Elimination intestinale à l'hôpital. Réflexion éthique sur sa prise en charge par les soignants
Recherche en soins infirmiers 2010 Dec(103): 67-77
The intestinal elimination of the 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 which are mostly translated into a diagnosis of constipation requiring therapeutic prescriptions and sometimes even aggressive and expensive medical examinations. 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 3 questions: how come the nursing staff have difficulties taking care of the intestinal elimination of the hospitalized patients? What are the determiners which influence the care of the intestinal elimination by the 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 auxiliaries and students in care of the sick working in medicine, surgery and intensive care of the same hospital. This survey allowed to question 130 persons among whom 36 doctors, 37 male and female nurses, 30 nursing auxiliaries and 27 students. We were able to confirm that the care of the 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 the complaint of the patient Several determiners make that the nursing staff are not in a preventive approach. This care does not meet much interest, is experienced as devaluing, taboo and the relation nursing staff-patient is hindered because everyone has difficulties to speak about it. Institutional difficulties are also discussed, such as the lack of coordination of the nursing staff and the 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 the 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 inferred by the lack of social skills of the professionals, like the discomfort to speak about this particular need. This work thus allowed to lead this ethical reflection on the care of the intestinal elimination to understand its meaning.As Spinoza said: "One should not laugh, one should not despair, one should not curse, but one should understand".
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