Exploring the role of practical nursing wisdom in the care of patients with urinary problems at the end of life: a qualitative interview study.
OBJECTIVE
This study examined how nurses understand urinary problems at the end of life, and identified sources of evidence upon which they base their practice through semi-structured qualitative interviews. The aim was to decide whether research or interventions (such as formulation of best practice guidelines) could improve continence care at the end of life.


BACKGROUND
There is little evidence in nursing literature to indicate how nurses should manage urinary problems at the end of life. Evidence is particularly lacking regarding the insertion of indwelling urinary catheters.


METHODS
This was an applied qualitative interview study which used the 'guided interview' approach.


METHODS
Twelve participants who worked in two hospital wards and one hospice were interviewed about management of patients with urinary problems approaching the end of life. The transcribed interviews were organised using the qualitative analysis software qsr NVivo version 10 (QSR International, Melbourne, Australia). Constant comparison was used to analyse the interviews.


RESULTS
The patient and their family were a key concern of all interviewees. Participants focused on processes including: giving care, making decisions, managing uncertainty and assimilating knowledge. These processes are mediated by 'phronesis' or practical wisdom.


CONCLUSIONS
Within each of the processes (giving care, making decisions, managing uncertainty and assimilating knowledge), participants approached each patient as an individual, using experience, patient wishes, available resources, clinical knowledge and advice from colleagues to provide care. A generalised set of guidelines on managing urinary problems at the end of life would probably not be useful.


CONCLUSIONS
There is uncertainty about what constitutes best practice in specific areas of continence care at the end of life such as indwelling urinary catheter insertion. A careful approach is needed to ensure that the intellectual and moral knowledge that constitutes practical wisdom is shared and developed throughout teams.
Southampton General Hospital, Clinical Academic Facility, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Naomi
N
Farrington
Southampton General Hospital, Clinical Academic Facility, University of Southampton, Southampton, UK.
Mandy
M
Fader
Southampton General Hospital, Clinical Academic Facility, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK.|Faculty of Health Sciences, University of Southampton, Southampton, UK.
Alison
A
Richardson
Southampton General Hospital, Clinical Academic Facility, University of Southampton, Southampton, UK.
Samantha
S
Sartain
D000328:Adult; D000368:Aged; D001315:Australia; D003657:Decision Making; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009726:Nurses / Q000523:psychology*; D010166:Palliative Care; D062885:Urinary Catheters; D014555:Urination Disorders / Q000451:nursing*
continence; end of life; palliative; phronesis; qualitative