Hypothesis / aims of study
The urodynamic study, which seeks to respond to the suspicion of any functional alteration in patients with lower urinary tract symptomatology, allows the analysis of the different phases of urination. This is a procedure that, beyond being merely based on operational standards, changes according to each patient and allows a variation and individualized approach. The role of the nursing staff seeks to understand the person as a holistic and unique being according to the actual need. In addition, they are the ones who spend most of time in the procedure with the patient.
For the proper development of this study, it is necessary to perform an adequate anamnesis prior to the procedure, which according to the clinical aspects of the patient and the symptomatology allows us to address an adequate urodynamic question. A complementary tool is the use of standardized scales such as the International Prostate Symptom Scale or the International Consultation on Incontinence Questionnaire to identify the severity and characteristics of the symptomatology, as well as the affectation of the quality of life. In addition, the assessment of previous laboratory tests, such as urine culture, represents an important safety aspect in patient protection.
The understanding and individualization of the patient according to this process allows the recognition of risks inherent in the performance of the procedure and provides clinicians with key information in the performance of the examination. It also allows administrative assistance in decision-making to inquire about conditions that require cancellation or postponement of a study, considering patient safety and the risks of severe infection that correspond to 5 to 8%.
The presence of nursing staff in a center that performs urodynamic studies is key to the proper development of the same, so it is relevant to conduct a study of this profession and the impact it can have on the preparation, development, and analysis of this diagnostic study. The institutions are always looking for quality care, which is represented in higher standards of health, and a better patient experience in the procedures, also the articulated work of the medical team with nursing allows to facilitate the process to do this procedure.
In Colombia, there are only 22 centers where urodynamic studies are performed, of which only 4 have high-quality certification and in only one of them the person leading the process is a specialist.
This study aims to investigate the role of nursing in the process of education, administration, and assistance in the urodynamic study, in addition to sharing our experience and how it makes a difference, a fact that is represented in the results of nursing attention and care.
Study design, materials and methods
A narrative review of the literature was performed in PUBMED and EMBASE using the terms Urodynamic study, urodynamic study, urodynamics and nursing, a manual purging of articles with relevance to the proposed thematic was done and those that inquired about the role of nursing in urodynamics were defined to be included in the review.
Interpretation of results
Nursing intervention, as an educator, allows to reduce the anxiety or stress that may be generated by exposure to an invasive procedure, for which reliable language is used, and to answer any concerns prior to the procedure (1). In the specific aspect of urodynamics, the role of educating the patient is key, not only in inherent aspects of the procedure but also in emphasizing the moments that the patient should indicate, such as sensations or symptomatology (2). This previous education allows an understanding and an improvement in the feelings of anxiety and depression during the urodynamic study.
During the study, the role of the nurse becomes transcendent since he/she oversees assessing and accompanying the patient before and during the procedure, following up on the different questions that were addressed during the education and that would allow the clinical team to find an adequate answer to the urodynamic question (1,3). In this case, continuous and effective communication between the physician performing the study and the nursing team is key.
Finally, at the end of the procedure, it is the nursing staff who reminds the patient of the associated signs and symptoms of infection, in addition to performing a follow-up 24 to 72 hours later for the management indicators of the service and continuing with the key role of guaranteeing patient safety (1). On the other hand, monitoring and follow-up by nurses allow timely identification of patients at risk of complications, which would allow a guide for the proper management of these complications. Our institution's virtual institutional tool allows us to perform a standardized follow-up of these patients and focus on those who require strict follow-up according to the initial risk assessment.
Finally, by having nursing participation at the time of guaranteeing adequate reception, education, and initiation of the study, we have observed a reduction in the cancellation of procedures, by allowing an adequate approach in conjunction with the physicians, resolving the specific needs of the patients and carrying out efficient management of resources. This in turn, by means of active feedback between those who make up the nursing team and the clinical staff, creates processes that allow for improving patient care during the procedure, guaranteeing adequate patient safety.
This evaluation and the joint work with other areas such as infectiology allowed the identification of patients in special conditions that will have an indication of antibiotic prophylaxis in our institution (Table 1).
Concluding message
Nursing as a profession seeks to respond to patients' individual needs, but its marked contribution to the health system is usually administered in a service. This has allowed aspects such as adequate use of resources, but it is necessary to have a greater impact on the patient with tools such as education, previous assessment, and continuous follow-up. It is essential for the nursing team to have a comprehensive understanding of the different aspects and specific needs of the patients before and during the urodynamic study. This participation allows having a positive impact on patients, with benefits for urological patients. Finally, the continuous accompaniment of the patient, the previous education, and the understanding of the study allow the decrease of anxiety symptoms, allowing results closer to reality.