Intestinal elimination at the hospital: Ethical reflection on care by nursing staff

Research
By Valérie Berger, Luc Durand, Martine Grocq
English

The intestinal elimination of hospitalized patients is a function insufficiently taken into account by the nursing staff from a preventive point of view. Nevertheless, numerous patients present transit disorders, mostly translated into a diagnosis of constipation requiring therapeutic prescriptions and sometimes even aggressive and expensive medical examination. The objective of this work is to lead an ethical reflection on the care of intestinal elimination by the nursing staff. Through a questionnaire, we wish to answer three questions: How come nursing staff have difficulties taking care of the intestinal elimination of hospitalized patients? What are the determiners which influence care of the intestinal elimination by nursing staff? Does training prepare the nursing staff to take care of the intestinal elimination of the hospitalized patients? The questionnaire was distributed to doctors, male and female nurses, nursing aides, and students working in medicine, surgery, and intensive care in the same hospital. This survey questioned 130 persons, including 36 doctors, 37 male and female nurses, 30 nursing auxiliaries, and 27 students. We were able to confirm that care of intestinal elimination is insufficiently taken into account in a preventive way, because 56% of the people interviewed explain that the problem of intestinal elimination is not approached before patients raise complaints. Several determiners mean that the nursing staff do not take a preventive approach. This care does not meet much interest, is experienced as devaluing or taboo, and the relation nursing staff-patient is hindered because everyone has difficulty speaking about it. Institutional difficulties are also discussed, such as lack of coordination of the nursing staff and lack of time. Another point of this survey shows that work experience is not an element which facilitates this care because the more the nursing staff have experience, the more they postpone this care, and more embarrassment is felt. Finally, we were able to point out that the received training does not prepare the nursing staff to take care of this function. Indeed, 61% of the people interviewed explain that certain difficulties are cause by professionals’ lack of social skills, like the discomfort in speaking about this particular need. This work enables us to reflect ethically on care of intestinal elimination in order to understand its meaning. As Spinoza said: “One should not laugh, one should not despair, one should not curse, but one should understand.”

Keywords

  • transit disorders
  • hospitalization
  • nursing care
  • ethics
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