From health organization‐centred standardization work process to a personhood‐centred care process in an Italian nursing home: effectiveness on bowel elimination model

Abstract

An Italian nursing home's standardized work process redesign towards a personhood-centred nursing care is the focus of this study. The aim was to develop and implement a multi-method, personhood-centred, bowel elimination programme, to reduce the number of patients suffering from constipation and lessen the use of the invasive practises routinely adopted in nursing home (laxatives, enemas, rectal exploration). Although the importance of the application of personhood-centred care concepts in gerontology nursing has been widely recognized, the actual tendency of the Italian National Health System, which has few nursing resources for to the care of the older persons, is standardization. Standardization is enacted mainly by a functional pattern and carries the risk of using the same nursing answer to patient's different needs, priorities, preferences and histories. Constipation in older people living in nursing homes is one of the effects of extreme standardization. A case-crossover study design was adopted from 2006 to 2007. Twenty persons were enrolled in the programme. The multi-method programme included three phases: assessment (first phase), development/implementation (second) and evaluation (third phase). In the first phase, nine (45%) persons were constipated; in the third phase, only two (10%) were constipated (χ(2) 6.14, P = 0.013). The relative risk of being a constipated person in the first phase compared with the third phase was 4.5 (confidence interval 95%: 1.11-18.27). During the first phase 562 invasive procedures were observed (± 25.5, range: 2-85) for bowel elimination whereas during the third phase 120 were observed (± 12, range: 0-58). After the personhood-centred multi-method programme, seven persons have modified their bowel elimination pattern, and they were no longer constipated. The programme has also reduced the use of invasive procedures. The reduction of invasive practises might have affected positively the persons' quality of life, their comfort and also the workload of the nurses, reducing the time they needed for constipation management and using it for prevention strategies.