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An Evidence-Based Look at the ‘Unvoiced Symptom’: Fecal Incontinence

First, a confession: initially the subject of this month’s CE, fecal incontinence, seemed so daunting that we considered lighter titles (“Don’t Pooh-Pooh Fecal Incontinence,” for one). But we decided against going that route, because we didn’t want to minimize the condition’s importance or its life-altering effects. Indeed, fecal incontinence has been called the “unvoiced symptom,” one so embarrassing that sufferers often fail to tell their health care providers about it—and one that many providers never ask about.

Fecal incontinence has been defined as the “involuntary loss of liquid or solid stool that is a social or hygienic problem.” As authors Donna Zimmaro Bliss and Christine Norton report, possible causes include cognitive or physical disability, impaired sensory or motor function, poor coordination of defecation processes, and loose stool consistency; in some cases the cause may be multifactorial or idiopathic. Although studies of nursing home residents have found prevalence rates of more than 40%, the condition is by no means limited to elderly or disabled people.

Quality-of-life issues. Bliss and Norton provide an overview of fecal incontinence and describe what the research thus far has revealed about its impact on patients’ quality of life. […]

2016-11-21T13:15:53-05:00September 7th, 2010|Nursing|0 Comments
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Nightingale, One More Time

By Shawn Kennedy, AJN interim editor-in-chief

I know we’ve written a lot about Florence Nightingale on this blog recently (see Susan Hassmiller’s series of posts, In Florence’s Footsteps: Notes from a Journey) and I don’t want to put off those who aren’t necessarily fans, but I came across an editorial written by Gloria Donnelly, editor-in-chief of Holistic Nursing Practice, that resonated with me.  She writes about how the holistic nature of Nightingale’s approach fits with much that’s going on today in health care reform, citing as one example the trend toward teaching people to take charge of their own health. (The entire Fall issue highlights the work of holistic practitioners—I especially liked Garden Walking for Depression: A Research Report.)

Donnelly writes:

We believe that Ms. Nightingale, an advocate of health, self-healing, and healthy environments, would be proud of the strides that nurses have made to promote holistic health and care around the world. . . . Nightingale believed that ’health nursing‘ and cultivating good health were equally important to ’sick nursing,’ the art and principles of which she developed almost single-handedly. Prevention superceded cure in Nightingale’s schema as she advocated for Health Missioners to work, first in the villages of rural India and then in England, teaching women how to prevent disease and maintain healthy environments.

This, in a nutshell, describes nursing at its core. It’s a shame that of all of Nightingale’s philosophies and improvements that were […]

2016-11-21T13:15:54-05:00September 2nd, 2010|health care policy, nursing perspective|1 Comment
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Back to School: Team Sports and Concussions

By Shawn Kennedy, AJN interim editor-in-chief

Concussions among young athletes are on the rise—are parents and coaches taking them too lightly?

My sons played ice hockey and football in their high school years, what my husband and I referred to as “collision sports.” The unmistakable sound of helmet-hitting-helmet always made me cringe, especially in hockey where a good skater can generate considerable speed (and therefore force) before impact. I’ve witnessed many players being helped off the ice. The coach, who knew I was a nurse, would sometimes signal to me to come to the bench and check out a player. Most of the time, the player was fine; but there were a few times when it was clear that the player was a bit more than just shaken up.

I recall one 12-year-old who had nystagmus and ringing in his ears and kept asking the same question in a slow, sleepy voice. The coach wanted to put him back out on the ice (“He just saw a few stars, right?”), but instead I sent him with his parents to the ED for evaluation. After an overnight stay in the hospital he was released, but was cautioned not to play hockey for two weeks because he’d suffered a concussion. So he waited two weeks and […]

2016-11-21T13:15:56-05:00September 1st, 2010|nursing perspective|0 Comments
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Fighting HIV–AIDS with Public Health Billboards: September ‘Art of Nursing’

By Sylvia Foley, AJN senior editor

On a recent trip to the capital of Guinea­-Bissau, Dawn Starin noticed numerous public health billboards urging people to get tested for HIV or to practice safer sex by wearing condoms. One of the six poorest countries in the world, according to the Central Intelligence Agency’s World Factbook, Guinea-Bissau faces an ongoing epidemic of HIV and AIDS. Prevalence is especially high in urban areas and among pregnant women and sex workers. Starin, a writer and a research associate in the department of anthropology at University College London, UK, was struck by the bright colors and larger-than-life figures in the billboards, and photographed several, including the one featured in the September Art of Nursing.

Are the billboards effective?  Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

Starin has also photographed public art by Thongleum Damviengkum, a mixed-media artist whose work appeared in the April Art of Nursing. Damviengkum’s often witty pieces, intended to raise public awareness about HIV and AIDS and address the stigma associated with having the disease, are on display at a restaurant in Bangkok, Thailand. “Humor is important if you want people to listen,” […]

2016-11-21T13:15:57-05:00August 30th, 2010|Nursing|5 Comments
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Taking Away Choice — The Wrong Answer to Domestic Violence

By Meg Stone, MPH. Stone is the executive director of IMPACT Boston, an organization that works to prevent violence and abuse by giving people the tools to protect their safety and advocate for healthy relationships and sexual respect in their communities. A long-time domestic violence advocate with a degree in public health, she has, in her own words, “a strong interest in raising awareness of the issues facing women who present to emergency departments with injuries related to abuse. My professional background includes training nurses and first responders in asking about domestic violence and documenting incidents of abuse on medical records.”

This post is longer than our usual, but we thought it was worth running in entirety. The names and identifying details of those mentioned have been changed.

In the mid-1990s it was rare in most places for nurses and social workers to call domestic violence organizations when women came to the emergency department with injuries related to abuse. I only remember one call from a hospital social worker in the upstate New York town where I worked as an advocate at the local battered women’s program.

Carolyn, the director of the battered women’s service, called me at home on my day off. Nobody else was available, she said, so could I please please […]

2016-11-21T13:16:11-05:00August 10th, 2010|Nursing, patient engagement, Patients|1 Comment
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