No. 7 To facilitate the maintenance of elimination
By: Dominique Ann Pacatan

If we hear the theory of the 21 nursing problems by Faye Abdellah, the immediate thought that pops in our head is that her theory is focused on the nurse, her responsibilities as member of the healthcare team and her scope of practice. But, as much as her theory is concerned, the 21 nursing problems are actually focusing more on the patient. These 21 nursing problems are the major things that the nurses need to help the patient with. Along with proper assessment and planning of care, implementation of nursing care will be more efficient and evaluation will yield positive results if given that nothing went wrong along the nursing process. Her theory also stressed the importance of holistic care. The nurse should not only render physical nursing care, but also give psychological, emotional, and spiritual support towards the patient. With regards to this, the nurse should include the patient’s significant others in doing the care plan of the patient. For health education, the significant others are equally important factors in supporting the patient to be able to recover from his/her illness. The patient is viewed as a person who needs to maintain a balance of these 21 nursing problems for him/her to maintain optimal health. With the use of therapeutic communication by the nurse towards the patient and his/her family and by giving sufficient health education and support, the nurse will foster the patient’s ability to recover independently.

Moreover, I believe that the 7th nursing problem which is facilitating the maintenance of elimination is as equally important as the other 21 nursing problems because it is part of sustaining a person’s need to eliminate wastes to maintain homeostasis. I believe in the saying that what goes in eventually goes out. A creature that is designed to ingest food and liquid should later on eliminate it because the longer it stays inside the system, it will get rotten and therefore it can cause imbalance. The body’s system is working in the same cyclical motion thus the same idea goes for the human body. What the person eats and drinks, he needs to eliminate the waste after because if it will not be eliminated from the body, he will get sick.

When I was still a student nurse, I was privileged to be the scrub nurse for a surgical case involving a teenage girl who was not able to defecate for 3 months. When I first heard of the case, I could not believe it; I could not imagine myself not defecating for even a day! Furthermore, I read the assessment endorsed by the bedside nurse and it was stated that the patient verbalized that she just ignored the urge to defecate. She stated that she experienced constant abdominal pain but she just disregarded pain that she felt. She was afraid that something was wrong with her and she thought that if she would let herself be confined in a hospital; her parents would get angry with her for not taking good care of her health and also because of the expenses that the hospitalization may cost them. She was thinking that hospitalization would just add to their financial problems. But as the weeks passed by, she could not bear it any longer because her abdomen was increasing in size and she was experiencing fever already. Her parents thought that she was pregnant and that is when they went to the doctor. The physician ordered some diagnostic tests and he said that the patient needs to be surgically treated because of fecal impaction. The family decided that their daughter will undergo the surgery because her condition was getting worse. After the operation, the physician and the healthcare team did an evaluation of the case where the physician explained the details of the surgery done. He said that the bowel of the patient tried to compensate for the increasing bulk of waste products being passed on to it. Because of the body’s coping mechanism, the bowel tried its best to accommodate as much waste as it can and because the patient did not defecate normally it continued to add up waste products and the objective assessment revealed the enlargement of the abdomen. The physician added that the “old” waste products dumped at the lowest part of the bowel later on became so hard because of the reabsorption of water and it got stuck at the end of the bowel. This phenomenon made it hard for the patient to defecate and this is when other problems started to come out and manifest their signs and symptoms. The physician said that if the patient was not given immediate medical help, she will suffer from sepsis and experience complications. This case is a simple illustration of Abdellah’s theory that the nurse must facilitate the maintenance of elimination to prevent further problems from happening. It may not be that the nurse will always be there to tell the patient to regularly eliminate but the nurse can do health education about the benefits of a regular bowel elimination and urination. Also, proper diet and an adequate amount of water consumption must be stressed by the nurse.

The body will try its best to compensate for imbalance but it can take just as much. We need to understand our body’s needs for it to function properly and for us to sustain optimal health. Therefore, balance between the 21 nursing problems must be maintained by the person to maintain optimal health conditions.     

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