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Running head: NURSING CARE OF ENEMAS
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Nursing Care of Enemas: Comfort Measures
Research Paper
Julia Corey, Hannah Holladay, Sam Mills, Arlie Moore, Demeter Neal, Gallie
Shugarman
Research 362
Bryant
3/5/13
NURSING CARE OF ENEMAS
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Enemas are performed for varies of reasons. Enemas are administered to
determine the integrity of the colon and to relieve constipation. Administering an enema
allows physicians to look at the internal structure of the large intestine to determine
presence of colon rectal cancer, inflammatory disease, polyp’s diverticulitis, and
structural changes in the large intestines or to relieve constipation. Symptoms patients
may present that indicate the need for this procedure include: abdominal pain, blood in
stool or altered bowl habits (Taylor, Lillis, LyMone, & Lynn, 2011). According to the
Center for Disease Control and Prevention, “Colorectal cancer is the second leading
cause of cancer related deaths in the United States among cancers that affect both men
and women,” (Center for Disease Control and Prevention, 2008). The enema procedure
is important in nursing practice because of the large scale of people who potentially may
require this type of diagnostic testing.
The main purpose of our paper is to focus on the importance of comfort measures
during administration of an enema. Because enemas have a very broad spectrum of use,
the significance of comfort measures is beneficial knowledge for nurses to be aware of.
The current practice of enemas is based on natural or field setting research, which
includes descriptive research. The procedure may be done in hospitals, doctors’ office,
and nursing homes or inside the patient’s home. Prior to this procedure patients must
adhere to a clear liquid diet starting 24 hours before to cleanse their intestines. The
procedure involves the insertion of a catheter filled with barium that is released into the
rectum. The insertion of the barium enables visualization of the colon by X-ray (Pellico,
2012). The patient must hold in the barium for the entirety of this procedure, which may
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cause discomfort, embarrassment, and stress for the patient (Taylor, Lillis, LyMone, &
Lynn, 2011).
For many years, clinical practice has involved safety and comfort. The nurse must
obtain informed consent; provide information about the procedure, the actions of
medication, and any side effects that may be experienced. All of these interventions are
thought to reduce the patient’s anxiety (Pegram, Bloomfield, Jones, 2008). To keep the
patients dignity intake, certain social interventions must be taken by the nurse. These
include establishing a repertoire with the patient to build trust, providing privacy, and
ensuring minimal discomfort during procedure. Patients should be given clear and simple
directions and the rationale behind them (Taylor, Lillis, LyMone, & Lynn, 2011).
Due to the discomfort and embarrassment with this procedure, studies have been
done to enhance the patient’s experience. Based on current research, patients who are told
to briefly hold their breath, shift their position, and apply slight pressure to their abdomen,
experience less discomfort during the administration of the enema (Exit Care, 2012)
According to the article Rectal 5-Aminosalicylic Acid for Maintenance of Remission in
Ulcerative Colitis, Side effects from the administered enemas that were performed were
generally mild in nature and common side effects included anal irritation and abdominal
pain (Marshall, Thabane, Steinhart, Newman, Anand, Irvine, 2012). Educating a patient
about the potential for this side effect is a nurse’s responsibility.
Social interactions and communication with the staff were documented as very
important to the overall experience and particularly important in controlling the patients’
embarrassment. According to Wagner, “Staff interaction with the patient through touch,
verbal praise, and even humor were frequently cited to diminish embarrassment,”
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(Wagner et al. 2008,p.6). Staff encouragement moderated patients’ pain and discomfort
as well. The nurses and radiographers involved with the procedure must have developed
communication skills that able them to create a trustworthy relationship with their
patients during their short initial meeting (Kataria, 2011). Having a more intimate
relationship with the physician facilitated better patient understanding, trust and overall
satisfaction, which led to, reduced post-test anxiety (Wagner et al. 2008).
From the information gathered up to this point, we can conclude that enemas are
beneficial to the current health care system. Such benefits include the ability to identify
colon rectal cancer, inflammatory disease, polyp’s diverticulitis, and structural changes in
the large intestines or to relieve constipation. Our main finding was that the social aspect
of administration of an enema was more comfortable if the nurse formed a relationship
with the patient and talked them through the procedure. By doing so, the patient reported
decreased anxiety and embarrassment, with an increase in their comfort level during the
procedure.
While financials are an issue in any health care procedure, the cost of an enema is
covered under health insurance. Therefore, the cost of an enema would be covered by the
patients copay, depending on their health insurance coverage. This cost cannot be
avoided due to the requirement of a colonoscopy after the age of fifty recurring every five
years. Enemas may be implemented in clinical practice in many ways. It can be used as a
diagnostic element as well as a treatment method for constipation. This study concludes
that there are significant health benefits of comfort measures during enemas used in
health care. Because enemas have a very broad spectrum of use, the significance of
comfort measures is beneficial knowledge for nurses to be aware of.
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NURSING CARE OF ENEMAS
References
Centers For Disease Control. (2008). Use of colorectal cancer tests---united states 2002,
2004, 2006. Retrieved March/01, 2013, from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5710a2.htm
Exit Care. (2012). Barium enema. Retrieved February/28, 2013, from
http://www.mdconsult.com/das/patient/body/4042370732/1413440454/10089/56280.html
Kataria, B. (2011). Patient's preference for examination of the large intestine with double
contrast barium enema or computed tomography colonography. Elsevier, 30(2), 70-81.
Marshall, J., Thabane, M., Steinhart, H., Newman, J., Anand, A., & Irvine, J. (2012).
Rectal 5-aminosalicylic acid for maintenance of remission in ulcerative colitis.
Cochrane Database of Systematic Reviews, 11
Pegram, A., Bloomfield, J., & Jones, A. (2008). Safe use of rectal suppositories and
enemas with adult patients. Nursing Standard, 22(38), 39-41.
Pellico, L. (2012). Chapter 21: Nursing asessment : Digestive gastrointestinoal and
metabolic funtion. Focus on adult health: Medical-surgical nursing (pp. 590).
Philadelphia, PA: Lippincott Williams & Wilkins.
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Taylor, Lillis, LyMone, & Lynn. (2011). Chapter 38: Bowel elimination. Fundamentals
of nursing: The art and science of nursing care (7th ed., pp. 1305-1311). Philadelphia,
PA: Lippincott Williams & Wilkins.
Von Wagner, C., Knight, K., Halligan, S., Atkin, W., Lilford, R., Morton, D., & Wardle,
J. (2008). Patient experiences of colonoscopy, barium enema and CT colonography:
A qualitative study. British Institute of Radiology, 82(973), 13--19. doi:
10.1259/bjr/61732956