The Development of Clinical Nursing Practice Guideline for Continuous Bladder Irrigation in Patient undergoing Transurethral Resection Prostatectomy using Evidenced Based Practice

Abstract

Objective : This study was to develop clinical nursing practice guideline (CNPG) for continuous bladder irrigation in patient undergoing Transurethral Resection Prostatectomy (TURP)

Materials and method : This study was using evidence-based practice (EBP) model as a conceptual framework. An evidence-based practice model had four phases which consisted of : 1) Evidence triggered phase, 2) Evidence supported phase, 3) Evidence observed phase, and 4) Evidence based phase. Evaluation the credibility level and the feasibility of implementation were performed. From a total of 17 studies. Result of EBPs syntheses included 4 steps : 1) Prepare patient for operation and equipment, 2) Nursing Care of during Continuous Bladder Irrigation (CBI), 3) Exercise and Rehabilitees and, 4) stop CBI and off urinary catheter. The content of this CNPG was validated by 5 urology experts. The draft of CNPG were try out in 10 patients undergoing TURP and adjusted for appropriation before the implementation. The implementation of completed CNPG into practice at urology ward were pilot during January 2014 and June 2014. Sample of 40 patients undergoing TURP, 2 urologist and, 12 nurses.

Results : There were used to evaluate nursing outcome.The findings were as follows : the patient received holistic preparing for CBI care and learned in virtual scenarios that resulted in a very good level self-care practice ; the patient can extend leg by didn’t flex knee and hip at the time assigned; effective pain control was found, the mean of pain score was 2 ; 85 percent of patient didn’t ask for opioid at the 1st period post op care; there is no urinary catheter balloon slide out of the position; using two bottle CBI that adjust to the high of stand for infusion bottle and adjust to the normal saline rate by urine color resulted in the normal saline flowing is very good and no blocked blood clot; the average date of CBI was 2 ; the average date of urinary catheter retaining was 3 ; there were found that the average normal saline used per patient were lower (30,000 cc. vs. 140,000 cc.), the CBI cost were lower (1200 baht vs. 5600 baht), patient lengths of stay were shorter (5.4 days vs. 8 days) than those before initiated the CNPG; It was also found that no patient with urinary tract infection, no unplanned rehospitalizations within 28 days, patient satisfaction with the CNPG were 97.8 percent ; staff satisfaction with the CNPG were 96.6 percent.

Conclusion : The findings indicated that the CNPG for continuous bladder irrigation was practical and effective CNPG.

Keywords : Clinical nursing practice guideline, continuous bladder irrigation, transurethral prostatectomy