Continent Urinary Diversions: Planning Nursing Interventions with the Iowa Model

Topic:  The Iowa model of evidence-based practice is utilized to identify the best method to care for continent urinary diversions.  A problem focused trigger, identification of a clinical problem, led to a literature review on the care of continent urinary diversions.  Cancer of the bladder affects thousands of Americans yearly.  Cystectomy with urinary diversion is a mainstay of treatment for patients with muscle invasive disease.  Although no one type of urinary diversion has been determined to be superior, current regional surgical trends with cystectomy are leading surgeons to opt for continent urinary diversions for patients undergoing cystectomy.  Measures to manage a continent urinary diversion needed to be selected to provide optimal outcomes.  

Purpose:  To demonstrate the application of the Iowa model as a means to determine care of continent urinary diversions.  A plan was formulated that included an institutional policy and a teaching plan including  pre and post-operative patient information and a long term management plan.  The Iowa model helped to incorporate research-based evidence as well as other forms of evidence when randomized clinical trials were lacking.  

Objective:  To develop patient education tools and institutional policy for care of patients undergoing continent urinary diversions utilizing the Iowa model of evidence based practice. 

Outcomes:  A review of the literature was performed to explore available evidence on the care of continent urinary diversions.  The health care team embraced the use of a new institutional policy and patient teaching literature as it  was based on the available evidence.  A preoperative teaching plan, an institutional postoperative care policy and written patient educational materials were developed.  The Iowa model provided a firm foundation to review the evidence and determine a course of action for providing care.  This model also allows for the advancement of research by encouraging the development of studies when evidence is lacking.