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Patients diagnosed with bladder cancer may require a urinary diversion to maximize their health care outcomes. These patients, faced with sudden changes in their health status, develop complex unmet needs that can be addressed by a planned program of education. Peplau's theory of interpersonal relations offers a framework for patient teaching that emphasizes the importance of the nurse-patient relationship. This therapeutic relationship enables the nurse to provide the patient with the information needed to understand the diagnosis, cooperate in the treatment plan, facilitate postoperative recovery, and return to a state of independence with quality of life.
Bladder cancer is the second most common urologic cancer in the United States resulting in over 61,000 new cases in 2006 (American Cancer Society, 2006). Approximately 30% of all new cases present with muscle-invasive disease that requires a radical cystectomy and a urinary diversion for the best cure rate. Surgical options for a urinary diversion include an ileal conduit diversion or the formation of a continent urinary reservoir (CUR) (Kane, 2000a; Perimenis & Koliopanou, 2004). The teaching needs of persons with a surgically altered urinary tract system are significant. Patients undergoing this major abdominal surgery are at risk for multiple postoperative complications including pneumonia, ileus, infections, thrombophlebitis, and emboli. Further, the potential for altered body image, incontinence, and changes in sexual functioning exist (Perimenis & Koliopanou, 2004). As the length of hospitalization decreases, the patient and/or family are required to assume more responsibility for postoperative care at an earlier date. A well-planned, concise nursing intervention/teaching program is necessary to facilitate the transition from hospital to home. The purpose of this article is to show how Hildegard Peplau's Theory of Interpersonal Relations can guide the nurse's effort to provide critical teaching for these patients.
Overview of Continent Urinary Reservoir
Continent urinary reservoirs reflect the state of the art approach to urinary diversion. Two types of CURs are constructed by isolating and detaching various sections of the intestine and configuring this tissue into a sphere (Gray & Beitz, 2005; Kane, 2000a). This sphere-shaped reservoir is then anastomosed to the intact upper urinary tract system (Gray & Beitz, 2005). Elimination of urine depends on the type of diversion created. The orthotopic neobladder is reattached to the urethra so that the patient...