The IDC-IMPROVE Project: Addressing indwelling urinary catheter care in residential aged care

The IDC-IMPROVE Catheter Care Bundle: The study will be conducted in 24 residential aged care homes (RACH) across three Australian states: Victoria, Queensland and South Australia. Residential aged care managers, registered nurses (RN), enrolled nurses (EN) and personal care workers (PCW) in the intervention group within each RACH will have access to a multicomponent intervention ("IDC-IMPROVE Catheter Care Bundle") for five months. The Bundle will be implemented in two consecutive phases: (1) education and (2) application to practice. The Bundle intervention includes access to the following components: a. The IDC-IMPROVE Catheter Care Course for Nurses: This course is specifically designed for RNs & ENs working in RACHs. It consists of five modules and is available online. The content is designed to equip nurses with the knowledge and confidence to: • Emotionally support a person living with an indwelling urinary catheter. • Apply clinical decision making prior to urinary catheterisation. • Understand and apply principles of insertion and/or removal of a urethral or suprapubic catheter. • Know and implement evidence-based nursing interventions to promote physical and emotional wellbeing. • Minimise and troubleshoot common issues related to urinary catheterisation. The course will be self-paced and will take approximately 5-8 hours in total to complete. The content is interactive and includes a combination of text, short videos, voiceovers, quizzes, scenario-based reflective exercises, and links to further resources (e.g., catheter care guidelines, helplines, and discussion forums). It will be delivered online. Participants will access the course by entering a username and password on the NARI online learning management system. Participating nurses will be required to complete this online course within 8 weeks following baseline data collection. Once they have completed the online course, nurses are eligible to attend the catheterisation skills workshop. Adherence to the learning modules will be monitored via the online learning management system’s reporting and analytic features. b. The Catheterisation Skills Workshop for Nurses: The workshop has been designed by the Continence Foundation of Australia, a key partner in this Project. The workshop allows participants to practice the skill of indwelling catheterisation insertion on both male and female manikins as well as suprapubic catheterisation and to receive to feedback. Workshops will be conducted in-person to nurses (registered and enrolled) and delivered by facilitators employed by the Foundation. Facilitators are advanced practice nurses who have postgraduate expertise and/or advanced clinical skills in continence or urology nursing. There will be 4 participants per workshop, with 1 facilitator. Workshop facilitators will use a comprehensive checklist to ensure that all areas of the procedure are addressed and to rate learners’ performance. The skills workshop will take approximately 4-5 hours in total to complete and will be conducted either at the participating RACH, or if a suitable room is unavailable, at a nearby alternative venue suitable for those attending. c. The IDC-IMPROVE Catheter Care Course for PCWs: An online course designed to take account of PCWs’ role in RACHs. The content is designed to equip them with the knowledge and confidence to: • Understand the lived experience of having an indwelling urinary catheter. • Understand what person-centred catheter care is and why it is important. • Support a person with a urinary catheter and their families. • Understand the basics of the urinary system and urinary catheters. • Understand their role in caring for the person with a urinary catheter. • Apply principles of infection prevention and control to a person with a catheter. • Deliver everyday care to a person with a urinary catheter, i.e. know how to empty the urine drainage bag, add or detach a night bag to a leg bag. • Know when to seek help. Participating PCWs at the intervention sites will complete their own IDC-IMPROVE Catheter Care Course that consists of three learning modules that have been designed to take account of their roles and responsibilities in RACHs. The learning material has been validated by expert nurses. We estimate it will take up to 1 hour to complete each module. The content is interactive and includes a combination of text, short videos, voiceovers, quizzes, scenario-based reflective exercises, and links to further resources (e.g., catheter care guidelines, helplines, and discussion forums). It will be delivered online. Participants will access the course by entering a username and password on the NARI online learning management system. Participating PCWs will be given 8 weeks to complete this course. d. The IDC-IMPROVE Catheter Care Toolkit for Managers/Senior Leaders: This Toolkit is a knowledge translation resource designed by the Project team to support RACH Managers and Senior Leaders to coordinate, supervise and manage catheter care in the workplace. It will be delivered online via a PDF document, available only to participants. Given the lack of evidence and guidance about IDC care, we anticipate RACH Managers and Senior Leaders require the information we have collated in order to influence the quality of catheter care. The toolkit provides information on the following topics: • The risks associated with IDCs. • Best practice recommendations for high quality person-centred catheter care. • Aged Care Quality Standards related to catheter care. • The IDC-IMPROVE Catheter Care Bundle. • Staff capabilities required to deliver person-centred catheter care. • Scope of practice as it applies to coordinating, supervising, managing catheter care in the workplace. • Meeting the specific needs of a resident living with cognitive impairment and a catheter. • Integrating person-centred catheter care into practice. • Evaluating organisational alignment with best practice recommendations. e. Application to Practice Support The education phase of the Bundle implementation will be followed by phase two which involves supporting Managers/Senior Leaders and nurses to apply the Bundle to practice (‘Application to Practice phase’). As nurses and managers/senior leaders will be required to drive changes in ICS care in their aged care home, an IDC-IMPROVE Evidence-to-Practice Support Model has been designed to support them. The model is a coaching program designed to build Managers/Senior Leaders’ and nurses’ capacity to adopt and consistently use learnings from the Bundle in everyday practice. This is a formal short-term arrangement. For nurses, the purpose of coaching is to reinforce what they have learnt in the IDC-IMPROVE Catheter Care Course and the Catheterisation Skills Workshop and to build their knowledge and confidence to deliver person-centred catheter care. For managers/senior Leaders, the purpose of coaching is to reinforce what they have learnt from the IDC-IMPROVE Catheter Care Toolkit for Managers/Senior Leaders, and to invite them to reflect on their current organisational policies and practice related to catheter care. The coaching will be available for three months after nurses have completed the IDC-IMPROVE Catheter Care Course and the Catheterisation Skills Workshop. Each site will have access to up to 15 hours of coaching, which will be provided by Advanced Practice Nurses who have expertise in continence or urology nursing, practice development and education. Coaching will be available on an individual basis and offered online and by phone, depending on the nurses’ and managers’/senior leaders’ individual preferences. The frequency will also be flexible and responsive to their preference. The duration of support on each occasion will also be flexible e.g. 10 min conversation on 1 day, 20 min on another. For nurses, the most appropriate form of communication will be established at the end of the Catheterisation Skills Workshop. For managers/senior Leaders, it will be established during site enrolment. Coaching sessions will be voluntary. Discussion will centre on the following topics: • Confidence in having achieved course learning outcomes: • Alignment between course content and current policies/guidelines: • Navigating potential misalignment between course content and current policies/guidelines: • Possible gaps in knowledge/confidence: Participants will also be encouraged to seek out suitable professional mentors in their organisation to support them in their ongoing professional development. The coaching will not extend to providing clinical advice about individual’s living in an aged care home. Rather nurses will be encouraged to refer to and use guidelines and resources such as clinical decision-support tools to increase their knowledge and confidence in troubleshooting. The National Continence Helpline will be promoted as a source of clinical information, and they will be advised to follow the usual care escalation policy within their organisation. The feasibility of the model will be evaluated through post intervention interviews with: (i) Advanced Practice Nurses, (ii) nurses, and (iii) participating managers/senior leaders. Adherence: Adherence to the intervention will be monitored by (i) online learning management system's reporting and analytics features; (ii) workshop attendance records; and (iii) completion of data collection at each time point. Intervention fidelity will be assessed through qualitative semi-structured interviews with participants, workshop facilitators, and experts delivering the online/phone support.