title: Bowel problem management among nursing home residents: a mixed methods study.
abstract: BACKGROUND
  Bowel problems such as constipation, diarrhoea and faecal incontinence (FI) are prevalent conditions among nursing home residents and little is known about nursing management. This study aimed to elucidate how Norwegian registered nurses (RNs) manage bowel problems among nursing home residents.
  
  
  METHODS
  A mixed methods approach was used combining quantitative data from a population-based cross-sectional survey and qualitative data from a focus group interview. In the cross sectional part of the study 27 of 28 nursing homes in one Norwegian municipality participated. Residents were included if they, at the time of data collection, had been a resident in a nursing home for more than three weeks or had prior stays of more than four weeks during the last six months. Residents were excluded from the study if they were younger than 65 years or had a stoma (N = 980 after exclusions). RNs filled in a questionnaire for residents regarding FI, constipation, diarrhoea, and treatments/interventions. In the focus group interview, 8 RNs participated. The focus group interview used an interview guide that included six open-ended questions.
  
  
  RESULTS
  Pad use (88.9%) and fixed toilet schedules (38.6%) were the most commonly used interventions for residents with FI. In addition, the qualitative data showed that controlled emptying of the bowels with laxatives and/or enemas was common. Common interventions for residents with constipation were laxatives (66.2%) and enemas (47%), dietary interventions (7.3%) and manual emptying of feces (6.3%). In addition, the qualitative data showed that the RNs also used fixed toilet schedules for residents with constipation. Interventions for residents with diarrhoea were Loperamide (18.3%) and dietary interventions (20.1%). RNs described bowel care management as challenging due to limited time and resources. Consequently, compromises were a part of their working strategies.
  
  
  CONCLUSIONS
  Constipation was considered to be the main focus of bowel management. Emptying the residents' bowels was the aim of nursing intervention. FI was mainly treated passively with pads and interventions for residents with diarrhoea were limited. The RNs prioritized routine tasks in the nursing homes due to limited resources, and thereby compromising with the resident's need for individualized bowel care.
authors.affiliation: Faculty of Nursing, Sør-Trøndelag University College, Postbox 2320, 7004 Trondheim, Norway ; Department of Public Health and General Practice, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway.
authors.forename: Susan
authors.initials: S
authors.lastname: Saga
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway.
authors.forename: Arnfinn
authors.initials: A
authors.lastname: Seim
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Postbox 8905, 7491 Trondheim, Norway ; Clinical Service, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
authors.forename: Siv
authors.initials: S
authors.lastname: Mørkved
authors.affiliation: Faculty of Nursing, Sør-Trøndelag University College, Postbox 2320, 7004 Trondheim, Norway ; Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
authors.affiliation: Faculty of Nursing, Sør-Trøndelag University College, Postbox 2320, 7004 Trondheim, Norway.
authors.forename: Anne Guttormsen
authors.initials: AG
authors.lastname: Vinsnes
keywords: Constipation; Cross-sectional survey; Diarrhoea; Faecal incontinence; Focus groups; Nursing homes