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Professional Development and Ethics

Indus College of Nursing and Midwifery

NU 633: Professional Development and Ethics

Reflective log (Urinary Retention)

Suzana

POST RN year II semester III

Facilitator

M. Rafique Siyal

Date: 03rd February, 2022

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Professional Development and Ethics

REFLECTIVE LOG

DESCRIPTION:

In my duty shift I was assigned to take complete care of 4 patients in surgical ward. While

taking over from the Evening shift staff, the RN reported that one of our post-operative patients

had an indwelling catheter (IDC) which was taken out in the evening shift and patient voided

after removal of IDC. The RN reported that the patient's incontinent aid was moderately wet at

night, however, the patient was still complaining of not being able to void which made RN think

that the patient was confused. Upon receiving a handover, I went to check my patients and I

found that particular patient was restless and when asked he stated he had a lot of pain in his

lower abdomen. After reviewing his clinical notes I noticed patient received PRN (as needed)

analgesia for abdominal pain early that evening however no further investigation and

intervention were done for pain.

FEELING:

At that time, I felt the situation wasn't correct therefore I palpated the bladder.

EVALUATION:

A comprehensive physical examination must be performed by palpating and percussing the

bladder and other abdominal or pelvic organs (Selius, B. A., 2008). A quick physical

examination revealed distended lower abdomen. I immediately notified the junior medical officer

(JMO) working on the floor who reviewed the patient and ordered for immediate insertion of

IDC. Upon Insertion of IDC within few minutes the urine output was 600 ml and patient stated

he felt much more comfortable, and then it was clamped. Postoperative urinary retention is an

acute and painful inability to urinate following surgery, which can result in problems and a delay
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Professional Development and Ethics
in hospital discharge. The use of a urinary catheter is associated with an increased risk of

infection and can be stressful and inconvenient (Jackson J, 2018). Patient thanked me for not

ignoring his complain and responding ardently.

ANALYSIS:

Reflecting on this incident I feel I performed fairly well however, I should have acted much

sooner to alleviate my patient suffering. I now realize if I would have ignored the incident

thinking the patient is confused I would have put my patient's well-being at risk.

CONCLUSION:

Retention of more than 800mls of urine in bladder increases the risk of bladder over distention

injury. The bladder is a distensible organ and is typically able to hold up to 500 milliliters of

urine (Shermadou, 2021). Approximately 80% of health-care-associated UTIs are caused by the

use of indwelling urinary catheters; catheter-associated UTIs have been linked to increased

morbidity, mortality, length of stay, and hospital costs (Lachance, C. C, 2019).

ACTION PLAN:

Urine retention and incontinence have a significant negative impact on a person's life, and nurses

play an important role in assisting patients. Catheterization is frequently required for acute urine

retention but is only used as a last resort for incontinence. When using a catheter, however,

asepsis technique during insertion and ongoing management can help to minimize associated

problems. Urinary elimination issues are humiliating and distressing, and nurses must handle

them with sensitivity and empathy (Pellatt G. C, 2007).

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Professional Development and Ethics
REFERENCES:

1. Selius, B. A., & Subedi, R. (2008). Urinary retention in adults: diagnosis and initial

management. American family physician, 77(5), 643–650.

2. Jackson, J., Davies, P., Leggett, N., Nugawela, M. D., Scott, L. J., Leach, V.,

Richards, A., Blacker, A., Abrams, P., Sharma, J., Donovan, J., & Whiting, P. (2018).

Systematic review of interventions for the prevention and treatment of postoperative

urinary retention. BJS open, 3(1), 11–23. https://doi.org/10.1002/bjs5.50114

3. Shermadou, E. S., Rahman, S., & Leslie, S. W. (2021). Anatomy, Abdomen and

Pelvis, Bladder. In StatPearls. StatPearls Publishing.

4. Lachance, C. C., & Grobelna, A. (2019). Management of Patients with Long-Term

Indwelling Urinary Catheters: A Review of Guidelines. Canadian Agency for Drugs

and Technologies in Health.

5. Pellatt G. C. (2007). Urinary elimination: Part 2--retention, incontinence and

catheterization. British journal of nursing (Mark Allen Publishing), 16(8), 480–485.

https://doi.org/10.12968/bjon.2007.16.8.23419

Suzana