SETTING: Hospital Ward
Model role play by LTC

SETTING: Hospital Ward NURSE: ‘You see a 40-year-old patient who had a urinary catheter inserted following a hernia repair. He/she had the catheter removed six hours ago and you are monitoring his/her bladder function. TASK: § Find out how the patient is feeling (any pain, whether passed urine, etc.). § Find out more details about the pain (onset, treatment tried, etc.). Explore the patient’s hydration (quantity, time of last drink, etc.). § Explain the purpose of the trial without catheter (e.g., ensure bladder function restored, etc.), and trial failure (no urine passed in six hours). Outline next steps (re-insert catheter, discharge with catheter bag, retrial within one week). § Warn the patient of possible risks of not re-inserting the catheter (e.g., urinary retention, infection, etc.). § Give details of catheter management (ease of emptying catheter bag, community nursing support available, etc.). Establish patient consent for catheter reinsertion. § Inform the patient of timescale for returning to hospital (within 1 week to remove the catheter, then repeat trial without catheter) and advise him/her to return sooner if he/she is worried (increasing pain, etc.).

Model answer

Nurse: Hi John, I am Matthew, one of the registered nurses, working in this hospital ward. How are you feeling?

Patient: I am okay nurse, thanks.

Nurse: I am glad to hear that. From your records, I understand that you underwent a hernia repair, and presently your bladder function is being monitored without the aid of a catheter. Is that correct?

Patient: Yes, that’s correct.

Nurse: Okay. Before we proceed any further, I would like to ask you a few questions for documentation purposes. Is that alright?

Patient: Yes, sure.

Nurse: Thanks. I would like to know how you are feeling overall.

Patient: I am okay.

Nurse: Do you experience any pain?

Patient: Yes, I have a little pain in my abdomen area, but it is manageable. I don’t worry about it.

Nurse: Have you passed urine after the catheter removal?

Patient: No, I haven’t.

Nurse: Okay, when exactly did the pain start?

Patient: I think it started after the catheter was removed.

Nurse: Have you taken any pain medication?

Patient: No, I haven’t.

Nurse: Okay. Now, I would like to know about your fluid intake. Have you been drinking enough water?

Patient: Yes.

Nurse: When did you last drink water?

Patient: I’ve been drinking every hour.

Nurse: How much water have you been drinking?

Patient: Two glasses each time.

Nurse: That’s good.

Patient: I was hoping to be discharged as the catheter was removed.

Nurse: I understand John. Let me explain to you what’s going on. We’ve been checking your bladder function without the help of a catheter to see if your bladder function is fully restored. Unfortunately, the trial is a failure as you’ve not passed urine in the past six hours.

Patient: Okay.

Nurse: John, I know that it might sound frustrating; however, we need to make sure that your bladder function is fully restored; therefore, we need to re-insert the catheter.

Patient: I really don’t want the catheter to be reinserted. I hate it. There must be another way.

Nurse: I totally understand it John. However, please try to understand the situation. Let me explain to you the next steps. We will re-insert the catheter and discharge you with a catheter bag. You take rest at home, and in a week’s time, we will redo the trial. We hope that by that time, everything will be functioning fully. What do you think, can we proceed with that?

Patient: Actually, I hate the idea of wearing a catheter bag. Moreover, I don’t even know how to empty the bag.

Nurse: I understand. This indeed is not a pleasant situation. However, we must consider the risks that are involved if we don’t re-insert the catheter. For example, if we do not re-insert the catheter now, in worst-case scenarios, it could lead to urinary retention, urinal infection, and so on. Therefore, I would recommend you comply with the procedure for now as to avoid further complications.

Patient: Fine, I will do it; let me just go home after you re-insert the catheter. By the way, when exactly do I have to be back to the hospital?

Nurse: Thanks, John, for your agreement in this matter. Like I mentioned earlier, within one week, let’s say in 5-6 days, you can come back to the hospital for the retrial. However, please note that you can return to the hospital sooner in case if you feel any sort of abnormal or increased pain. How does that sound?

Patient: Sounds okay to me. I will be careful and monitor my pain. I really hope to get the catheter removed as soon as possible.

Nurse: We desire the same for you, John. Do you have any other questions or doubts that you would like to ask me?

Patient: No.

Nurse: To summarize our conversation, you’re currently under a catheter trial after undergoing a hernia repair. As you were not able to pass urine even after six hours of removal of the catheter, we will discharge you after re-insertion of the catheter and redo the trial within a week. Please remember to return immediately to the hospital if you feel any sort of elevated pain. I also recommend you stay hydrated at home as it would help your bladder function. Please drink plenty of water every hour. Do you understand everything I have explained, John?

Patient: Yes, nurse.

Nurse: Wonderful. Do I have your permission to re-insert the catheter?

Patient: Yes, you may.

Nurse: Thank you, John.

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