Development of Teaching Aids to Facilitate Independent Defecation in School-Age Children with Defecation Disorders

Tuesday, 13 July 2010

Miyuki Nishida, RN, PhD
Faculty of Health Care and Nursing, Juntendo University, Chiba, Japan

Learning Objective 1: develop tools for facilitating independent defecation in school-age children with defecation disorders.

Learning Objective 2: learn how to teach the defecation caring to school-age children with defecation disorders.

Objective: To develop tools for facilitating independent defecation in school-age children with defecation disorders.
Method: A picture book and a defecation journal for school-age children were created employing figurative characters to draw children's interest to aspects surrounding defecation, namely: 1) bodily structure, 2) review of defecation behavior (eg. wearing/removing underwear, wiping, hand-washing), 3) symptoms of diarrhea/constipation, and 4) relating one's condition to adults. The defecation journal was designed as a sticker-book to enable recognition of one's own defecation pattern through play. Seven school-age children were enlisted in a pilot study to evaluate these tools as teaching aids.
Ethical considerations: The study was conducted with approval from both the University and Hospital Ethics Committees.
Results: In sessions conducted with the mother present, the children often turned to their mothers, and did not respond to queries on their own. Although showing initial interest drawn by the figurative characters, excitement quickly dissipated, and children became increasingly despondent, with bowed heads and shoulders. At the end of the session, children nodded halfheartedly to instructions on using the defecation journal.
Discussion: The children appeared distressed being told what they were always hearing from their mothers, from an adult they were meeting for the first time. This indicated the difficulty of supporting such children in the absence of pre-established relationships, and that this difficulty was probably being exacerbated by the mother's presence, in turn suggesting the importance of first getting acquainted with the child, before educational approaches to invoke self-motivation for nurturing autonomy, preferably in settings apart from the mother.
Future outlook: As the tools appeared capable of attracting the attention of children, a thorough review to optimize the conditions and protocol for their use is being undertaken, for developing the tools into a program leading to self-reliant defecation behavior.