[Cerebral palsy associated urological pathologies. Nurse´s role.]

OBJECTIVES

The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child's urinary tract infection and CP and its degree of independence.

METHOD

Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico.

RESULTS

The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias. The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control.

CONCLUSIONS

The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disorders in children with CP. It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection.

Competencies for the Nurse Practitioner Working with Adult Urology Patients

The role of the nurse practitioner (NP) has expanded into specialty domains. This document proposes 24 competencies specific to the urology NP, which are also consistent with the recommendations of National Organization of Nurse Practitioner Faculties (NONPF) and compliment the American Urologic Association (AUA) 2014 white paper on the incorporation of advanced practice providers in urology practices. It describes three levels of practice and experience progression for the urology NP working with adult patients, independent of specific clinical setting. These urology-specific competencies supplement and complement the core competencies and population-focused competencies of generalist nurse practitioners.

Advances in Female Urology: A Review of the 2013 Literature

The field of female urology covers a broad spectrum of lower urinary tract dysfunction and pelvic disorders. The aim of this article is to provide a comprehensive review of the most significant literature published during 2013.

[A qualitative assessment of the impact of a specialist nurse in outpatient urology consultations]

AIM

This paper presents the results of a prospective study of outpatient urology consultations designed to provide evidence of the benefits of using a specialist nurse to improve quality of care.

METHODS

135 patients (95 men and 40 women) were included in the study. Urinary disorders were defined using the International Classification of Functioning, Disability and Health (ICF), developed by the World Health Organization (WHO). The activity/ participation component was studied from a communication perspective before and after the urology consultation. Scores were obtained using a visual analogue scale (VAS). The VAS was also used to assess the role of the nurse as a facilitator (environmental factors component). A statistical analysis was performed on the population, as was an analysis of variance (ANOVA) of the activity/participation component.

RESULTS

The participants were aged between 4years 10 months and 96years (m = 63.29; standard deviation (SD) = 19.71). The median score for the urological disorders was 2. An analysis of variance of the two questions relating to the activity/participation component indicated a significant difference between the two groups (F = 6.4172; p < 0.001). A third question was used to assess the environmental factors component (nurse as facilitator), with a mean VAS score of97.79% (SD= 4.67).

CONCLUSION

The purpose of this prospective study was to conduct a qualitative assessment of the impact of involving a specialist nurse in outpatient urology consultations. The study demonstrated that the qualitative impact of using a specialist nurse as a facilitator (environmental factors component) is extremely important for the participatory dimension of communication, particularly in terms of understanding medical information.

[Evidence-based nursing, a driver for change in nursing practice]

A urology nursing team examined its perioperative practices in the light of scientific data and implemented updated care practices adapted to this context.This experience favours the development of skills essential for interdisciplinary collaboration drawing on the resources of each profession, to work towards a common goal for the benefit of the patient.

Urology nursing practice educational preparation, titles, training, and job responsibilities around the globe

A descriptive study of urology nursing titles, educational preparation, and job functions revealed more than 80 titles, varied educational preparation, and some common and varied job functions. The results also indicated that urology advanced practice nurses continue to expand their independent roles.

Practical and legal implications of nurse practitioners and physician assistants in cystoscopy

Due to looming physician shortages and the increase in demand for quality medical care for the newly insured, as well as the aging Baby Boomer population, there has never been a more important time for physicians, administrators, and the public to endorse and develop the role that nurse practitioners (NPs) and physician assistants (PAs) will play in the future of medical practice. One way to begin to address this problem is by expanding investments in training, competencies, and certification for NPs and PAs in performing minor procedures, such as cystoscopy, which is currently being performed by NPs and PAs across the United States and United Kingdom safely and with consistently high quality outcomes.

A survey evaluating the current role of the nurse practitioner in urology

The role of the nurse practitioner (NP) continues to expand into the care of specialty populations. This article presents results of a survey that allowed NPs who self-identified as working specifically with people diagnosed with urologic conditions to describe their clinical role. The purpose of identifying NP-specific clinical tasks was to provide evidence to be used in revising the urology specialty certification examination for NPs.

The use of botulinum toxin type A in urological procedures

Botox is a sterile, vacuum-dried, purified BoNT-A produced from fermentation of Clostridium botulinum. There is an abundance of literature to support the use of Botox in urology, and its off-label use continues to grow. While there are no FDA-approved clinical indications, there are ongoing phase II and III studies to approve Botox for use in some urological conditions. This article will explore the use of Botox in urology and provide a brief review of the literature supporting its use.

Procedure competencies and job functions of the urologic advanced practice nurse

A 2-round modified Delphi study recruited a panel urologic advanced practice nurse experts to identify the procedure competencies and job functions unique to the role of the advanced practice nurse specializing in the care of urology patients.

Can pre-assessment of patients with LUTS result in early discharge from urology clinic?

Waiting times for appointments for urological out-patients in Ireland and the U.K. can be excessively long. Nurse-led Lower Urinary Tract symptom (LUTs) pre-assessment clinics have been introduced to streamline patient care pathways. We examined whether a nurse-led pre-assessment LUTS clinic could result in the rapid assessment and discharge of patients following their first out-patient visit. A pilot study was undertaken whereby patients referred with LUTS were sent for pre-assessment prior to their out-patients appointment. 214 consecutive patients underwent pre-assessment. Of these, 39 (18%) patients were discharged following their first out-patient visit and 27 (13%) patients were discharged after a second attendance. A further 35 (16%) patients continued to attend but underwent no further investigations or treatment, and possibly should have been discharged earlier. Overall 46% of pre-assessed patients could have been discharged early from the urology clinic. In conclusion a nurse-led pre-assessment LUTS clinic could result in the rapid assessment and discharge of patients following their first out-patient visit.

A CRASH course in cultural competence for nurses

Nurses are at the forefront of providing health care and need to be sensitive to the unique needs of all populations. Because urologic nurses care for individuals with sometimes embarrassing health care needs, we encourage urologic nurses to take a CRASH course in cultural competence, combining knowledge of Culture, Respect and Assessment of others' worldviews, Sensitivity to cultural differences, and providing care with Humility that can be integrated into urology. Resources for increasing cultural competence are also suggested.

Culture 101

America is a kaleidoscope of cultures, ethnic groups, and races. As America's emerging and changing populations continue to grow, it is imperative that health care providers become more culturally sensitive and competent. Health care providers need to recognize that care must be individualized and considerate of the cultural, racial, and ethnic identity of the recipient of their care. One of the many challenges that confronts health care, and urologic nurses, is learning how culture can influence a patient's response to health and illness.

Effective teaching strategies for the older adult with urologic concerns

Older adults are able to learn and apply new knowledge, such as management of a urological condition, but their learning style differs from that of younger clients. An understanding of the older adult's learning style, and knowledge of specific teaching strategies will benefit the urologic nurse in the ongoing effort to be a more effective patient educator.

An overview of adult-learning processes

Part of being an effective instructor involves understanding how adults learn best. Theories of adult education are based on valuing the prior learning and experience of adults. Adult learners have different learning styles which must be assessed prior to initiating any educational session. Health care providers can maximize teaching moments by incorporating specific adult-learning principles and learning styles into their teaching strategies.

Developing a comprehensive diagnostic and interventional nephrology program at an academic center

Procedure-related delays in the treatment of patients with renal disease can be minimized and nephrology care can be delivered more efficiently by a nephrologist trained in nephrology-related procedures. Referrals to a radiologist for renal ultrasound and biopsy, to a surgeon for dialysis access placement, and to an interventional radiologist for dialysis catheter placement and vascular access procedures are time consuming and inconvenient to patients with renal disease. Moreover, such an approach may result in delays in the availability of critical diagnostic information and a break in the continuity of care. In an effort to optimize the care of nephrology patients, we developed a diagnostic and interventional nephrology (DIN) program that effectively deals with nephrology-related procedures in a timely manner. At present, some of the commonly performed nephrology-related procedures at our center include diagnostic ultrasonography, ultrasound-guided renal biopsy, peritoneal dialysis access procedures, permanent tunneled hemodialysis catheter placement, and endovascular procedures for arteriovenous dialysis access dysfunction. To date, we have performed 893 procedures during a period of 2 years. This article describes our approach and the tools required to develop a DIN program at an academic medical center.

Can quality-of-life measures help in the care of urology patients?

Measuring a patient's quality of life aims to help practitioners concentrate on individuals' needs. But there are disagreements on how quality of life is defined and measured. Focusing on men with prostate cancer, this paper considers the problems of finding out what patients are really experiencing, and how nurses can help improve things.

Urinary catheter 'deflation cuff' formation: clinical audit and quantitative in vitro analysis

OBJECTIVE

To investigate reports from district nursing staff of difficulty in removing long-term urinary catheters (LTCs) because of the formation of a 'cuff' on deflating the self-retaining balloon.

PATIENTS AND METHODS

Problems experienced by district nurses when removing urethral and suprapubic LTCs were audited, noting the type of problem, the catheter and any action taken. Quantitative in vitro studies were conducted on the deflated self-retaining balloons after incubating a similar range of catheters in saline at 37 degrees C for 6 weeks, using suprapubic profilometry to assess the resistance to withdrawal (retention force).

RESULTS

Questionnaires were returned on 154 patients with LTCs; 56% had urethral and 44% suprapubic catheters. The catheters were hydrogel-coated (83%), all-silicone (13%) and PTFE-coated (3%). Twenty-two (14%) of the sample reported problems with catheter removal in the previous year, including 15 (68%) with all-silicone catheters and 15 (68%) with suprapubic catheters; cuff formation was noted in 60%. In the laboratory, 10 of the balloons formed a 'cuff' on deflation, but there was great variability in the effect this had on the retention force, with values of 0.5-3 N for different catheters.

CONCLUSIONS

Most problems with catheter removal involved all-silicone and suprapubic catheters. Suprapubic profilometry confirmed increased resistance to withdrawal by formation of a 'cuff' on deflation of the balloon of all-silicone catheters. These results suggest that the first choice of catheter material for long-term urethral and suprapubic use should be hydrogel-coated latex.

[Pediatric serial urinary cystoureterography. Needs, nursing diagnosis, and care protocol]

The authors present the causes which lead to carrying out a Series of Urinal Tract Retrograde Cystography (CUMS) study in a child and they discuss some reasons which justify the elaboration of a nursing treatment protocol and the corresponding procedures in order to care for the child. To make a protocol for a procedure facilitates and enhances its execution. Nursing treatments, like any other activity, are susceptible to having a protocol and therefore can improve their quality. Nurses in the radio-diagnostic pediatrics ward at the University Hospital Reina Sofía in Cordoba are elaborating treatment protocols for every one of their radiological studies for the care of every child to whom we attend whom requires nursing care. In this article some protocols and procedures are commented on along with the reasons which justify their elaboration.