Exploring reasons for variation in urinary catheterisation prevalence in care homes: a qualitative study

SIR—About half of long-term care home residents have urinary incontinence[1, 2]. Among elderly care home residents, urinary catheters are independently associated with increased mortality and morbidity[3, 4]. Urinary catheter care bundles are now used by acute and community trusts to focus on catheter care[5, 6]. English care homes with a high prevalence of urinary catheters among their residents did not vary significantly from lower-prevalence homes in home size, residents' medical needs, staffing, staff knowledge or reported catheter care practices[2, 7]. Care homes that have a complete care culture that is focused on residents individual needs rather than those that are task-centred or cosmetic (primary emphasis on business needs) may have fewer catheterised residents[8]. In this study, we used qualitative research methods[9] to explore whether different approaches to toileting and catheter care, and a home's culture of care (care delivery, attitudes and communication) are responsible for the variation in the prevalence of catheterisation.