(Re)defining nurse and patient roles in routine postoperative neurosurgical care: empowering autonomy and strengthening collaborative roles

Abstract

This dissertation redefines nurse and patient roles in routine postoperative neurosurgical care—especially after transsphenoidal pituitary and spinal fusion surgery—by targeting urinary monitoring and catheter use. Using qualitative studies (professionals and patients), a systematic review, and implementation work, it shows that early removal of indwelling urinary catheters (IDUCs) generally accelerates mobilization and can shorten hospital stay, while keeping IDUCs ≥24 hours increases UTI risk. Yet removal is often delayed by nurses’ fear of re-catheterization, workload routines, and hierarchical cultures. Patients report conflicting information, feelings of dependency and shame with IDUCs, but some prefer catheters during mandatory bed rest; overall, shared decision-making is limited. The thesis argues that standardized, nurse-led protocols plus behavioral support—not just guidelines—enable timely removal, and that empowering patients to monitor fluid balance (e.g., simplifying urine specific gravity checks) aids early detection of AVP-deficiency after pituitary surgery. It concludes with practical recommendations: adopt early, nurse-driven removal with vigilant retention monitoring, standardize complication definitions, and embed patient participation to improve outcomes and value of care.