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Summary
Going to the toilet to eliminate bodily waste in private is a normal daily activity that people tend to take for granted. The inability to perform this task independently can result in an intrusive, embarrassing and stressful experience for the individual. This article outlines the nurse's role in helping older people to use the toilet and the opportunities that this affords for therapeutic intervention, identification of other problems and the promotion of health and wellbeing.
Keywords
Continence, dignity, older people, person-centred care, urinary and faecal elimination
These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at nursingstandard.rcnpublishing.co.uk. For related articles visit our online archive and search using the keywords.
THE ELIMINATION OF urine and faeces from the body is a natural, essential human function. In Western societies, from childhood, individuals are taught to undertake this function in private. Influenced by cultural norms and personal beliefs, people develop their own rituals of elimination and cleansing that, for most of their lives, remain private.
Individuals who are unable to eliminate bodily waste independently, as a result of illness, disability or frailty, may need to ask others for help. Those who provide assistance then enter the individual's private world with all its sights, sounds and smells. The manner in which a person is assisted can have a profound effect on their lives. If individuals are not offered maximum respect, choice, control, privacy and dignity, this can damage not only their physical elimination functions, but also their self-concept, emotional wellbeing and social confidence.
Much still needs to be done to improve the care and facilities offered to older people who need help to use the toilet. The 2005 Royal College of Physicians National Continence Audit identified that many hospitals need to improve privacy and dignity for patients during bladder and bowel emptying ( Wagg et al 2005 ) . The Department of Health (2006) highlighted that people often have insufficient privacy when receiving care and are dissatisfied with toilet facilities in hospitals and care homes. Older people in acute care settings have little involvement in decisions regarding their personal care and limited choices...