AJN’s
teacher, who is beside me, can per-
form the procedure instead.
Most of my classmates experi-
ence this kind of scenario at the
bedside, even though we are skilled
and fit to perform the given proce-
dure. This is very frustrating, be-
cause we need experience to gain
more confidence.
Likai
Nanning, Guangxi, China
INCONTINENCE MANAGEMENT
I read “Self-Management of Uri-
nary and Fecal Incontinence” (Jan-
uary) and am concerned about
any recommendation to decrease
fluid intake. Patients often hear
this and stop drinking altogether.
Also, the use of antidiarrheal
medications isn’t usually recom-
mended without first conducting
a rectal exam and ordering an ab-
dominal flat plate X-ray, as losing
stool can be a sign of impaction.
These agents can make constipa-
tion much worse, resulting in ob-
stipation, megacolon, intestinal
rupture, and even death.1–3
Incontinence is an important
topic for the public to become
aware of, as it decreases quality
of life. Bowel and bladder train-
ing is crucial if we are to help older
and disabled patients to maintain
their independence.
Sheree L. Loftus, PhD, MSN,
GNP-BC, CRRN
New York City
REFERENCES
1. Doughty DB, ed. Urinary and fecal in-
continence: nursing management. 2nd
ed. St. Louis: Mosby; 2000.
2. Rehabilitation Nursing Institute. Part
III: unit 3: section1: elimination. In:
Rehabilitation nursing: concepts and
practice: a core curriculum. Evanston,
IL: The Institute; 1981. p. 141-74.
3. Baquis G. Treatment of bladder, bowel,
and sexual disorders. In: Younger D,
ed. Motor disorders. Philadelphia: Lip-
pincott Williams and Wilkins; 1999.
p. 493-500.
Authors Mary H. Wilde and
Donna Z. Bliss respond: We
wrote this article with a diverse
ajn@wolterskluwer.com
patient population in mind. The
issue of fluid management in Faces of
Caring:
people with incontinence is com-
plex, and we thought about this
a great deal. We agree that fluids
shouldn’t be restricted in the el-
derly. However, many with in-
continence are not elderly, and
managing fluids is a key issue re-
Nurses at Work
quiring information about what
an individual is drinking, includ-
goes on tour!
ing the amount and type of fluid.
We were unable to include this
detail in our manuscript.
Our recommendations for an-
tidiarrheal medications assume
best practices have been followed.
BED BATH
After reading “Bed Bath,” by
Kathleen Hughes (Reflections, Jan-
uary), I couldn’t help but think of
my experiences while working as a
certified nursing assistant and dur-
ing nursing school, from which I’ll
graduate this spring.
When the professor first gave
us instructions on how to perform
a bed bath on a manikin in the
lab, we all breezed through it, be-
lieving it would be one of our eas-
ier tasks. But manikins don’t take
pride in themselves, aren’t con-
cerned about privacy, and don’t
have feelings.
During the first bed bath I per-
formed on a patient, it became
clear that while I’d practiced the
correct techniques—how to fold
the towel over my hand appro-
priately, what order of body parts
to bathe—I hadn’t learned how
best to respect the patient’s dignity
and pride, and how to establish
rapport.
Now, when I walk into a pa-
tient’s room, I know it’s essential
that the patient trust me before I
put her or him into such a vulner-
able state. Hughes said it so well: For information on how
patient care is about “honoring
the dignity in that body, the dig- you can host the exhibit
nity in the desire for the most ba-
sic of human care.” contact Michael Fergenson
Hilary Clark at (646) 674-6609 or
Poland Spring, ME ▼
michael.fergenson@wolterskluwer.com