A bundle of care interventions to improve self-management and quality-of-life of community dwelling patients living with indwelling urinary catheters

<p dir="ltr"><b>Background</b> Living with an indwelling urinary catheter (IDC) can be a challenging and unexpected experience for patients, with some requiring long-term use. However, patients often lack adequate support in adjusting to life with an IDC and troubleshooting common catheter-related issues. Without appropriate education, patients frequently rely on readily available information or a trial-and- error approach to self-manage their catheters, which can lead to preventable complications and negatively impact their quality of life. IDC-related issues contribute to increased healthcare costs, preventable hospital presentations, unnecessary antibiotic use, and additional strain on an already overburdened healthcare system. The “Bundle-of-care interventions to <b>i</b>mprove self-management and <b>q</b>uality-of-life of patients living with <b>i</b>n<b>d</b>welling urinary <b>c</b>atheters” (<b>IQ-IDC</b>) research project spawned from these increasing challenges experienced by patients and the care providers. Nurses are well-positioned to empower patients in effectively managing their IDCs by providing tailored education. However, due to a lack of awareness and confidence, nurses often focus primarily on clinical aspects of catheterisation, overlooking patients’ selfmanagement and psychosocial needs. Enhancing nurses’ knowledge and skills in delivering holistic care is crucial for minimising unnecessary hospital presentations and improving patient outcomes.</p><p dir="ltr"><b>Purpose</b> The key objective of this doctoral component of the IQ-IDC project was to facilitate behavioural change among nurses by enhancing their Capability, Opportunity, and Motivation—the core components of the COM-B model—to enable them to deliver optimal care to patients with IDCs using digital technologies. This involved building their capabilities through education and training, creating opportunities through supportive systems and resources, and strengthening their motivation leading to the behaviour change required to transform their current practice.</p><p dir="ltr"><b>Methods</b> To achieve the objective, a mixed method approach underpinned by the Capability, Opportunity, Motivation - Behaviour (COM-B) theoretical model was employed to develop, implement, and evaluate a co-designed intervention to enhance nurses’ knowledge and performance in supporting patients to self- manage their IDCs and prevent IDC-related problems. The progressive outputs of this study were reported in a series of peer-reviewed papers, which are: 1) A scoping review to understand the information needs of patients living with IDCs and the impact of existing educational interventions; 2) A systematic review to identify the subject matter, educational approaches and effectiveness of existing educational interventions for nurses regarding delivering optimum care to patients living with IDCs; 3) A study protocol outlining the IQ-IDC project’s rationale and methodology to ensure rigor, transparency and reproducibility; 4) Psychometric analysis of the Expanded Catheter Self-management (E-CSM) scale, detailing its development, psychometric evaluation in assessing essential aspects of urinary catheter self-management; 5) Psychometric testing of the Catheter Assessment, Management and Performance (CAMP) scale, describing its development, theoretical underpinnings, and effectiveness in detecting changes in nurses’ self-reported behaviour change following educational intervention; and 6) A co-design study evaluating the effectiveness of the spaced eLearning intervention delivered via a digital platform, assessing its impact on nurses', capability, opportunity, motivation and behaviour in I DC management.</p><p dir="ltr"><b>Results</b> The scoping and systematic reviews in Papers 1 and 2 identified gaps in I DC selfmanagement education and highlighted the need to upskill nurses to provide optimal care. The reviews informed the development of the co-designed educational intervention (Protocol Paper), incorporating input from patients and nurses (Paper 3). Paper 4 and 5 revealed that the E-CSM and CAMP scales have strong psychometric properties demonstrating their usefulness in assessing patients’ self-management skills and nurses’ behaviour to support them. These scales provided a reliable tool of identifying educational needs and tailoring interventions for both groups.</p><p dir="ltr">Finally, Paper 6 reported on the effects of the co-designed eLearning intervention for nurses delivered via the Qstream digital platform, using micro and spaced learning strategies and multimedia content to enhance engagement. Following the intervention, the composite mean knowledge score improved from 65.03 to 84.30 (p< 0.001), with significant increases across seven of eight assessment areas. The overall CAMP scale scores also showed significant improvement (85.53 versus 95.98, p < 0.001) and across all subscales: a) Capability: 28.66 to 33.83 (p <0.001); b) Opportunity: 24.13 to 26.78 (p <0.001; c) Motivation: 16.52 to 17.86 (p <0.001; and d) Behaviour: 16.33 to 17.51 (p <0.001). These results indicate that the intervention, underpinned by the COM-B model, effectively enhanced nurses' behaviour, leading to improved patient care. Qualitative findings further support that the intervention led to an increase in nurses’ awareness and ability to support patients’ self-management and address psychosocial needs.</p><p dir="ltr"><b>Conclusion</b> Outputs of this doctoral study included the development of a co-designed eLearning intervention that addresses knowledge and performance gaps in IDC management among nurses. Additionally, the E-CSM scale demonstrated effectiveness in predicting the IDC-related problems and supporting tailored interventions, while the CAMP scale provided a robust measure of nurses’ readiness and behaviour to improve their practice. Future studies may consider trialling these tools and the eLearning module in diverse clinical settings, including residential aged care facilities, and rural and remote area practice. By adopting participatory research methodologies and co-designing impactful interventions, this study provides valuable strategies to enhance outcomes for the patient, nurse, and healthcare system.</p>