Questioning this order???

[garnetgirl29, BSN, RN]

So, there is a new order for a patient whom is my age to stimulate the rectum digitally for one minute every day after dinner. This patient has paralysis but still has sensation in this area. There were already orders for suppositories Q4H PRN, which the patient asks for regularly (and has asked nurses to wiggle their finger). I have never heard of an order like this it makes me pretty uncomfortable. Has anyone seen an order like this before???

[ArmaniX, MSN, APRN]

Uhm.. no.

[mirandaaa]

:wideyed::***:

[scottaprn]

Perfectly reasonable order.

The stimulation from the digit in the rectum helps fire the reflexes of the internal sphincter and improve the bowel regimine.

[tsm007]

Perfectly reasonable order.

The stimulation from the digit in the rectum helps fire the reflexes of the internal sphincter and improve the bowel regimine.

That was my thought as well. Although I'm a brand new nurse I do recall reading about this and discussing this in school.

[KatieMI, BSN, MSN, RN]

The order is perfectly reasonable for paralyzed patient with some residual function of internal sphincter. I saw patients with long-standing paralysis using smallest size vibrators from "adult store" with the same purpose. If OP's staff has problems with following the order (which, anyway, needs to be done with a chaperone in the room), the vibrator might be suggested.

My patients apparently did it as part of bowel regiment, trying to avoid impactions they all hated. They never asked about a particular nurse helping them or anything like that. They barely wanted to have BM every 48 hours or so without taking more pills of any kind and eating something which doesn' t taste like cardboard.

[loriangel14, RN]

Yep have seen this before.

[amoLucia]

The order is perfectly reasonable for paralyzed patient with some residual function of internal sphincter.

This is the answer and does occur in LTC pts. It should be care-planned in the pt's bowel regimen.

It is understandably to be uncomfortably embarrassing for the staff.

[garnetgirl29, BSN, RN]

OK. Thank you for the input. He is allowed to have this done 3x daily and he asks for it much more frequently and even asks for it immediately AFTER having a BM. He became very upset with a nurse who refused to do it because the CNA said he had just had a large BM. On this particular day, he had a BM every shift.

[amoLucia]

Two things - if you think his requests are r/t something along more 'kinky' lines, then the issue needs to be brought up in some kind of care conference.

But to give these pts the benefit of the doubt, they do have impaired sensation and altered evacuation efforts. So they do become 'fixated' on defecating. Did that other nurse actually check out the CNA's estimation/approximation of what constituted a LARGE BM??? Everybody has different opinions of things, esp when it comes to 'quantifying' amts. And like does 'one small BM 'each shift' equal enough to make the pt feel comfortable or could he still have incompletely evacuated?.

This type of pt causes staff to walk a fine line. Perhaps new approaches to better assessment with more specific ordered parameters need to be defined thru care conferencing. You don't want to deny this pt from feeling physically comfortable nor do you want him anxiously 'obsessing' all the time about his 'going'. But then, neither do you and the other staff want to feel like you're being pulled into something that takes advantage of you, leaving you embarrassed and feeling uncomfortable.

Care conference this pt again.

[traumanightsRN, NP]

They are really only supposed to have a DAILY bowel movement so no reason for him to have multiple BMs a day and definitely no reason for him to ask you to stimulate his rectum AFTER a BM.

[mita23]

never heard of this order... good to know new things