University of Glamorgan, United Kingdom.
Int J Nurs Stud. 2013 Oct;50(10):1341-50. doi: 10.1016/j.ijnurstu.2013.01.009. Epub 2013 Mar 6.
Management of bladder function is important in rehabilitation of spinal injury. Failure to comply with bladder management techniques, such as intermittent catheterisation, can have long-term consequences leading to renal failure. It is important, therefore, that spinal injured people adapt to the therapy at an early stage, but there is little research aimed at exploring patient experiences of ISC.
This study explores the experiences of patients who have a spinal cord injury and who carry out ISC in order to identify psychological coping factors that might affect therapy adherence.
A qualitative study using a Grounded Theory framework involving individual interviews.
There were 15 participants (11 men and 4 women), median age 52 years (range 24-68) who were discharged from spinal rehabilitation, living in the community and using ISC. The sample was recruited from the patient lists of a tertiary spinal injury unit and a Specialist Continence Service.
In-depth interviews were carried out in participants' own homes by a trained interviewer. Interviews were audio-recorded, transcribed and analysis carried out using NUD*IST6 software.
A core category of 'normalisation' was identified and the causes and consequences related to this category are reported. Categories of 'independence' and 'control' were closely related to, and were interdependent with, 'normalisation'. Participants were relieved of worry when they could exert control over their bladder function, and a feeling of normalisation helped them to maintain the integrity of their self-image. The ultimate outcome was either adaptation or maladaptation. Adaptation was dependent on positive acceptance of intermittent catheterisation and the need for good bladder management at the outset, whereas maladaptation was a result of avoidance and denial.
Adherence to ISC is related to early psychological coping strategies of active acceptance rather than denial and avoidance in relation to bladder management. It is important to support positive appraisals of ISC, particularly from the patient perspective, which suggest that it is the first step to independence and that it also provides normalisation and control of bladder function. ISC can contribute to a good quality of life, dignity, privacy and self-esteem.
膀胱功能管理在脊髓损伤康复中至关重要。未能遵守膀胱管理技术，如间歇性导尿，可能会导致长期后果，导致肾衰竭。因此，脊髓损伤患者应尽早适应治疗，但针对 ISC 患者体验的研究却很少。
本研究旨在探讨脊髓损伤患者进行 ISC 的体验，以确定可能影响治疗依从性的心理应对因素。
采用扎根理论框架的定性研究，包括个体访谈。
共有 15 名参与者（11 名男性，4 名女性），中位年龄 52 岁（范围 24-68 岁），从脊髓康复机构出院，在社区生活，使用 ISC。样本从一家三级脊髓损伤单位和一家专科尿控服务的患者名单中招募。
由一名经过培训的访谈者在参与者的家中进行深入访谈。访谈进行录音，转录，并使用 NUD*IST6 软件进行分析。
确定了一个核心类别“正常化”，并报告了与该类别相关的原因和后果。“独立”和“控制”类别与“正常化”密切相关且相互依存。当参与者能够控制自己的膀胱功能时，他们会减轻担忧，并感到正常化，从而保持自我形象的完整性。最终结果是适应或不适应。适应取决于对间歇性导尿的积极接受，以及一开始就需要良好的膀胱管理，而不适应则是由于回避和否认造成的。
ISC 的依从性与早期积极接受的心理应对策略有关，而不是对膀胱管理的否认和回避。从患者的角度支持对 ISC 的积极评价很重要，这表明它是独立的第一步，还可以实现膀胱功能的正常化和控制。ISC 可以提高生活质量、尊严、隐私和自尊。
