The study conducted by Frederickson et al. was able to show the need to use a Bladder Scanner for the accurate and efficient assessment of bladder volume in postoperative care. The bladder distention that will be experienced by the patients can cause complications and health problems if appropriate measures will not be taken. The traditional solution which is to insert a catheter into the urethra of the patient is no longer a viable option because it increases patient discomfort as well as increases the rate of infections.
The solution therefore is to use ultrasound technology such as the Bladder Scanner that will accurately and efficiently assess bladder volume. The accurate assessment will lead to the reduced usage of catheterization in postoperative care this will also allow for the reduction in the rates of infection, the cost of treating UTI, increase the efficiency of the nurses. This will ease the burden of the nurses and make them more effective in focusing on other tasks this will also ease the psychological and physical discomfort of the patients.
The Implementation of Bedside Bladder Ultrasound Technology: Effects on Patient and Cost Postoperative Outcomes in Tertiary Care: A Critique of the Study In postoperative care it is common to encounter the problem of urinary retention. It can be said that one of the side effects of drugs, especially the use of anesthesia is bladder distention. This is characterized by the patient’s inability to distinguish if he or she has a full bladder and need to empty it. Bladder distention can cause complications and needless to say health workers must do their best to regularly empty the bladder.
Since there is no way of knowing if the bladder is about to be void or not the usual method of dealing with this problem is intermittent catheterization but it is an invasive procedure that is not only a cause for discomfort for the patient, added cost to healthcare and demands more time from the nurses. Aside from all these problems, catheterization can also cause urinary tract information or UTI. There is therefore the need to have another alternative solution to urinary retention and distention. One of the most practical solutions is the use of a Bladder Scan
It was determined that in postoperative care the effects of anesthesia and medication can cause distention. The patient loses the ability to feel that his or her bladder is already full and therefore realizes that it is time to empty the bladder. There is no need to elaborate on the fact that if this will continue then there would be harmful effects on the body as the bladder is a major component of the excretory system. Without the capability to “void” then the patient will increase the risk of developing complications. The solution was to use catheterization. This is a procedure where tubes are inserted into the urethra of the patient.
This is a painful process not to mention that it can humiliate the patient especially those who are not comfortable with the procedure. Aside from that the procedure is known to be the major cause of urinary tract infections. As a foreign object is inserted into the human body there is an increase in the probability that microorganisms can also be introduced into the system. This is the reason why the rate of infections shoots up whenever catheterization is regularly used in postoperative care. Health workers created a solution to this problem and it is to apply “timed intermittent catheterization.
” This simply means that a catheter is not permanently attached to the patient but only in a prescribed time. The period when it is optimal to insert a catheter can be divided into two. The first one is called “due to void” meaning that after a long period of time the bladder can be expected to be full. The second time when catheterization is expected is called “void with residual” this means that the patient was able to empty the bladder but there is still a “residual” and since there is no way to determine the exact volume of the residual, catheterization is required.
The solution therefore is ultrasound technology. This allows for the accurate assessment of bladder volume to determine if catheterization is required or not. The Bladder Scan comes in two models the Bladder Volume Instrument BVI 2000 and BVI 2500. It uses ultrasound technology and this simply means that the device emits waves in the same way that a submarine uses sonar or a bat emits sound to determine the distance and shape of solid objects that cannot be seen by the naked eye.
Therefore, when the Bladder Scan is placed near the bladder area the machine can generate a three dimensional image that will allow the health care worker to assess bladder volume. If there is a way for an accurate assessment of bladder volume then the number of catheterization can be reduced and therefore one can also reduce the rate of infections, the cost of treating UTI, and increase the productivity of nurses. 1. What is the study problem?
Intermittent catheterization is the major intervention used to ensure that the bladder is emptied in “due to void” cases and in cases where there is postvoid residual and yet incomplete emptying has occurred. But there is one only problem, catheterization increases the rate of UTI. It is also a waste of nurse’s time and effort not to mention that patients complain of psychological and physical discomfort when catheterization is used. There is therefore a need to find a way to minimize unnecessary catheterization.
A bladder scan VBI 2500 will be tested for its effectiveness and efficiency in tertiary postoperative populations. 2. What is the study purpose? It was determined that one possible solution is to use bedside bladder ultrasound technology, specifically, the BVI 2500 Bladder Volume Instrument. In this regard the purpose of the study was to determine the effect of ultrasound assessment of bladder volume on patient and cost outcomes for patients needing postoperative catheterization. 3. Is the literature review presented?
Previous studies were identified and cited as a basis for the research. The most significant review of literature was a study made using a similar instrument. Ouslander and associates were cited as having performed an experiment using the Bladder Volume Instrument BVI 2000 and BVI 2500. The relevance of the review of literature was also seen in the discussion on the accuracy of the BVI 2000 and BVI 2500 in measuring bladder volume. It can also be seen from the discussion of the accuracy of the instrument when measuring postvoid residual.
Aside from the relevance of the literature it was also ascertained that the references were current. Moreover, the author did not only discuss what were the pertinent information that can be found in the said references but also critiqued the said studies by saying that although results favor the use of a bladder scanner but a clinical study is needed to determine its effectiveness and cost in tertiary postoperative populations. The author was able to do this by making a summary of the current knowledge provided by the references cited.
As stated earlier part of the summary includes the discussion on the success of the bladder scanner in nursing homes and in an outpatient clinic but there is no data when it comes to its effectiveness and efficiency in tertiary postoperative settings. 4. Is a study framework identified? The study framework was identified and listed in the form of research questions: ? What is the accuracy of ultrasound assessment of bladder volume? ? Does ultrasound assessment of bladder volume result in less frequent catheterization for “due to void” and “residual” events?
? Is there a difference in frequency of catheterization when bladder ultrasound assessment is used rather than standard catheterization procedure? ? Does ultrasound assessment of bladder volume versus standard catheterization result in decreased tract infections? ? Does ultrasound assessment of bladder fullness versus standard catheterization result in decreased health care cost? ? What is the patient and staff satisfaction with bladder ultrasound technology? 5. Are research objectives, questions or hypotheses used to direct the conduct of the study?
The aforementioned research objectives can be used to direct the conduct of the study. Its main focus is the determination of the accuracy and efficiency of the BVI 2500 bladder scanner in tertiary postoperative populations as well as to find out the satisfaction levels of patients and the nurses. 6. Are the major variables or concepts identified and defined (conceptually and operationally? Identify and define the appropriate variables. The variables were: 1) the number of catheterizations avoided; 2)infection rates; 3) cost analysis of catheter acquisition; and 4) patient/provider satisfaction.
The dependent variable is the number of catheterizations while the independent variable is the use of the bladder scanner as a tool to assess bladder fullness. Another dependent variable is the rate of UTI infections, the cost analysis of catheterization equipment and the satisfaction of patient and provider. 7. What attribute or demographic variables are examined in the study? An example of a demographic variable is the age of the subjects, age and surgical procedure that they had to go through. 8. Is the research design clearly addressed?
The research design was clearly addressed because the author made clear from the onset that this study is about an intervention, specifically the avoidance of catheterization which in turn will reduce the rate of infections. The author was also able to clarify how this can be achieved – by using a bladders scanner and for the control group the use of straight timed intermittent catheterization. The subjects were not randomly assigned there was a deliberate plan to use four surgical units as data collection sites. From these four surgical units the proponents of the study divided the 132 samples into two groups.
The first group contains 50 samples who had urologic, colon and gynecologic surgery while the second group contains 82 having total joint replacement and spine surgery. It is clear that the subjects were divided based on the type of surgeries that they went through. An explanation for this can be extracted from the review of literature wherein it says that bladder distention can be caused by anesthesia and medication. Thus, in order to minimize error it is best to group the subjects into the type of surgery that they went through.
But this type of grouping can result in the creation of extraneous variables. For instance even though there are surgeries that fall under general surgery such as urology and operation on the colon these two deal with different parts of the body. Urology for instance deal with the urinary tracts of males and females therefore it can have an effect on the bladder or the rate of infections in the urinary tracts of the patients. Another extraneous variable is the skill level of the nurses that were assigned to operate the bladder scanner.
There were no pilot studies conducted beforehand. All the necessary information needed for the design of the study were taken from the review of related literature. 9. Are the following elements of the sample described? The inclusion criteria includes patients who had undergone general and orthopaedic surgery. Exclusion criteria includes patients that had dermal ulcers, nephrotomy, obesity, confirmed pregnancy, in incision in a location that precludes ultrasound exam, or a known pelvic mass greater than 2 cm.
The sampling frame includes only those who are patients in a particular large tertiary care hospital chosen by the proponents and satisfy the following conditions: ? they had undergone general surgery; or ? they had undergone orthopaedic surgery. Based on the sample frame the sample size was determined to be 132. Power analysis was done after the experiment. The proponents wanted to find out if there age, gender and type of surgery had an effect on the test results. They were able to determine that only age and type of surgery had an impact on the test results whereas there was no significant difference when it comes to gender.
With the general surgical unit all were approved but with the orthopedic surgical unit only 53 was approved and therefor the attrition rate for the orthopaedic surgical unit was 39%. Before the patients were allowed to participate in the experiment the hospital’s Human Subjects Review Board had to approve the study protocol and all patients who had the stated surgeries and were “due to void” or “void with residual” assessment were screened for exclusion criteria and then approached for consent. All consenting patients on the general surgical unit were cleared to undergo ultrasound assessment of bladder volume.
Those who were approved to participate from the orthopaedic surgical unit were catheterized or assessed with the ultrasound technology. The setting was appropriate for the conduct of the study because it is a large tertiary postoperative facility and that the patients under their care needed to be catheterized especially those who are due to void or void with residual. 10. Are the measurements strategies described? The study used the Likert format having five anchors ranging from not satisfied to very satisfied.
This measurement strategy was developed by Rensis Likert and this was used to determine the level of satisfaction felt by the patient as well as the provider when it comes to the usage of bladder scanner. Another measurement strategy utilized in the study was the t-test, Chi Square and Pearson correlation. The t-test and Chi Square were used to examine difference between groups while the Pearson correlation was used to examine relationships between two variables. In the Likert system the level of measurement was ordinal. While the rest of the measurement strategies that were used in the study, the level of measurement was a ratio.
The measurement strategies used in this study were all reliable especially when it was reinforced by the use of the Statistical Package for the Social Sciences – a computer program that allows for quick but accurate computations. In the previous study or the experiment described in the literature review, the proponents used Test-Retest Reliability measurement. This measurement strategy is not as reliable as the measurement strategies used in the current study. It is simply a retesting of the same subjects but at a different time period.
If the design of the experiment was flawed to begin with the Test-Retest Reliability measurement will not be able to determine this type of error. 11. How were study procedures implemented and date collected during the study? The study procedures were implemented using standard timed intermittent catheterization protocol as well as ultrasound protocols. In the former there was a strict schedule to be followed and in the latter bladder scanners were used to assess bladder volume and from there make a decision to catheterize the patient or refrain from doing so. 12.
What statistical analyses are included in the research report? The Statistical Package fro the Social Sciences was used for analysis and an alpha level of 0. 5 was chosen as a level of significance. 13. What is the researcher’s interpretation of the findings? The researcher was pleased with the findings. Aside from the fact that the proponent was very confident of the reliability and accuracy of the data, the result also closely resembled the results of previous studies as seen in the literature review. 14. Are the limitations of the study identified by the researcher?
The researchers were able to point out the limitations of the study. First of all there was a problem with the sampling. The sample size was very small and because of this predicament the proponent of the stud was unable to make random selection of patients. For instance there were 50 patients in the general surgical unit and everyone were included in the experiment. There were also other factors that needed to be tested such as the type of surgeries that the subjects went through were varied especially in the general surgery group. 15.
What conclusions did the researcher identify based on this study and previous research? The proponent of the study was able to determine that ultrasound technology is an accurate and efficient way to assess bladder volume. But they were also able to ascertain that it would be better if a portable scanner will be used instead of a bigger and bulkier machine. 16. How does the researcher generalize the findings? The researcher made the generalization that the Bladder scanner is accurate and efficient. This is based on the results that say it was able to detect even low levels of urine in the “void with residual” category.
Researchers were also able to generalize that patient and provider were both highly satisfied with the use of the Bladder Scanner. 17. What implications do the findings have for nursing practice? This device can definitely help health workers to maximize their time and be more efficient. Standard timed intermittent catheterization requires for the insertion of a catheter on a regular basis and this will easily consume their time as well as increase the discomfort of the patients. 18. What suggestions are made for further studies? There is a need to look into the age difference of the subjects.
The researcher pointed out that age is a demographic factor that is significantly related to number of catheterizations required. In future studies there is a need to have a larger sample to so that the age of the subjects can be varied. 19. What are the missing elements of the study? One missing element is that there was no discussion regarding the warranty of the device. There was a generalization that it is cost-efficient to use the Bladder Scanner because it reduced the number of catheterization, the rates of infection and reduces the time needed for nurses to take care of UTI and intermittent catheterizations.
But there was no discussion regarding the ability of the Bladder Scanner to withstand repeated abuse. It was made clear that it would take 2. 9 years of continuous usage before one can recover the investment on the Bladder Scanner, there is a need to know if it is sturdy enough to last beyond a three-year period. 20. Is the description of the study sufficiently clear to allow for replication? The description of the study is sufficiently clear to allow for replication. The protocols that were established beforehand is a major reason why this study can be replicated.
The study conducted by Frederickson et al. was able to show the need for a Bladder Scanner or similar device in postoperative care. The bladder distention that will be experienced by the patients can cause complications and health problems if appropriate measures will not be taken. The traditional solution which is to insert a catheter into the urethra of the patient is no longer a viable option because it increases patient discomfort as well as increases the rate of infections.
The innovate solution of using standard time intermittent catheterization is not a very good solution because it still cannot eliminate the problems discussed earlier although it can slightly reduce the total amount of time that catheterization is used. The solution therefore is to use ultrasound technology such as the Bladder Scanner that will accurately and efficiently assess bladder volume. The accurate assessment will lead to the reduced usage of catheterization in postoperative care this will also allow for the reduction in the rates of infection, the cost of treating UTI, increase the efficiency of the nurses.
This will ease the burden of the nurses and make them more effective in focusing on other tasks this will also ease the psychological and physical discomfort of the patients. References Frederickson, M. et al. The Implementation of Bedside Bladder Ultrasound Technology: Effects on Patient and Cost postoperative Outcomes in Tertiary Care. Orthopaedic Nursing. 19(3): 79-87. Warner, A. J. et al. Postoperative Bladder Distention Measurement with Bladder Ultrasonograph. Journal of Perianesthesia Nursing 15(1): 20-5.