Catheterisation Case

REFLECTION

DESCRIPTION

During a third year placement, I had had a number of opportunities to catheterise patients. Previously, I had had limited opportunities to practice this skill, although I had attempted it before. Initially I was assisted by three different members of staff on different occasions to catheterise patients. On two occasions neither myself or the nurse assisting me had been able to catheterise the patients. On the third catheterisation I had been unsuccessful but the nurse assisting me had been able to complete it, with some difficulty. This had made me anxious about the procedure and I had identified it as a skill I needed to research and practice. On the next opportunity available, I watched a staff nurse complete a successful catheterisation.

One of the patients I was caring for had acute urinary retention and required catheterisation. I was working with an experienced member of staff who I had previously observed performing a male catheterisation. I explained my concerns to her and she assisted me to complete the task successfully without difficulty.

FEELINGS

When performing the catheterisations I felt uncomfortable as I felt it is not a pleasant experience for patients to have a student being taught to carry out their catheterisation. Some of the nurses I did it with were very good at involving and informing the patient. Others got flustered and I felt it was inappropriate for the patient, despite having gained their informed consent before hand. I questioned my ability to perform this clinical skill especially as my confidence had been knocked by the previous attempts. When I was able to complete a catheterisation successfully, I felt pleased but I still feel that I would like to become more confident in this area. I am concerned that I will be expected to complete catheterisations independently when I am qualified, as I do not feel confident to do this yet.

EVALUATION

I was able to identify a skilled nurse who was an excellent communicator with patients and a confident teacher. She was able to help me catheterise a patient successfully. All patients consented to me carrying out their catheterisations. The patients who had an unsuccessful catheterisation did not have a good experience. Although procedures and possible reasons for difficulties were fully explained clearly, I felt the patients emotional needs were not truly met within this acute environment.

ANALYSIS

I performed the procedure according to Yates (2008) guidelines and with advice from the nurse I was working with. Initially we prepared the patient, explaining the procedure and the reason it was necessary (the patient had acute urinary retention). Other indications may be monitoring renal function hourly in critical illness, during and post surgery, symptomatic chronic urinary retention, investigative purposes, or in some cases, to instil medication into the bladder. When the decision to catheterise is made, risks and benefits must also be weighed up.

After the explanation, I gained consent according to the NMC Code (2008) to do the procedure, ensuring that the patient was informed that I was a student. I chose the appropriate catheter size with my mentor, the smallest Ch that would allow for drainage (Yates, 2008). I washed my hands according to the local and national policy (NICE, 2003) and positioned the patient, ensuring she