Inability to independently perform tasks associated with bowel and bladder elimination

Difficulty completing toilet hygiene

Difficulty flushing toilet

Difficulty manipulating clothing for toileting

Difficulty reaching toilet

Difficulty rising from toilet

Difficulty sitting on toilet

Anxiety

Cognitive dysfunction

Decreased motivation

Environmental constraints

Fatigue

Impaired Physical Mobility

Impaired Transfer Ability

Neurobehavioral manifestations

Pain

Weakness

AUTHOR'S NOTE

Refer to Self-Care Deficit Syndrome.

Level 1 Fundamental Focused Assessment (all settings)

Use the Following Scale to Rate the Individual's Ability to Perform. Add the Number to the Individual's Nursing Diagnosis as Toileting Self-Care Deficit (3)

0 = Is completely independent

1 = Requires use of assistive device

2 = Needs minimal help

3 = Needs assistance and/or some supervision

4 = Needs total supervision

5 = Needs total assistance or unable to assist

R:This coding allows for establishing a baseline from which to evaluate progress.

The individual will demonstrate increased ability to toilet self or report the need to have someone assist him or her to perform the task, as evidenced by the following indicators (specify when assistance is needed):

• Demonstrates the ability to use adaptive devices to facilitate toileting.
• Describes causative factors for toileting deficit.
• Relates the rationale and procedures for treatment.

Level 1 Fundamental Focused Interventions (all nonacute settings)

Assess Causative Factors

Refer to Related Factors.

Common Nursing Interventions for Toileting Difficulties

• Obtain bladder and bowel history from the individual or family (see Impaired Bowel Elimination or Impaired Urinary Elimination).
• Ascertain the individual knows how to use the communication system to request assistance.
• Avoid development of "bowel fixation" by less frequent discussion and inquiries about bowel movements.
• Be alert to the possibility of falls when toileting an individual (be prepared to ease him or her to the floor without injuring either of you).
• Allow sufficient time for the task of toileting to avoid fatigue. (Lack of sufficient time to toilet may cause incontinence or constipation.)

R:The person's maximum involvement in toileting activities can reduce the embarrassment associated with needing assistance with toileting These strategies provide a structured, consistent environment and routine for achieving goals.

Specific Toileting Interventions for People with Visual Deficits

• Keep the call bell easily accessible so the individual can quickly obtain help to toilet; answer the call bell promptly to decrease anxiety.
• If the bedpan or urinal is necessary for toileting, be sure it is within their reach.
• Avoid placing toileting equipment to the side of the individual with a field cut. (When he or she is visually accommodated to surroundings, you may suggest he or she search the entire visual field for equipment.)
• Announce yourself before entering or leaving the toileting area.
• Observe the person's ability to access equipment or get to the toilet unassisted.

R:These strategies provide a structured, consistent environment and routine for achieving individual goals.

Specific Toileting Interventions for People with Cognitive Deficits

• Offer toileting reminders every 2 hours, after meals, and before bedtime.
• When the individual can indicate the need to toilet, begin toileting at 2-hour intervals, after meals, and before bedtime.
• Answer the call bell immediately to avoid frustration and incontinence.
• Encourage wearing ordinary clothes. (Many confused people are continent while wearing regular clothing.)
• Avoid the use of bedpans and urinals; if physically possible, provide a normal atmosphere of elimination in bathroom. (The toilet used should remain constant to promote familiarity.)
• Give verbal cues as to what is expected of them and positive reinforcement for success.
• Refer to Impaired Urinary Elimination for additional information on incontinence.

R:Interventions focus on assisting the individual and family to maintain safely as much functional independence as possible (Miller, 2019).

Initiate Health Teaching and Referrals, as Indicated

• Assess the understanding and knowledge of the individual and family of foregoing interventions and rationales.
• Ensure an in-home evaluation by a home health nurse, physical therapy, occupational therapy, or social service as indicated.

^†This characteristic has been included by the author for clarity or usefulness.

^†This characteristic has been included by the author for clarity or usefulness.