Nurse decision to insert a urinary catheter in a female patient in orthopaedic speciality: The development of a protocol to guide care

Insertion of a urinary catheter has long been considered a basic nursing skill and role (Robinson, 2006 and RCN, 2008). Yet the decision to insert a catheter is mostly cited as a medical decision (Stockowski, 2009, Robinson, 2006, Robinson et al., 2007 and Reilly et al., 2006). Inserting a urinary catheter is an invasive procedure, and should only be performed when absolutely necessary (Crouzet et al., 2007 and RCN, 2008). However, the practicalities of waiting for a medical decision to insert a catheter can sometimes lead to a delay in the delivery of appropriate patient care at the appropriate time. Incidentally, patients are at risk of increased discomfort and stress and nursing staff can be left feeling disempowered and frustrated. The introduction of care protocols has been linked with enhanced patient care, improved patient outcomes, and enhanced nursing job satisfaction due to increased autonomy (Hewitt-Taylor and Melling, 2004). Protocol based care has been successful in initiating the removal of unnecessary catheters (Reilly et al., 2006, Robinson et al., 2007 and Gotelli et al., 2008), and as a guide for the insertion of catheters in the community setting (Booth and Clarkson, 2007). This article describes the development of a protocol to guide nurses in their decision to catheterise female patients in an Orthopaedic unit of a Large Urban Hospital in the West of Ireland.