20 4.3.4 Cognitive Ability Teaching self-catheterisation to children is affected by both the age of the child and its level of cognition. In the first instance, the teaching method and the information should be adapted to the child's age and ability. Impaired cognition can affect insight, motivation, compliance, and long-term independence. It should also be recognized that some children may appear verbally competent but have a significant cognitive impairment, for example, children with hydrocephalus. Inadequate assessment can severely hamper the learning process.21 Discussions regarding the child's social situation and educational ability can help clarify cognitive ability and achieve the best outcome. Children with autism spectrum disorders (ASD) are likely to require specific and extra attention. Some children may experience organisational and sequencing difficulties (notably those with hydrocephalus).30 Pictorial teaching aids and step-by-step guides are available on websites (Appendix F) and can be useful in these circumstances. Watches with an alarm or vibrating buzzer that can be set to go off at fixed times can also be useful reminders to catheterise. For some children, learning a new, tricky technique can be traumatic. In such cases, support from a psychologist may be indicated. … Recommendation LE GR Assess cognition before teaching the technique. Does it match the child's age? Adjust your instruction to both age and cognition (pictograms), and where necessary arrange for additional support and aids e.g., vibrating/alarming watches 4 C 4.3.5 Physical ability Difficulties when learning self-catheterisation can be caused by a lack of gross motor skills such as sitting or standing, fine motor skills such as dexterity and good hand function) or sensory skills such as poor vision and limited or absent sensation. Special catheters and devices, as mentioned in Chapter 3, may be useful to aid independence; however, sometimes, the child will need the help of a parent or healthcare professional to carry out the procedure. Sometimes, it is just not possible to catheterise via the urethra; in this case, a catheterise stoma may be an option. 37 Although there are many similarities in the learning process, for clarity, we have chosen to exclude catheterisation via a catheterisable stoma from these guidelines. For patients to continue to use CIC/CISC successfully as part of their daily routine, the procedure must be made as easy and quick as possible. 38 The procedure of CIC/CISC has been shown not to negatively affect children emotionally, no matter their age. However, most parents initially found it unpleasant to have to catheterise their child, but despite this, they complied with the proposed bladder management schedule. 25 It is important for healthcare professionals to consider the psychological, emotional, and social implications for parents and children who need to learn and perform CIC/CISC. This can often pose the biggest challenge of this treatment. Effective communication, information giving, and positive attitudes can help to alleviate patients' anxiety and embarrassment.27 4.3.6 Practical/Social Considerations Whatever the age of the child, it is important to ensure dignity and privacy are promoted whenever and wherever catheterisation is taught or performed. The correct facilities must be available for hand washing, storage, and catheterising in both home and school settings. Poor sanitary conditions and hygiene can also increase the risk of infection. Parents may need advice or help with ensuring adequate facilities. It is essential that catheterisation is integrated easily into all parts of daily life, including school, travel/holidays, sports clubs, and activities. Failure to do so will affect the child’s physical, social, and emotional development and affect compliance with catheterisation. 33,39 Children and parents must be given choices and involved in negotiating the catheterisation regime to fit their lifestyle and activities. Children should be allowed to choose who knows about their catheterisation and who they wish to be informed. It is, however, beneficial for the child if certain people, e.g., a class teacher or a staff member at out-of-school activities, are aware. They can be a support for the child if there is any stress, anxiety,
RkJQdWJsaXNoZXIy NjM1NTk=