title: Urinary catheterization in acute stroke: clinical realities. A mixed methods study.
abstract: OBJECTIVE
  To determine what influences the decision to insert an indwelling urinary catheter in acute stroke patients.
  
  
  METHODS
  A prospective casenote review and semi-structured interviews were conducted and corporate catheterization policy in the study sites was investigated.
  
  
  METHODS
  Three teaching hospitals, typical of stroke service provision in most developed countries.
  
  
  METHODS
  Casenotes from 70 consecutive acute stroke admissions; 50 doctors, nurses and physiotherapists working in acute stroke units and medical receiving units.
  
  
  RESULTS
  Stroke patients were catheterized for output monitoring, relief of urinary retention or, especially for older patients, continence-related issues. Half of all catheterizations occurred in acute stroke units. Continence and catheterization were considered less important than other aspects of acute stroke care. No catheterization policy or standardized continence assessment tool was in use. Documentation was often lacking. Patients and relatives were not fully involved in the decision to catheterize. Continence assessment and catheterization practices varied widely. Complex unwritten rules relating to gender proliferated. Such rules demonstrated heuristic problem-solving could potentially cause conflict. Decisions to catheterize 'belonged' to doctors or nurses depending upon clinical indications. Clinical assessment and specialist referrals were often seen as 'not my job'.
  
  
  CONCLUSIONS
  Clear corporate policy on catheterization is required to direct practice. Use of standardized continence assessment tools is recommended to set and monitor standards of care. Documentation relating to urinary catheterization needs to improve.
authors: Nursing and Health Care School, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK. eileen.cowey@glasgow.ac.uk
authors: Eileen
authors: E
authors: Cowey
authors: Lorraine N
authors: LN
authors: Smith
authors: Jo
authors: J
authors: Booth
authors: Christopher J
authors: CJ
authors: Weir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D054869:Clinical Audit; D003657:Decision Making; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D014546:Urinary Catheterization / Q000009:adverse effects / Q000592:standards*; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D055815:Young Adult