At RCN Congress 2017, the RCN Continence Forum hosted a fringe event where we discussed the role of the nurse in digital rectal examination (DRE) and manual evacuation. Over 50 members from primary care, secondary care and the private sector attended the event.
From the discussions, we discovered that:
- 8 of the attendees had carried out a digital examination.
- 10 had provided digital removal of faeces.
- 15 of the attendees were students who had no experience of DRE or manual evacuation.
- 100% of the attendees agreed that DRE and manual evacuation were nursing roles.
- 7 attendees stated that they had procedures/ protocols at their places of work regarding DRE and manual evacuation.
DRE and manual evacuation is still withdrawn in some areas where managers have highlighted it as a form of abuse. The attendees discussed this and offered support for those facing this challenge.
The attendees also discussed the inconsistent approach with regards to supporting the needs of patients who require DRE and manual evacuation. A community nurse present was asked to attend hospital to manage a patient from her caseload, while another nurse was not allowed to attend hospital to support her patient’s needs, which were subsequently not met by the hospital. The attendees agreed that they would welcome the implementation of a standardised bowel management programme.
Since the publication of the original RCN bowel care guidance in 2000, the RCN Continence Forum have taken steps to support members working in this area:
- We have written to the NMC to raise this issue with them and to request that bladder and bowel care is part of pre-registration training.
- In conjunction with the RCN Neuroscience and Gastrointestinal Forums, we will be holding a workshop on appropriate bowel management in October 2017.
- We are currently updating the RCN guidance on the management of lower bowel dysfunction.
- At Congress 2018, we will apply to hold another fringe event on DRE and manual evacuation.