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J Pediatr Nurs ; 47: 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048115


BACKGROUND: When born with spina bifida, there are numerous neurologic disorders that accompany this birth defect, including neurogenic bowel. Proactive, systematic, and rational approaches can lead to continence and a more functional lifestyle [1]. METHODS: Based on the evidence in the literature and expert experience, our approach to bowel management was developed as a step by step, individualized approach. This was converted to a decision tree for easy guidance of treatment decisions. The approach includes teaching patients and families normal bowel function, changes resulting from neurogenic bowel, common pitfalls in bowel management, and techniques that may improve outcomes. The decision tree, starting with dietary management, breaks into a two-fold attack, oral and rectal. Our data as part of the National Spina Bifida Patient Registry (NSBPR) database was compared to public data from the NSBPR. RESULTS: Preliminary data from the NSBPR in 2011 reported bowel continence in 42.1% (n = 898) compared to our clinical outcomes of 72.1% (n = 43). As the variable of bowel continence was further defined and more patients were enrolled, the clinic results were comparable to the national reports. CONCLUSION: Consistency among providers and caregivers is critical to evaluating the management of continence in spina bifida. While this protocol warrants further evaluation, it is offered as an evidence-based, step by step, approach to bowel management in spina bifida with good outcomes for patient management.

Árvores de Decisões , Intestino Neurogênico/etiologia , Intestino Neurogênico/enfermagem , Disrafismo Espinal/complicações , Disrafismo Espinal/enfermagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
J Wound Ostomy Continence Nurs ; 45(2): 163-167, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29521927


PURPOSE: The purpose of this study was to explore the experience and perceptions of nurses providing bowel care to patients after spinal cord injury. DESIGN: Qualitative study using thematic analysis of semistructured interviews. SUBJECTS AND SETTING: Eleven RNs who provided bowel care to patients following spinal cord injury and were deemed competent to do so by their employer were invited to participate. The study setting was a large, London NHS Trust providing acute hospital care to a population of around 1 million people. METHODS: Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analysis of data was undertaken using Braun and Clark's 6 stages of thematic analysis. RESULTS: Four main themes emerged: (1) unpleasantness of task; (2) perceived patient experience; (3) motivation and avoidance; and (4) barriers to care. There was stoic acceptance of the unpleasant nature of bowel care for the nurse, but unpleasantness for patients was not as readily acknowledged. Perceived patient experience ranged from descriptions of positive aspects of comfort and continence to negative aspects of embarrassment and discomfort. Nurses were motivated by the medical need for bowel care but often saw it as low priority due to the unpleasant nature and displayed avoidance tactics. The barriers concerned inadequate training, the taboo nature of bowel care, and potential sexual interpretations of care. CONCLUSION: Nurses described bowel care as unpleasant but accepted its physiologic need and importance. The standardization of bowel care training and increasing the numbers of nurses trained in bowel care may decrease stigma surrounding provision of care. Study findings suggest that male nurses' experience may differ from female nurses' experience, but this result requires further investigation.

Intestino Neurogênico/complicações , Enfermeiras e Enfermeiros/psicologia , Percepção , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Londres , Masculino , Intestino Neurogênico/enfermagem , Pesquisa Qualitativa , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/enfermagem , Medicina Estatal/organização & administração
J Clin Nurs ; 27(5-6): e1146-e1151, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29193471


AIMS AND OBJECTIVES: To study the effect of quantitative assessment-based nursing intervention on the bowel function and life quality of patients with neurogenic bowel dysfunction after spinal cord injury. BACKGROUND: Neurogenic bowel dysfunction after spinal cord injury was clinically manifested by abdominal distension, intractable constipation, prolonged defecation and faecal incontinence, which seriously affected the normal life of patients. Traditional ways of nursing for these patients focused on basic care, but lacked sufficient recognition of disease severity and individual needs. DESIGN: One hundred and eighty-four patients with neurogenic bowel dysfunction after spinal cord injury were randomly allocated into observation group (n = 92) and control group (n = 92). METHODS: The patients in the control group were given regular nursing, and the patients in the observation group were given quantitative assessment-based nursing intervention. Recovery of bowel function, quality of life and satisfaction were compared between the two groups. RESULTS: Scores for bowel function including bloating, constipation, prolonged defecation, defecation drug dependence and faecal incontinence in the observation group were significantly lower than those in the control group (p < .05). The scores for the quality of life including physical function, general health, social functioning, role-motional, mental health in the observation group were significantly higher than those in the control group (p < .001). Finally, the satisfaction rate in the observation group was 95.56%, which was significantly higher than that in the control group (83.7%) (p < .01). CONCLUSION: We concluded that quantitative assessment-based nursing intervention contributed to recovery of bowel function and improvement of life quality and satisfaction. RELEVANCE TO CLINICAL PRACTICE: Our finding can increase the rational allocation of nurse-patient ratio and provide personalised nursing for severe patients to reduce complications and promote the rehabilitation of the disease. Our findings can also serve as a reference for other countries to develop the nurse practitioner role.

Incontinência Fecal/enfermagem , Intestino Neurogênico/enfermagem , Traumatismos da Medula Espinal/enfermagem , Adulto , Constipação Intestinal/etiologia , Defecação , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Neurogênico/etiologia , Satisfação do Paciente , Qualidade de Vida , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento
Rehabil Nurs ; 37(3): 128-35, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22549630


PURPOSE: To investigate the association between characteristics of individuals with spinal cord injury and neurogenic bowel and their perceived quality of life. DESIGN/METHODS: The study design is an exploratory, descriptive correlational design. To measure the variables of the study the Quality of Life Survey developed by Randell et al. (2001) was used to measure perceived quality of life related to bowel management. Individual bowel management preferences and subjective costs and benefits of the preferences were gathered through the Neurogenic Bowel Characteristics Survey. PARTICIPANTS/METHOD: Data were collected from a random half of the individuals who met the inclusion criteria from the patient database (n=1193). Two hundred and forty one surveys were analyzed for this study. DISCUSSION: More than half of the sample (n=134) provided their own bowel management consisting of digital stimulation, suppositories, and other aids; 8% (n=19) had a colostomy. Regardless of the bowel management program 54% (n=127) were satisfied with current methods. Although time reported to complete bowel programs ranged from 1 to 120 minutes, there was no difference in rating of satisfaction with time. There was a statistically significant difference between those satisfied and dissatisfied with current bowel management and quality of life; those satisfied demonstrated a higher quality of life on three subscales, work function (p= .021), bowel problems (p< .001), and social function (p< .001). Those dissatisfied with their bowel program perceived a lower quality of life and indicated problems of time (p= .001), pain or discomfort (p= .033), and poor results (p< .001). CLINICAL RELEVANCE: Research data provide the patient's perspective on bowel management characteristics, complications, satisfaction, and their perceived quality of life. Results of this research will be incorporated into bowel management education and possible modification of the current inpatient bowel management program.

Intestino Neurogênico/enfermagem , Intestino Neurogênico/reabilitação , Qualidade de Vida , Traumatismos da Medula Espinal/enfermagem , Traumatismos da Medula Espinal/reabilitação , Inquéritos Epidemiológicos , Humanos , Intestino Neurogênico/psicologia , Pesquisa Qualitativa , Distribuição Aleatória , Enfermagem em Reabilitação/métodos , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
Int J Palliat Nurs ; 14(10): 510-5, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18978698


The consequences of malignant spinal cord compression (MSCC) can be devastating. If not detected early, MSCC can result in paralysis and significant bowel and bladder dysfunction that is not improved by treatment. Patients have to cope with sudden and unexpected disability alongside a diagnosis of advanced cancer. A multidisciplinary group was established within a cancer centre to review the care of patients with MSCC. Two linked studies were carried out: a staff questionnaire sent to senior medical staff and all nurses and an audit of documentation. The documentation audit reviewed the notes of 50 patients who had received radiotherapy for MSCC. The symptoms patients presented with on admission and before discharge demonstrated that many experienced significant physical problems as a consequence of developing MSCC. Usually, these symptoms were either unaffected by treatment, or had deteriorated further by the time of their discharge from hospital. The average number of days between admission with MSCC and death was 58.6 days (range 2 to 319 days). The project identified variations in practice in a range of aspects of care and provided clear evidence for the need to develop interventions in relation to specific concerns.

Auditoria Médica , Neoplasias/complicações , Auditoria de Enfermagem , Compressão da Medula Espinal/terapia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Repouso em Cama , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/enfermagem , Intestino Neurogênico/etiologia , Intestino Neurogênico/enfermagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/enfermagem , Compressão da Medula Espinal/psicologia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/enfermagem