Analysis of the surveys on the use of new bag for collecting urine amongst men who have difficulties walking, conducted amongst patients and medical personnel (Valencia, October 2002) (Valencia, octubre de 2002)
SUPERVISOR OF THE UROLOGY WARD OF THE VALENCIA UNIVERSITY GENERAL HOSPITAL AND QUALIFIED NURSE
– Arcadio Real Romaguera
QUALIFIED NURSES AT THE VALENCIA UNIVERSITY GENERAL HOSPITAL
– José Buforn Valero.
– Amalia Rubia Fernandez
– Elena Ferrer Casares
– Cecilia Piquer Bosca
QUALIFIED NURSES EXPERT IN RESEARCH
– Cecilia Piquer Bosca
– Amparo Muñoz Izquierdo
Introduction to and the purpose of the bag
The first creatures to emerge at the dawn of time had no control over their sphincters, but over the course of evolution, mankind came to develop this ability. There were various consequences of this, such as aesthetic and social improvements, as well as better hygiene, but also the need to have to wait until one finds the right place for satisfying one’s physiological needs. The problems entailed by collecting urine in a controlled manner amongst people with impaired mobility has given rise to the invention of a whole host of devices employed for this purpose, from the urine flask introduced by Ambroise Paré to those used nowadays.
The receptacles most commonly used today to collect urine are rigid and are either disposed of or need to be cleaned after use. Our proposal is to use a disposable, recyclable plastic bag with spill-proof system to collect urine amongst men.
The purpose of this study is to analyse the preferences and views of healthcare professionals (nurses, nursing auxiliaries and healthcare assistants) on the use of urine flasks, pans and the new bag, and to compare them with the preferences and views of patients.
This study will provide us with information that will enable us to evaluate:
– The different views of the selfsame product
– The advantages of the product
– Other possible uses
– Possible improvements
No pre-existing literature on the subject has been identified.
Bag, diuresis bag, excreta bag, diuresis, urine bag.
Material and methods:
This is a descriptive, analytical, cross-sectional study.
– Male patients with impaired mobility admitted to the General Hospital and Valencia University receiving treatment for cancer as inpatients and outpatients.
– Healthcare professionals.
-From 1 June to 31 July 2002 for patients and from 15 to 31 July for healthcare professionals.
-No probability criteria, 150 healthcare professionals* (nurses and nursing auxiliaries), representing 25% of a total of 600; and 120 patients, representing 21.05% of a total of 570. * The initial proposal was to include doctors and healthcare auxiliaries in the study on the grounds that they are healthcare personnel, but the decision was subsequently made to exclude them as they do not generally handle such equipment and items.
-Questionnaire drawn up in-house consisting of eight questions, six of them dichotomic and two open.
Manner of administration of questionnaire:
-Self-administered. Patients and healthcare staff were each given three bags for use, after which they completed the questionnaire. The fact that the entire study sample completed the same questionnaire made it possible for us to compare and analyse the responses.
Manner in which the questionnaire was collected:
-The completed questionnaires were collected in person, the aim being to ensure that none went missing.
-In order to study the differences, the nurses and nursing auxiliaries have been grouped together in a single category as ‘professionals’, and hospitalised patients and those being treated in health clinics* have been grouped together in a single category as ‘patients’.
* These are outpatients receiving local cancer treatment whose urine has to be collected so that they can be properly treated.
A total of 325 questionnaires were administered. Some of those surveyed did not answer all the questions, as a result of which the total value for each item varies between 325 and 310. The study analyses 109 professionals (35.16%) and 201 patients (64.84%), all of whom are men. The study did not include relatives.
Do you think the new bag is convenient?
Professionals: Yes: 82%; No: 18%
Patients: Yes: 94%; No: 6%
Most of those surveyed state that the new bag is more convenient; the difference is statistically significant. The highest percentage (98.4%) of those declaring the new bag to more convenient is found amongst health clinic patients (cancer treatment), and the lowest amongst nurses (75%).
Do you think it is more hygienic than the previous receptacles?
Professionals: Yes: 99%; No: 1%
Patients: Yes: 95%; No: 5%
In the main, the new bag is thought to be more hygienic; the difference is not statistically significant. The percentage figures for responses are very high in both cases, though it is especially striking that nearly all the professionals declared it to be more hygienic.
Do you think it is easier to use?
Professionals: Yes: 66%; No: 34%
Patients: Yes: 88%; No: 12%
Amongst professionals, 66% believe the new bag to be easier to use, though there are a clear 34% who do not think this to be the case. When we analyse the distribution within this group, we find that 54% of nurses believe it to be easier to use, as compared to 79% of nursing auxiliaries.
This analysis is related to the following factors:
Nursing auxiliaries in the main give bottles, flasks, pans or the new bag to patients, They are also the ones who benefit most directly from the advantages that would derive from introducing this new system (less work involved in cleaning receptacles, the spill-proof system prevents spillage, the urine is held in a sealed system, etc.).
Nurses give flasks, pans or the new bag to patients in a clinically worse condition. They have to take the patient’s penis in their hand in order to insert it into the bag and do not in principle connect the advantages to be gained from changing over to bags (improved asepsis and no spillages).
Do you think it is easier to dispose of?
Professionals: Yes: 93%; No: 7%
Patients: Yes: 96%; No: 4%
Patients and professionals alike consider that the bags are easier to dispose of and more discreet than flasks; the difference is not statistically significant.
Do you think it is more discreet than previous receptacles?
Professionals: Yes: 95%; No: 5%
Patients: Yes: 95%; No: 5%
The vast majority believe that the bags are more discreet than previous receptacles. It is difficult to find a logical reason why 5% should believe it to be less discreet.
Would you prefer to use the new bag or the previous receptacle?
Professionals: the new bag: 80%; the previous receptacle: 20%
Patients: the new bag: 91%; the previous receptacle: 9%
Most of those surveyed declared that they prefer to use the new bag, in particular patients (91%) in comparison with professionals (80%); the difference is statistically significant.
Seven potential other uses were mentioned, the most noteworthy being for use as vomit bags while travelling, and for spitting or expectorating into. Suggestions have been grouped into 13 categories, the most frequent being the comment that the bag could be made larger.
The survey also highlighted the facts that:
1- The bag has a spill-proof system that prevents urine in it from getting out. Pans and flasks can overturn when being removed, with all the consequent upset for the patient and additional work and cost (changing the sheets or bed, washing the patient, etc.). 2- There are no unpleasant smells produced when the new bag is used. As the urine is sealed in the bag, it does not come into contact with the air or oxidise, and hence does not smell. 3- The new bag is superior in terms of hygiene: Amongst patients: the bag prevents diseases from being passed from one patient to another due to mistakes over whose flask or pan is whose, etc. Amongst medical professionals: they do not have to handle the receptacle for cleaning and disinfection. 4- The new bag is an invaluable tool in the fight against nosocomial infections. 5- The new bag saves both human and material resources: – Nursing auxiliaries’ time and labour – Cleaning products and disinfectants, packaging, the risk of possible infection, etc. – The bags take up less space during transport and storage. 6- The new bag is an evident improvement in image. 7- The new bag prevents patients and others from being embarrassed at the sight of a pan or flask on the bedside table or in the room. 8- To conclude, this bag is a breakthrough reminiscent of the introduction of diuresis bags for catheters, disposable syringes, etc. It is today unimaginable to think that such products might have to be washed and disinfected for use by other patients.
Conclusion and discussion
Increasing numbers of men with difficulties walking are being admitted to our hospital, which means that we are forced to use receptacles for collecting urine. The same is also true of wards and hospitals for the chronically ill and of patients receiving hospital treatment at home, in old people’s homes, etc.
The results that we have obtained from our study sample show that the introduction of this new system is to be encouraged. Those aspects of the bag most highly valued are convenience and hygiene.
It is interesting to note that although both groups largely prefer or opt for the new bag, patients are even more predisposed towards it than professionals.
The health system is constantly changing and every new system improves the previous state of affairs. According to our results, the new bag can be more comfortable for men with impaired mobility to use. Moreover, as it is disposable. it eliminates the risk of infection amongst patients and medical professionals and hence is safer.
There is no specific literature
Translated by: Sue Brownbridge