VOL: 98, ISSUE: 04, PAGE NO: 47
Ray Addison, RN, FETC, Cert.H.Ed, BSc, is nurse consultant, bladder and bowel dysfunction, Mayday Healthcare NHS Trust, Croydon, honorary nurse consultant to the UK Continence Foundation and honorary lecturer, St George's Medical School and Kingston UniversityThere have been sporadic cases heard at the UKCC related to poor bowel care, and there are wide variations in standards and practice in bowel care interventions throughout the country. Why is this so?
There have been sporadic cases heard at the UKCC related to poor bowel care, and there are wide variations in standards and practice in bowel care interventions throughout the country. Why is this so?
Compared to bladder dysfunction, bowel dysfunction is the poor relative. Nursing interventions for bowel care are frequently based on historical belief and custom and practice rather than a strong evidence base. In fact, the evidence base supporting many bowel care interventions is patchy. Many nurses may not know if the way they manage bowel dysfunction is best practice and the most appropriate care for their patient. Equally, nurses need to be aware of the harmful consequences of inappropriate care. It is important to remember that patients give consent to certain nursing bowel care interventions - for example, an enema - and nurses need to consider how informed that consent is.
The advent of nurse prescribing has stimulated interest in bowel care. The RCN receives many inquiries about bowel care, resulting in its first published document on rectal examination and manual evacuation in 1995 (Addison et al, 1995). Due to increasing demand, a second document was published in 2000 (RCN, 2000). In my experience in assessing continence advisers undertaking the ENB A57 continence course, continence assessment forms poorly address the problem of bowel dysfunction, and this issue needs to be addressed urgently.
Continence advisers have started to establish formal training which focuses on digital rectal examination and manual evacuation, with some general bowel care topics included, which is a welcome development.
There is a need for nurses to improve the evidence base of bowel care to support practice. Continence assessment forms need to address bladder and bowel problems equally. We need to develop training for bowel care to ensure that competent practitioners are available. We need to ensure that we have policies and procedures to underpin our bowel care practices locally. It is important to remember that nurses have the potential to improve dramatically the quality of life for patients presenting with bowel dysfunction.