16 Chapter 4 Nursing interventions 4.1 Teaching self-catheterisation CIC/CISC is currently an important therapeutic procedure in paediatric urology and is carried out in all age groups. The aim of CIC/CISC is to enable adequate and safe bladder management, which is necessary for children to be healthy, have self-esteem, and promote independence as they grow up. 7,23 We know that CIC/CISC does not cause any major emotional or behavioural problems.24,27,35 CIC/CISC can give children freedom and self-respect, facilitating an independent life. The positive experiences of CIC/CISC reported by Lopes et al. 2011 may result from achieving continence and no longer requiring incontinence products. 25 However, learning and teaching CIC/CISC can be challenging. A specialist nurse is indispensable when teaching a child CIC/CISC. The nurse should be familiar with the emotional and psychological impact of CIC/CISC on children, adolescents, and adults and aware of the child’s level of development. The age at which a child can learn to self-catheterise depends on the cognitive level of both the child and the parents, which must be considered when teaching children and parents. It is important to take account of any resistance to the procedure, concerns of embarrassment and fear of possible pain. The child and family's existing knowledge of the anatomy of the urinary tract, the reason for CIC/CISC, and insight into the medical condition, along with other possible treatment options, is also important. 23 Nowadays, new virtual aids are being developed rapidly, such as virtual reality (VR) glasses or Qwiek-up (https://www.qwiek.eu). With a growing body of evidence supporting VR distraction, clinicians, notably nurses, will be able to leverage VR technology to reduce the high rates of pain and anxiety associated with medical procedures. 28 For VR glasses, literature is available for managing paediatric procedural pain and anxiety. But also comfort talk, which is done through structured attention and self-hypnotic relaxation, has proven beneficial during invasive medical procedures.29 Teaching CIC/CISC can take place individually or in a group.21,26 Taking a relaxed approach, giving them sufficient time, offering them privacy and respect for intimacy are needed to overcome embarrassment and anxiety and make it easier to exchange and acquire information. 26,27,29 The ideal place for teaching CIC/CISC is usually the home setting as it is familiar territory, and the patient feels safer there.26 However, in daily practice, this is not always possible. It is also very important to motivate and compliment parents and children to boost self-confidence.27 Holland J et al. 2015 describe a pilot study evaluating the safety, feasibility, and usefulness of the SelfCathing Experience Journal (SC-EJ), an online resource for patients and families to address issues and stigma surrounding clean intermittent catheterisation.30 It is a psychoeducational tool designed to facilitate healthy coping and acceptance of the medical benefits of self-catheterization for patients and families who are recommended to initiate CIC. (The SC-EJ can be viewed at http:// www.experiencejournal.com/journals/self-cathing) It is essential, when teaching catheterisation, that the healthcare professional is knowledgeable about the types of catheters available and can give advice and information regarding the most suitable options for the child and family depending on their underlying medical problem, individual circumstances and surgical procedures, which the child may have undergone.26 These factors may dictate specific types or lengths of catheters which may be needed. Other factors such as frequency of catheterisation, hygiene issues, predisposition to UTIs, medication, physical problems such as dexterity, access due to wheelchairs, and additional need for continence aids may also influence the choice of catheter and teaching of CIC/CISC.
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