The care workforce is central to the quality of care in aged care homes in Australia. The knowledge, confidence and skill of the aged care workforce is fundamentally important for the quality of life and wellbeing of people in aged care homes. The Royal Commission into Aged Care Quality and Safety has identified the need to grow a skilled and high-quality workforce to care for senior Australians.

Continence care is a critical issue in aged care, as almost three quarters of people in residential aged care are impacted by continence issues. One aspect of care that warrants particular attention is indwelling urinary catheter care. An analysis of data from the Australian National Aged Care Classification funding model (AN-ACC) for 2022-2023 conducted by the National Ageing Research Institute (NARI) found 8% of people living in aged care homes in Australia require catheter care. This represents 20,021 aged care residents. Whilst some peoples’ lives are improved by having a urinary catheter, others experience complications that affect their physical and emotional health, independence, dignity and quality of life.

The Royal Commission heard evidence of poor quality, unsafe practice in relation to indwelling catheter care and recognised its importance. To gain a deeper understanding of the issues related to catheter and care in aged care homes, in 2023 researchers from NARI consulted with residential aged care stakeholders in Victoria. They found people in aged care home who had a urinary catheter often experience catheter-associated urinary tract infections, catheter blockage, catheter leakage, pain, and hematuria, and are at risk of being admitted to hospitals and emergency departments for these problems. Stakeholders described a lack of confidence and capacity within the sector to insert and remove/replace catheters, and to assess and manage catheter-related complications. Some stated the consequence of this situation is that people with catheters can experience delays in accessing treatment which can have devastating effects on their overall health and wellbeing. Specifically, a delay in responding to catheter blockage increases the risk of bacteremia, sepsis, damage to the upper urinary tract and premature death.

Although pre-registration nursing programs in Australia equip both registered and enrolled nurses with knowledge and skills to provide catheter care, nurses’ exposure to people with catheters are likely to vary. Indeed, many nurses will have had had limited experience caring for people with catheters outside the acute care context.

To support aged care providers to consistently deliver evidence-informed and person-centred catheter care, researchers at NARI are conducting a nurse-led project titled ‘The IDC-IMPROVE Project’ to establish the feasibility of a bundle of resources about catheter care. The resources, which were designed in consultation with people with the lived experience over the last 18 months, take account of the contextual conditions of catheter use in Australian aged care homes and address both the emotional and physical impacts of urinary catheter care. As most guidelines and resources about urinary catheters focus on short term urinary catheterisation in acute care settings and on the clinical issues, the IDC-IMPROVE resources are unique.

The IDC-IMPROVE bundle of resources consist of:

• Principles for Person-Centred Catheter Care
• An online short course for Registered and Enrolled Nurses about person-centred catheter care.
• An online short course for Personal Care Workers about person-centred catheter care.
• A Catheter Care Toolkit for Managers/Senior leaders
• A Catheter Care Audit Tool
• Catheter Care Capabilities for nurses and personal care workers
• An Evidence-to-Practice Support Model

NARI have partnered with the Continence Foundation of Australia to also deliver site based Catheterisation Skills Workshops where nurses can practice the catheterisation process in a safe environment.

NARI’s program of research on continence and catheter care led by Dr Joan Ostaszkiewicz (a nurse researcher), advocates for the dignity of the person to be at the centre of decision-making about social and healthcare. The project team are part of a global transdisciplinary network that aims to improve continence care for older people who are care dependent.

Having a catheter signifies to others a loss of bladder control. People with urinary catheters should not have to contend with other peoples’ negative opinions and judgement. They have a right to care that is clinical safe as well as care that upholds their dignity. Dr Joan Ostaszkiewicz

In the next stage of the project, the project team will conduct a multi-centre, facility-level cluster randomised control trial to investigate whether the resources are feasible to implement in Australian aged care homes. They are aiming to recruit 24 aged care homes from Victoria, South Australia and Queensland.

We are hopeful that implementing the IDC-IMPROVE resources will increase staff knowledge, confidence and skill that will subsequently improve the identification and management of catheter-related problems, reduce avoidable transfers to hospital and emergency departments, and improve the emotional wellbeing, independence dignity and quality of life of people with catheters in aged care homes. Dr Joan Ostaszkiewicz

The IDC-IMPROVE Project is funded by the Medical Research Future Fund (MRFF) under the 2022 Clinician Researchers Initiative [MRFF2023825]. It represents a partnership between NARI, the Continence Foundation of Australia, the University of Melbourne, the University of South Australia, Central Queensland University, Flinders University, the University of Alberta, Darling Downs Hospital and Health Service, the Australian Prostate Centre, Austin Health, Regis Aged Care, the Australian Nursing and Midwifery Federation, the Continence Nurses Society Australia and the Australian and New Zealand Urological Nurses Society. It is guided by a project advisory group of key stakeholders including aged care residents with urinary catheters, family carers of residents with catheters, clinical experts, and aged care employees.

If you or your provider wish to participate in the trial or would like to know more about the IDC-IMPROVE Project, please contact Dr Joan Ostaszkiewicz, Email: j.ostaszkiewicz@nari.edu.au or go to the NARI IDC-IMPROVE website to register: https://www.nari.net.au/idc-improve