Confidence and Perceived Benefit of Nurses Participating in a Simulation-Based LearningExperience for Male Urethral Catheterization:A Quality Improvement Project

Introduction: Men undergoing urethral catheterization are at increased risk of urethral trauma, infection and long-term sequela resulting from insufficient training, depleting skills, or lack of knowledge bynurses who perform this procedure. The use of simulation and training oversight by an experienced urology nurse practitioner has the potential to address loss of competency in practicing nurses’ skills and improve confidence in male catheterization thereby decreasing iatrogenic urethral injuries and infection.Purpose:The aim of this quality improvement project was to assess nurses’ skills, knowledge, and confidence in male Foley and coudé catheter placement utilizing clinical simulation to improve future outcomes for men undergoing this procedure.Methods: Fifty Registered Nurses (RNs ) practicing in the perioperative department were invited to participate in a clinical simulation-based learning experience for male catheterization. Prior to simulation, the hospital’s policy and procedure checklist was provided to each RN for review. A5- point Likert scale survey assessing respondent characteristics, confidence, skills, and perceived benefits of simulation training was administered before and at the completion of the educational experience. Skills assessed included the use of sterile technique, and methods for catheter placement in a male patient.Results: The project outcomes showed discrepancies in knowledge and skills for techniques in male catheterization including failing to insert the Foley catheter to the bifurcation, failing to obtain urine output prior to balloon inflation, uncertainty about how to insert a coudé catheter and sterile draping and cleansing the urethral meatus when using the catheter insertion kit. Finally,5RNs were found to be unfamiliar with their hospital’s policy for this skill. Results of a Wilcoxon signed rank test revealed a highly significant increase (p<.001) in both performing male urethral catheterization, as well as nurse confidence after the simulation educational intervention.Discussion:This educational intervention showed clinically significant outcomes in increasing nurses’confidence and skills in performing male catheterization and identified gaps that could compromise the care of male patients undergoing urethral catherization.