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Evidensbaserad blåsövervakning vid ortopedisk vård: Patienters erfarenheter och personals följsamhet till riskbedömning vid höftkirurgi
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-6181-3932
2023 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [sv]

Background: Hip surgery, a common healthcare procedure in Sweden and worldwide, is like other surgical procedures associated with risks of complications, such as urinary retention. Urinary retention is prompted by several factors experienced by the orthopaedic patient, such as pain, bed rest, medication (opioids, anaesthesia) and intravenous treatment with fluids. To prevent urinary retention or other voiding complications, there are evidence-based guidelines, supporting safe clinical care and averting unnecessary care injuries. Prior studies indicate that these guidelines are neither fully known nor used by orthopaedic staff, but bladder distension is still one of the most common adverse events in Swedish orthopaedic care. This licentiate thesis represents two studies, constituted by baseline data from 17 orthopaedic units in the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trial.   

Aim: The overall aim was to explore patients’ experiences of bladder care and voiding issues due to hip surgery and to evaluate staffs’ adherence to risk assessment for urinary retention according to evidence-based guide-lines.  

Design and method: Study I had a descriptive design and data was analysed using inductive content analysis. Study II was an observational study analysed with descriptive and comparative statistics, and logistic regressions.  

Findings: Patients experienced that bladder care and monitoring seemed important, although the reason was not fully explained to them, nor the related risk between hip surgery and urinary retention. Those experiencing bladder issues postoperatively managed and sought care on their own, not associating such events with their hip surgery. The bladder issues were described as negatively affecting daily life.  

Documentation in medical records (n=1382) indicated low adherence to recommended risk assessment for urinary retention (23.4%), and performed assessment was significantly associated with acute surgery or being treated at an academic hospital. Acute patients experienced urinary retention or other bladder issues more frequently, and among those patients completing a survey (n=447), 11.9% reported increased bladder issues after surgery.  

Conclusions: With a lack of communication with patients about bladder care, and limited adherence to risk assessment for urinary retention, further efforts to reinforce guideline implementation are needed. This should include a more patient-centred approach in the attempts to provide better, safer and more equal care. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. , p. 61
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 140
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-198574DOI: 10.3384/9789180751759ISBN: 9789180751742 (print)ISBN: 9789180751759 (electronic)OAI: oai:DiVA.org:liu-198574DiVA, id: diva2:1805680
Presentation
2023-11-29, Hasselqvist-salen, Hus 511, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2023-10-18Bibliographically approved
List of papers
1. Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care
Open this publication in new window or tab >>Patients experiences of urinary retention and bladder care-A qualitative study in orthopaedic care
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2023 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 50, article id 101034Article in journal (Refereed) Published
Abstract [en]

Background: Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines pre-scribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation.Purpose: The aim was to describe patients experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery.Method: This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden.Results: The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients ex-periences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self -management strategies and further care.Conclusions: Patients perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2023
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-196690 (URN)10.1016/j.ijotn.2023.101034 (DOI)001037809900001 ()37437464 (PubMedID)
Available from: 2023-08-18 Created: 2023-08-18 Last updated: 2024-01-04

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Winberg, Madeleine

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