van Achterberg Theo, Holleman Gerda, Cobussen-Boekhorst Hanny, Arts Rita, Heesakkers John
Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Clin Nurs. 2008 Feb;17(3):394-402. doi: 10.1111/j.1365-2702.2006.01893.x. Epub 2007 Apr 5.
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.
Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature.
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.
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.
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.
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.
本研究旨在探讨阻碍或促进成人清洁间歇性自行导尿（CISC）操作依从性的因素。
清洁间歇性自行导尿与良好的患者预后相关，但国际文献中未涉及该操作的依从性问题。
在两项研究中探讨了相关因素。第一项研究（n = 10）关注掌握情况和短期依从性，而第二项研究（n = 20）关注这些患者的长期依从性。通过对患者进行预先结构化访谈，并采用内容分析程序，得出患者依从性的决定因素。
发现了一份包含16个掌握情况和短期依从性决定因素的清单以及一份包含12个长期依从性决定因素的清单。这些决定因素大多在老年（≥65岁）和年轻患者中都存在。然而，有5个掌握情况和短期依从性决定因素以及6个长期依从性决定因素是65岁以下患者所特有的。
我们的研究结果首次深入了解了CISC的依从性。依从性的一般决定因素涉及知识、操作复杂性、误解、恐惧、羞耻感、动机以及专业护理的质量和连续性。此外，将CISC融入日常生活可能会很困难。对于年轻患者，材料的可获取性、身体损伤以及对患病角色的抵触情绪会进一步影响依从性。
在决定采用CISC并指导患者之前，应解决知识、恐惧、动机以及进行CISC可能产生的心理影响等问题。应改善后续护理，包括重新评估技能、讨论依从性、将CISC融入日常活动以及一般应对问题。
