Commentary by Marion Allen and Kathleen Oberle

If one of the main purposes of qualitative research is to initiate dialogue, this article is important because it brings into the open something hidden and often invisible. Although the literature exploring causes and putative effects of fecal incontinence is substantial, there is little exploration of people's experience of living with this problem, which supports the need for the present investigation. The purposes of this study appear to be twofold: to explore the experiences of women living with fecal incontinence and to determine the effects of modifying diet to manage the incontinence. Both questions are vitally important to understanding how women understand and manage this socially troubling problem.

Today's healthcare system in general is oriented toward "quick fixes" so that those facing persistent problems are often marginalized and left on their own to discover ways to manage. They may feel that they are alone with their concerns and isolated in their experience.1 This is particularly the case when the problem is associated with social stigma.2-3 Nurses working with women who have fecal incontinence need knowledge on which to base their supportive interventions, and such knowledge can only come from the women themselves. This research goes some distance toward uncovering the experience of living with chronic fecal incontinence and strategies for dealing with it.

A strength of this study is that the voices of women with fecal incontinence are made audible, thus taking it out of the shadows and allowing the reader to get a glimpse of what it is like to live with the condition. In this way, it provides nurses with a portal to understanding what their patients or clients are going through and opens possibilities for dialogue and problem sharing. The vignettes can be shared with other patients and can be useful in helping them realize that they are not alone in their feelings of distress and isolation.

The study results are useful, but the research may have been stronger had the investigators focused on 1 method. Although they indicate that their design is phenomenological, in fact they have combined methods, using a modified phenomenological approach to study the women's experience and a qualitative descriptive (content analysis) approach to identify the dietary modifications used by women. The reader is left somewhat confused regarding how the sample is obtained and the analysis is conducted, and the dual purpose necessarily limits the depth of understanding. Nonetheless, the results are compelling, because they paint a graphic picture of women's daily struggle to deal with their chronic condition and carry on a life that is meaningful and fulfilling.

Findings of this study are congruent with the broader literature in chronicity and living with a persistent health problem. From the early work of Strauss and Corbin4 to that of more recent nursing scholars, research has identified the importance of self-care management and normalizing the condition.5 Decisions related to self-care arise in relation to the effects and course of the problem, and the context in which it is experienced.6 Strategies for self-care management are worked out by individuals in their daily living.7 The meaning that patients or clients attach to their chronic condition is vital to how they experience it.8 Listening to clients is the only way that healthcare providers can access this important knowledge source.9 However, individuals with chronic problems seldom name them in the terms used by health professionals, and as a result, this knowledge may be missed or misunderstood. Clearly, nurses must be familiar with the language used by their clients.10 This research allows us some insight into the knowledge that women with fecal incontinence possess about managing their condition and the language they use to describe it. The study provides evidence that listening to the voice of experience can be illuminating for nurse and client alike.

Acknowledgments

This study was funded in part by a grant from the American Nurses Foundation, Eli A. Lilly Award, to Cynthia Peden-McAlpine PhD, RN, APRN, BC and Donna Z. Bliss, PhD, RN, FAAN and by R15 NR04028 from NINR, NIH to Donna Z. Bliss. The authors also thank Joanne Slavin, PhD, RD for reviewing the manuscript.

References