Alison While
The topics of urine and faeces are considered the nurse's domain, yet chronic constipation and poor bowel health are taboo conditions with which many people suffer in silence. The Bowel Interest Group (BIG) (2020) estimated that about 6.5 million adults have some form of bowel problem, with constipation causing 55 497 emergency admissions in 2018/19. A 2016 YouGov survey of 2352 adults found that 20% of adults were embarrassed talking about constipation with their GP, and, if they considered themselves constipated, 20% would try to resolve it themselves without talking to anyone. Some 19% of adults reported that talking about constipation and erectile dysfunction were equally embarrassing (BIG, 2020).
The Cost of Constipation report (BIG, 2020) reminds us that the costs of constipation are not only incurred by the health service but also by people, as it causes misery and significantly undermines quality of life (QoL). Constipation affects one-in-seven adults and was the cause of nearly 80 000 hospital admissions and cost NHS England £168 million in 2018/19. Interestingly, regional health data suggest a relationship between higher spend on laxatives and higher admission rates, indicating the potential gains in those areas if bowel health is improved.
Constipation may have a serious impact on mental wellbeing and QoL, with 40% of adults reporting anxiety and 38% experiencing depression, alongside physical health problems such as haemorrhoids, anal fissures and rectal prolapse (BIG, 2020). For some, constipation is a secondary health issue arising from an existing health condition or its treatment and, as such, is an unwelcome additional health burden. The personal consequences of constipation cannot be underestimated, as it affects travel and socialising daily, damaging confidence and self-esteem.
Community nurses can make the difference to their clients' lives by building on their existing strong rapport to engage in intimate professional conversations, so that constipation can be identified without delay, its causes recognised and effective treatments or referral offered. There is growing evidence that nurse-led care, compared with doctor-led care within the ambulatory setting, has equivalent or better outcomes relating to symptom burden, care satisfaction and perceived health-related QoL (Chan et al, 2018).
A very recent Delphi study attempted to identify patient outcomes for community-living older people which are district nurse (DN)-sensitive-that is, within the scope of DN practice and likely to be influenced by DN practice (Veldhuizen et al, 2021). The panel comprised 11 experts who had current or recent clinical experience as DNs, as well as expertise in research, teaching, practice or policy in the area of DN selected purposively from across the Netherlands. The Delphi study had two rounds; in the second round, the experts were asked to rate 46 outcomes regarding their nurse relevance and influenceability, with 26 outcomes emerging as nurse sensitive. The patient's autonomy, ability to make decisions regarding the provision of care, satisfaction with delivered DN care, the quality of dying and death and compliance with needed care were scored the highest for both relevance and influenceability. Veldhuizen et al (2021) argued that these five nurse-sensitive outcomes should form the basis for DN service quality indicators, with further research identifying other outcomes for specific client sub-groups. It will be interesting to see if these outcomes are incorporated into a framework for assessing and assuring the quality of DN care delivered behind the closed doors of clients' homes within different parts of the UK.
‘Community nurses can make the difference to their clients' lives by building on their existing strong rapport to engage in intimate professional conversations so that constipation can be identified without delay, its causes recognised and effective treatments or referral offered.’