AIMS & OBJECTIVES:The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self-catheterization (CISC) procedures in adults. BACKGROUND:Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature. METHODS:Relevant factors were explored in two studies. The first study (n = 10) addressed mastery and short-term adherence, whereas the second study (n = 20) addressed long-term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure. RESULTS:A list of 16 determinants of mastery and short-term adherence and a list of 12 determinants of long-term adherence was found. Most of these determinants were found in both older (>or=65 years of age) and younger patients. However, five determinants of mastery and short-term adherence and six determinants of long-term adherence were specific to patients under the age of 65. CONCLUSION:Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence. RELEVANCE TO CLINICAL PRACTICE:Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.

译文

目的和目标:本研究的目的是探讨阻碍或促进成人清洁间歇性自导管(CISC)手术依从性的因素。
背景:干净的间歇性自我凯瑟琳化与良好的患者预后相关,但国际文献中未提及对手术的依从性。
方法:在两项研究中探讨了相关因素。第一项研究(n = 10)针对精通和短期依从性,而第二项研究(n = 20)针对这些患者的长期依从性。患者依从性的决定因素是使用内容分析程序从与患者进行的预先结构化访谈中得出的。
结果:找到了掌握和短期坚持的16个决定因素的清单和长期坚持的12个决定因素的清单。这些决定因素大多数是在年龄较大(>或= 65岁)和年轻患者中发现的。但是,掌握和短期依从性的五个决定因素以及长期依从性的六个决定因素特定于65岁以下的患者。
结论:我们的发现为CISC的依从性提供了第一见解。依从性的一般决定因素涉及知识,程序的复杂性,误解,恐惧,羞耻,动机以及专业护理的质量和连续性。此外,将CISC整合到日常生活中可能很困难。在较年轻的患者中,材料的可获得性,身体上的损伤和对疾病的抵抗力可能会进一步损害依从性。
与临床实践的关系:在决定进行CISC和指导患者之前,应解决执行CISC的知识,恐惧,动机和潜在的心理影响等问题。应当改善后续护理,包括重新评估技能,讨论依从性,将CISC纳入日常活动和一般应对问题。

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