Many patients admitted to a hospital for a number of reasons many of which have very little to do with the alimentary tract, complain about inadequate bowel function. Nurses are, professionally speaking, familiar with those complaints that, until now, have hardly ever been investigated. Nearly no information is available about for example the number of patients commonly suffering from bowel problems, the nature of the meant troubles, in short about the extent and seriousness of defecation problems in hospitalized patients. This provided a challange for research and finally led to a series of research projects some of which are reported in this study, in mutually independent chapters.

In chapter 1, a historical overiew of bowel habits, especially aming sick persons, and their relationship to privacy is given. During centuries bowel activities were, in a continuously civilized process, declined from public to private life. As a result of civilization, expectations raised by society, and rules of sanitary conduct, a sense of shame and embarrassment accompanied bowel actions inducing a change from public to private life.
In chapter 2, privacy as a concept is elaborated, resulting in a general definition with distinct dimensions. Indicators of privacy in relation to bowel action among hospital patients were indentified. One of the facts described was the so called 'imaginary membrane', which is supposed to protect somebody's privacy.

In chapter 3 a reseach study is reported, involving a population of 90 healthy participants selected by means of convenient sampling. The participants were asked to keep diaries for two weeks, on the process and products of bowel function. Together with information about stools, data were gathered about health and wellness, nutrition, medication, sanitary pratices and others. Among the human-biological aspects, two diffirent stool patterns were found.
One is related to modalities of defecations (i.e.: to form and quantity of stools and the moment of defecation), and the other to the functional aspects of defecation (i.e.: its delay and duration). Results of this study showed no single bowel pattern. Defecation patterns of the participants in this study when classified by sex and age, showed divergent variations on the two marked patterns.

Chapter 4 deals with experienced feelings related to defecationin the same healthy population. Four modalities of experienced feelings appeared: three of them are related to issues of sensitivity, namely: susceptibility for sanitary cleanliness, for excretory odours and for flatulency, and the fourth being a global attitude to bowel activity.
Women appeared especially susceptible for sanitary cleanliness. Susceptibility for flatulency was found in the elderly. Susceptibility for excretory odours appeared among those with stomach and abdominal complaints and those using laxatives. In summary, bowel problems seemed to be more common among women suffering from a malfunctioning bowel, or using laxatives.

Chapter 5 presents a research study on feelings of excretory privacy. A sample of 92 patients from medical units was selected. Research on bowel worry and concern among hospital patients is reported in chapter 6. This study was setup originally as a replication of Wright's (1974) research on Bowel function in hospital patients, and elaborated later as an enlarged or 'constructive replication study' (Connelly, 1986).
A population was selected including 160 hospital patients from both medical and surgical wards, in two academic and two non-academic general hospitals. Structered and non-structured questions were asked about bowel function, sanitary practices, feelings of privacy, shame and embarrassment as well as about medication , nutrition and (other) nursing and environmental factors.
Data gathered showed that 41% of the patient population studied evidenced worry and concern about bowel functioning after admission to the hospital. For the whole group as well as for those who used the toilet, worry and concern appeared in relation to fixation on both bowel processes and products, and also to a changing frequency of defecation.
In order for the nurse to make an accurate assessment of a patient on admission, reliable information about the patient's perception of his sickness and welness at home, including his bowel habits and patterns are important. In chapter 7, the reliability of information provided by patients when admitted to hospital was studied.
The information concerning the patient's health and wellness at home including bowel activities appeared to be reliable.

Finally, in the concluding chapter 8 practical, methodological and theoretical considerations are summarized and implications for theory development, research and the practice area are drawn.

Thesis is available at the library of the Florence Nightingale Institute