Table 2 Typology of RNs’ experience of bowel care management: challenges in bowel management
From: Bowel problem management among nursing home residents: a mixed methods study
Category | Problem | Consequence(s) |
|---|---|---|
Challenging resident group | Immobility | -Inactivity |
-Cannot reach toilet in time | ||
-Suppression of the need to defecate | ||
Bedridden | -Unable to sit during defecation | |
Cognitive impairment | -Cannot find toilet | |
-Cannot communicate needs or problems | ||
-Take off pads although they are needed | ||
Heterogeneous resident group | -Require different approaches | |
Monitoring problems | -Residents go alone to the toilet | |
Dehydration | -Constipation | |
Medication | -Pain- killers may cause constipation | |
-Extensive use of laxatives may lead to intestines unable to function without laxatives | ||
Resident and family experience | Faecal leakage or accidents | -Does not bother residents with dementia |
-Anxiety attack | ||
-Shamefulness | ||
-Attention-seeking behavior | ||
-Pads as safety | ||
Constipation | -Residents are restless or jumpy | |
Family | -Some family will not talk about bowel problems | |
-Residents do not want family to know about it | ||
-Next of kin have occasionally found their loved-ones in a mess with faeces | ||
Physical and organizational working conditions | Staff shortage | -Busy working days with many tasks |
-Toileting is time-consuming | ||
-Cannot follow resident to the toilet in time | ||
-Good bowel routines have a low priority | ||
Staff discontinuity | -Discontinuity in resident contact | |
-Unskilled nursing aides | ||
-Poor recording of bowel movements, fluid intake etc. | ||
Impractical physical environment | -Makes toileting difficult | |
-Makes recording of bowel movements difficult | ||
Professional challenges for the nursing group | Pre-conceptions | -Advanced age equated to FI |
-Constipation is considered to be a significant problem | ||
-Diarrhoea and FI are not considered to be significant problems | ||
Pad use | -Residents have been waiting for help from staff so many times | |
-Residents do not want to bother busy nurses | ||
-Residents have got used to defecating in pads | ||
Interdisciplinary cooperation | -Nurses often alone in decision-making and initiative to treat | |
Unfamiliar with FI treatment | -Never heard about electrical stimulation or biofeedback | |
-Just barely heard about residents receiving surgery | ||
Care organization | -Primary nursing is viewed as positive for bowel management |