Learning to pee and poo (again!)

I did not have to learn to pee and poo - you could say it came naturally.

My apologies: I know this is not the way to engage people, but believe me there is an issue in this waste-land.

Loving parents, guardians, and baby sitters the world over come to the rescue of hygiene, skin care and the quality of environmental aroma tending to the nappy / diaper changing when we are babies. Family pride counts too in place of the yet to be gained person-al sense of dignity.

We all (well the vast majority of us) have the potty training tee-shirt - even if at the time we were illiterate (an amazing woman this Mother Nature). I've also experienced potty training - the ups, downs and spills with my three children. It really is magic seeing them gain that control and independence.

When I was a student nurse hygiene, skin care, privacy and dignity were constantly stressed. These were a measure of the standard and quality of nursing care. It was the one thing around which continuity of care was built. We don't usually think of care continuity in these basic terms, but there it is. While there is so much that can divide ward / care shifts, day and night staff here was something that indicated performance, or the lack of it. Obviously enough, it was closely associated with continence and toileting.

Over the past decade and more we have all noticed the many changes in nursing, social care and with it the use of continence pads. Not just as a stand-by, but a routine continence management device that saves staff time and pressure on the call alarms. If you are catheterized then plainly there is no need for the commode, or bed-pan.

Now it seems with i-pads (no pun intended) the same applies,

now the nurses say "use your pad"!

Amid the clamour for dignity and respect, personalised care, high quality nursing care the location and bounds of the political care domain are found. Nursing has changed with social care. Nursing duties have been contracted out of the profession, freeing nurses to nurse.

This past week in England the BBC reported: Ex-ballerina Elaine McDonald care ruling 'shameful'

Elaine McDonald, 68, took Kensington and Chelsea Council to court over its decision not to provide her with a night carer to help her use a commode.

The court ruled the council had acted lawfully in reviewing her care plan.

It seems many people are having to learn to pee and (perish the thought) poo again.

• What is that like when you are not* 'on the toilet' and are fully oriented, have mental capacity?
• What is it like when there are people around?
• What is that like when you are on your own at 0100 hours and the carer's due at 0830-0900?

We know social care is an acknowledged mess. Dilnot has arrived.

For Elaine McDonald and others in her situation this is a special type of problem. It is a logistical, temporal, care-logic nightmare. Committing someone for a whole night for the sole purpose of toileting is hard to justify, but are there no compromises, no alternatives? Is there no pattern to discern? Does the Big Society - social enterprise not see an opportunity here? Care in the community never is the cheaper option. Are we discounting the value of mental health and the sense of well-being that will be an inevitable ('soul') casualty?

I must locate some resources on nursing reviews of continence - there must be several - reports, theses, guidelines, standards? The contexts in which this matters are legion. If you know of any please let me know (see right for contact details). At some future date I'll explore the dimensions of continence across the health care domains.

Attitudes to toileting are already impacting on nursing's status. Too posh too wash...

We know this speaks volumes and reflects upon what we describe as nursing and how we define nursing. 

But it goes much deeper than that -

not only does it represent how nursing is practised 

it reflects the very values that nursing must then take as its own -

that is nursing the profession.

*in a space suit - STS 135 space walk 12 July 2011 > 6 hours.

Image and story source:
BBC http://www.bbc.co.uk/news/uk-england-london-14042078