Beth Britton, Trainer and Social Care Consultant chats to Rachel Furniss, Health and Wellbeing Facilitator, MacIntyre, around tackling the taboo of poo, why staff need this knowledge, and how to deliver this in a transformative way.
The provision of personal care has always meant dealing with poo, and yet a huge taboo still exists around the topic of bowel movements. When the importance of regular pooing isn’t understood by staff, fatal consequences can result. The death of Richard Handley, a gentleman with Down’s syndrome, in 2012 is one high-profile example. Richard’s inquest verdict in 2018 [1]concluded he died from constipation complications, with 10kg of faeces having been removed from Richard’s body two days before he died.
LeDeR (Learning Disability Mortality Review) said of constipation in their ‘Action from Learning Report 2022/23’ [2]
“People with a learning disability are at greater risk of constipation. Constipation was one of the 10 most frequently reported long-term health conditions among people with a learning disability who died in 2020 (55%).”
LeDeR commissioned a new Constipation Campaign Toolkit in 2023[3] and MacIntyre’s Health Team have increased constipation awareness for their staff by running interactive workshops. I caught up with my colleague, the pioneer of these workshops – Rachel Furniss – MacIntyre’s Health and Wellbeing Facilitator, to find out more.
Why did MacIntyre begin constipation workshops?
Rachel:
Chris, a person we support, was constipated for over a week because they were waiting for their key worker to come back from annual leave and didn’t want to talk to anyone else. On returning to work Chris’ keyworker swiftly spoke to Chris’ GP and arranged medication, but it raised questions within our Health Team about why Chris, who has a mild learning disability and is otherwise outgoing, was only comfortable talking about this topic with one person. Our concern was that if this could happen with Chris, it could be happening with other people who draw on MacIntyre’s support.
Our staff use the Anticipatory Care Calender[4] but for Chris this just meant staff asking if they’d had a poo and recording their response as ‘self-care/unknown’. We talked to Chris and together with their keyworker we designed a constipation awareness workshop called ‘Let’s talk about poo’
What content have you included in ‘Let’s talk about poo’?
Rachel:
We created slides that were checked by MacIntyre’s Learning Disability Nurse, and added some fantastic resources to bring the training alive including:
- The ‘Poo Busters’ video[5]
- A chocolate version of the Bristol Stool Chart
- ‘The Trouble with Poo’ Beyond Words [6]
- ‘Fishing for Floaters’ game (using gravy to symbolise diarrhoea, which can be a lesser-know
- n sign of constipation).
- ‘Let’s talk poo’ graphic
- A film about Richard Handley[i] We share this film sensitively to raise awareness of how important it is to recognise changes in bowel patterns.
How have staff found the ‘Let’s talk about poo’ workshops?
Rachel:
Our first session was delivered on our fortnightly online call with senior staff. Everyone loved the training and wanted it to be available to all frontline teams. We had an initial plan for a 3-month roll out of 1-hour virtual sessions with a maximum of 20 staff per session; we found demand was high.
The workshops have had lots of positive feedback, including:
“I would recommend for all staff to do this training as it is an eye opener and will ensure more vigilance re constipation.” Alison
“I found the training very informative and relaxed. I will show the Poo Busters video at our team meetings.” Adam
We currently have dates to run in-house workshops until Summer 2024, and plan to create further resources and provide accessible workshops for people who attend MacIntyre Lifelong Learning. We also track
constipation trends and provide service-specific support where needed.
Chris didn’t want to co-deliver the workshops but observed and enjoyed the first se
ssion. We are looking to find an expert with lived experience within MacIntyre to be a co-trainer.
What would be your top tips to be more poo aware in all social care services?
Rachel:
- Make poo part of everyday conversations: “I’ve had a poo, have you?”
- Use your senses to check a person’s pooed: a smell in the bathroom after a person’s left or seeing less toilet paper on the roll.
- Observe – Is a person going back and forth to the loo? This could indicate they are struggling to poo.
- If someone is rectal digging, has poo under their fingernails or has smeared poo on surfaces/pants, look more closely at the person, their bowel habits and discuss with their GP.
- Pay attention to diet & exercise – Food should be fibre-rich and encourage water to drink. Bananas can cause constipation so don’t eat more than two per day. Exercise frequently to help with digestion.
- Think about positioning on the loo – using a stool can help.
- If a person is on more than three medications that can cause constipation they should be offered a prescribed laxative.
As a postscript to this story… Since working on the constipation awareness training with the Health Team, Chris has come to understand how important it is to tell someone if they can’t go to the toilet and now has several members of staff who they would feel comfortable to discuss this with. This is what we’re aiming to achieve for everyone who draws on MacIntyre’s support.
* Name changed to protect identity
@bethyb1886 @MeetMacIntyre
bethbritton.com macintyrecharity.org
[1] www.bbc.co.uk/news/uk-england-suffolk-42989091
[2] www.england.nhs.uk/wp-content/uploads/2019/05/action-from-learning.pdf
[3] www.england.nhs.uk/long-read/constipation-campaign-toolkit/
[4] www.macintyrecharity.org/our-approach/health/
[5] www.youtube.com/watch?v=R16WY6MLBBU
