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Getting Everyone in the Same Room

The Combined Therapist Approach to Teaching Independence in Clean Intermittent Catheterization

Singh, Ranjit Kaur Jarneal, BScN; Sng, Jamie, BSc, OT; Yeong, Melissa May Yan, BSc, OT; Nadeson, Vannaja, BScN; Ong, Caroline Choo Phaik, MBBS, FRCS, MSurgicalEd

Journal of Pediatric Surgical Nursing: October/December 2018 - Volume 7 - Issue 4 - p 126–131
doi: 10.1097/JPS.0000000000000192
Feature Article

Introduction Most pediatric patients with neurogenic bladder require clean intermittent catheterization (CIC), several times daily, for maintenance of continence and health. CIC is performed by the caregiver until the child is developmentally ready to learn self-CIC. Children with associated mobility, dexterity, and cognitive deficits tend to take much longer to learn self-CIC. We piloted a combined pediatric urotherapy and occupational therapy clinic to address this problem.

Methods Five children (6–14 years old) and their parents attended combined therapist sessions for 6 months. Explanation of self-CIC was done using show-and-tell method followed by doll play and/or supervised practice. Patients' mastery difficulties were identified by demonstration and collaborative discussion. Specific tasks and activities were recommended for home practice after task assessment and analysis. Reasons for slow progress in learning self-CIC were documented.

Results All five children had motor and cognitive difficulties. Previously, caregivers regularly overassisted, which prevented patient practice and exposure. Task assessment, analysis, and recommendation had been suboptimal because patients' different combinations of disabilities caused unique difficulties with self-CIC that were unrecognized when attending individual therapist sessions. After the combined clinic, patients increased participation in the preparatory phase of self-CIC, functional mobility and dressing tasks.

Discussion Despite longer session duration and scheduling constraints, the combined therapist approach was more efficient and effective for this category of patients, with fewer return sessions needed to achieve the desired outcome. We recommend early identification and referral of appropriate patients for a combined therapy clinic.

Ranjit Kaur Jarneal Singh, BScN Nurse Clinician, Division of Nursing, KK Women's & Children's Hospital, Singapore.

Jamie Sng, BSc, OT Occupational Therapist, Occupation Therapy Service, Rehabilitation Centre, KK Women's & Children's Hospital, Singapore.

Melissa May Yan Yeong, BSc, OT Senior Occupational Therapist, Occupation Therapy Service, Rehabilitation Centre, KK Women's & Children's Hospital, Singapore.

Vannaja Nadeson, BScN Assistant Director Nursing, Division of Nursing, KK Women's & Children's Hospital, Singapore.

Caroline Choo Phaik Ong, MBBS, FRCS, MSurgicalEd Senior Consultant, Department of Paediatric Surgery, KK Women's & Children's Hospital; and Duke-NUS Medical School, Singapore.

The authors have declared no conflict of interest.

Correspondence: Ranjit Kaur Jarneal Singh, BScN, Division of Nursing, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899. E-mail:

Copyright © 2018 American Pediatric Surgical Nursing Association
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