Diapositiva 1

1
Inventing and solving a problem Nursing a patient
with a nephrostomy tube
Åsa Bäärnhielm, Lars Sturesson, Ewa Gustafsson,
Stefan Anania
A cooperative study between the Department of
Urology, the Medical Imaging Centre and the
Accident Emergency Department at Stockholm
South General Hospital
Objectives
Urological patients sometimes, for a number of
different reasons, need to be given a nephrostomy
catheter for a period of time or for life. After
receiving the catheter, the patient stays at the
hospital for around 24 hours. This is to ensure
that the catheter is working and to teach the
patient how to manage his or her new way of life,
including what to do if the catheter stops
working.


Source UCL Institute of Child
Health
At the start of the project we wanted to find out
whether there was a trend for long waiting times
for patients with nephrostomy problems. If so,
how could we provide the most appropriate
information and achieve optimum results in
reducing waitig times. We also wanted to examine
the routines relating to consultations forthese
patients and if necessary amend the
guidelines. The Nephrostomy Project has attempted
to identify and describe the problems faced by
patients when the nephrostomy tube malfunctions.
We have also presented proposals for certain
amendments to the standard procedures and
guidelines.
Methods

• To establish whether there was a problem with
  long waiting times in Accident and Emergency, we
  studied 75 patient records from 2004-2006. We
  found that the average wait was between six and
  seven hours. In other words, there really was a
  problem.
• The initial aim was to reduce waiting time by
  50. However, the principal aim then changed from
  reducing waiting times to advising most patients
  not to attend Accident and Emergency but to make
  appointments directly at the Medical Imaging
  Centre.
• Meetings were held to inform staff involved in
  managing these patients. and talks have been
  given on nursing patients with nephrostomy tubes
  throughout the hospital. An information brochure
  was produced and distributed to patients and to
  staff involved, both in and outside the hospital.
• The number of patients attending the Medical
  Imaging Centre was recorded and compared with the
  number attending Accident and Emergency over the
  period 2004-2008.
• A questionnaire was handed out during the autumn
  of 2008 to obtain the views of patients on this
  matter.

Results
There was more than a 100 decrease in the
number of patients who presented in Accident and
Emergency to have their nephrostomy tubes changed
in 2008 compared with 2005.
Conclusions
The conclusion is mainly based on the assumption
that several kinds of improvements represent a
better situation for patients with nephrostomy
tubes. We have found that good quality
information is vital and enables patients to take
action themselves, which also fosters a sense of
self-determination. We have also found that
information provided to staff involved with these
patients reliably improves the nursing of the
patient. The main aim, to persuade patients to go
to the Medical Imaging Centre directly in order
to avoid long waiting times in the Accident and
Emergency Department, has been achieved, with the
result that there is more space and time for
patients with other illnesses.
References

• Urologic Nursing, Dec. 1995, Vivian A. Cofield,
  RN, CURN Percutaneous Nephrostomy Tubes Nursing
  Care
• Urology ward attenders auditing a nurse-led
  service - Joseph Nariculam, Declan G Murphy Cathy
  Jenner, International Journal of Urological
  Nursing, Volume 1, Issue 2, Page 71-76, Jul 2007,
  International Journal of Urological Nursing,
  Volume 1, Issue 2, Page 71-76, Jul 2007