catheter-related problems and improved quality of life. Despite its importance, no research has been conducted to formulate models of urine flow self management and its relationship to catheter-related adverse health outcome, and no studies have assessed the effectiveness of interventions to improve urine flow self-management. The proposed 4-year study uses a two-arm randomized clinical trial design to test the effectiveness of a urinary flow self-management intervention developed by the PI based on previous work. A total of 160 patients will be recruited (80 each in the intervention and standard of care arms) and assessed with repeated measures over 12 months of follow-up. The experimental intervention is designed to enhance self-management of urine flow in individuals with long-term urinary catheters, with the goal of decreasing catheter related complications and enhancing quality of life. The self-management intervention will involve four contacts with a study nurse: two home visits a week apart in the first month, a follow-up telephone call two weeks later, and a final "booster" home visit at 4 months. Catheter users will learn how to increase awareness and self-monitoring of their own patterns of urine flow and modify self-management behavior as needed. All three aspects of urinary self-management, i.e., awareness, self-monitoring, and self-management behaviors, are iterative and provide feedback to the patient. The intervention and research plan are informed by Social Cognitive Theory and findings from the PI's preliminary studies, and modeled on the Stanford Chronic Disease Self-Management Program. The study will be conducted at two sites: the University of Rochester and the Visiting Nurse Service of New York (NYC). The proposed specific aims of the study are to: 1) Determine the impact of the self-management intervention on health outcomes, 2) Determine the impact of the intervention on self-management behaviors, 3) Determine whether self-efficacy mediates the impact of the intervention on self-management behaviors, and 4) Assess the perceived value of the intervention by study participants. The major dependent variables include health outcomes associated with catheter problems (UTI, blockage and catheter dislodgement), health care utilization (excess nurse visits, hospitalizations, and emergency department visits), and catheter-related quality of life (QoL). If shown to be effective, the intervention will provide a much-needed prevention tool for self-care by people with long-term urinary catheters and one that can be easily scaled and implemented in a variety of care settings. PUBLIC HEALTH RELEVANCE: Learning to self-manage urine flow may help people prevent or minimize persistent complications from long-term indwelling urethral or suprapubic catheters. This new intervention was inductively derived from descriptive and qualitative studies based on what experienced catheter users do to prevent problems. More effective self management behaviors in this population may improve their health status outcomes, decrease heath care utilization, and enhance catheter-related quality of life.

描述（由申请人提供）：尿导管用户（美国家庭护理机构估计为148,000个）通常会经历不良健康影响，例如尿路感染（UTI），阻塞，脱位，脱位和泄漏，导致生活质量指标的差。与导管有关的问题通常需要医疗保健利用，从而增加医疗保健成本。对于长期尿导管的人来说，尿流的自我管理是自我护理的重要组成部分，可能导致预防或减少导管相关问题并改善生活质量。尽管它很重要，但尚未进行任何研究来制定尿流自我管理模型及其与导管相关的不良健康结果的关系，并且没有研究评估干预措施的有效性以改善尿液流动自我管理。拟议的4年研究使用了两臂随机临床试验设计，以根据先前的工作来测试PI开发的尿流自我管理干预措施的有效性。总共将招募160名患者（干预和护理臂标准中的80名患者），并在12个月的随访中进行了重复措施评估。实验干预旨在增强长期尿导管患者尿流的自我管理，目的是降低导管相关并发症并提高生活质量。自我管理干预措施将涉及与一名学习护士的四次联系：第一个月相隔两次家庭访问，两周后的后续电话，以及4个月的最后一次“助推器”家庭访问。导管用户将学习如何提高对自己尿流模式的认识和自我监控，并根据需要修改自我管理行为。尿自我管理的所有三个方面，即意识，自我监控和自我管理行为，都是迭代的，并向患者提供了反馈。干预和研究计划以社会认知理论和PI的初步研究的发现为基础，并以斯坦福慢性疾病自我管理计划为基础。该研究将在两个地点进行：罗切斯特大学和纽约访问的护士服务（NYC）。该研究的拟议特定目的是：1）确定自我管理干预对健康结果的影响，2）确定干预对自我管理行为的影响，3）确定自我效能感是否介导对自我管理行为的干预措施，以及4）评估研究参与者干预的感知价值。主要因素的主要变量包括与导管问题（UTI，阻塞和导管脱位），医疗保健利用（过度护士探访，住院和急诊科）以及与导管相关的生活质量（QOL）相关的健康结果。如果证明是有效的，则该干预措施将为具有长期尿导管的人提供一种急需的预防工具，可以轻松地在各种护理环境中进行缩放和实施。公共卫生相关性：学习自我管理的尿流可能有助于人们预防或最大程度地减少长期留置尿道或腹膜上导管的持续并发症。这种新的干预措施是根据经验丰富的导管用户为预防问题所做的事情源自描述性和定性研究的。该人群中更有效的自我管理行为可能会改善其健康状况，降低健康护理利用并提高导管相关的生活质量。