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I am a Children’s Community Nurse working as part of a team of six people based at Darent Valley Hospital Dartford in Kent. Although the team as a whole looks after children with various health problems, my specialist interest is children with chronic constipation and soiling problems.
Initially, I was responsible for visiting children in the community who were severely constipated or impacted in order to administer rectal enemas. This can be highly distressing for all concerned; the child, their parents or carers and the nurse. I was keen to find a way of minimising the physical and psychological effects of this procedure and began to realise that it was not enough just to treat the impaction.
Despite my experience treating constipation as a paediatric nurse, I was not fully aware of the impact that constipation and soiling can have, not just on the child’s life but on that of the family as a whole. The fact that so many parents tell me that their lives revolve around their child having a poo is evidence of this. Relapses are common, and I soon came to realise that these children and their families need our continued support, advice and help.
In just two years, my caseload has expanded to include well over 200 children with constipation problems accounting for over 90% of my workload. This has lead to me being referred to affectionately as the “Poo Nurse” by my colleagues and patients’ parents. Ultimately we would like to expand our service to accept referrals from GPs and health visitors.
The children that I see in my own nurse-lead clinics have been referred to me by Consultant Paediatricians. During my appointments, which last an hour, I discuss what happens normally when we poo and what can go wrong when a child becomes constipated. I then explain the management of constipation with behavioural changes. It is particularly important to talk about behavioural difficulties surrounding withholding, toilet fears, use of nappies etc. in order to resolve a child’s constipation.
It is essential that families feel supported while managing their child’s constipation. All of the families on my caseload are given a contact telephone number to call should they have any problems or questions to ask. Initially, I follow up all the children by phone at least twice a week until they are having regular bowel movements. After this I make sure that the family knows how to contact me at the first sign of any relapses.
Another part of my role involves educating healthcare professionals into the causes, prevention and management of childhood constipation. I feel that it is very important to treat the children early and questionnaires sent out to families we are currently treating showed that most constipation problems arise at the toddler stage, therefore health visitors and GP’s are my target audience.
I am involved with healthy schools initiative, which focuses on trying to make school toilets better and more private places. I regularly visit schools, particularly those with children that suffer from soiling. I usually find that once the teachers understand, they have a much more sympathetic view.
In the future, I would like to help set up a support group for parents to raise awareness of the condition and reassure parents that they are not alone and that childhood constipation is very common. Parents are often reluctant to talk about this at the school gates and such a group could be a forum for discussion where parents could exchange experiences and ideas.
In 23 years of nursing, I have worked in many different areas of practice from neonates to teenagers but I have never cared for a group of children that has given me such job satisfaction. For example, I treated one child who had suffered from years of chronic constipation and soiling which had made their school life unbearable. The child had low self-esteem, few friends, and was the victim of bullying as well as growing more slowly than normal due to a poor appetite. However, I am pleased to report that he is now a healthy, confident and sociable child.
I am proud to be Dartford’s Poo Nurse. After all, how many other nurses can return to their desk to find a note from a child to say they have done a poo AND it was in the toilet!!
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