"Constipation"[MeSH Terms] AND management

NHS constipation adults self help treatment red flags

site:nice.org.uk constipation adults symptoms treatment patient self care

https://www.rightdecisions.scot.nhs.uk/media/0ekdqcg4/v4-con…

~/

mkdir -p "/tmp/workspace/constipation-leaflet/src" "/tmp/workspace/constipation-leaflet/output" && python3 - <<'PY' from docx import Document from docx.shared import Inches, Pt, RGBColor from docx.enum.section import WD_SECTION from docx.enum.text import WD_ALIGN_PARAGRAPH, WD_BREAK, WD_LINE_SPACING from docx.enum.table import WD_TABLE_ALIGNMENT, WD_CELL_VERTICAL_ALIGNMENT, WD_ROW_HEIGHT_RULE from docx.oxml import OxmlElement from docx.oxml.ns import qn from docx.enum.style import WD_STYLE_TYPE OUT='/tmp/workspace/constipation-leaflet/output/Emily_Constipation_Leaflet.docx' def shade(cell, fill): tcPr=cell._tc.get_or_add_tcPr(); shd=OxmlElement('w:shd'); shd.set(qn('w:fill'),fill); tcPr.append(shd) def borders(cell, color='F6C90E', sz='18'): tcPr=cell._tc.get_or_add_tcPr(); b=tcPr.first_child_found_in('w:tcBorders') if b is None: b=OxmlElement('w:tcBorders'); tcPr.append(b) for edge in ('top','left','bottom','right'): tag='w:'+edge; el=b.find(qn(tag)) if el is None: el=OxmlElement(tag); b.append(el) el.set(qn('w:val'),'single'); el.set(qn('w:sz'),sz); el.set(qn('w:space'),'4'); el.set(qn('w:color'),color) def set_cell_margin(cell, top=110, start=120, bottom=110, end=120): tc=cell._tc; tcPr=tc.get_or_add_tcPr(); m=tcPr.first_child_found_in('w:tcMar') if m is None: m=OxmlElement('w:tcMar'); tcPr.append(m) for side,val in [('top',top),('start',start),('bottom',bottom),('end',end)]: node=m.find(qn('w:'+side)) if node is None: node=OxmlElement('w:'+side); m.append(node) node.set(qn('w:w'),str(val)); node.set(qn('w:type'),'dxa') def set_repeat_table_header(row): trPr=row._tr.get_or_add_trPr(); el=OxmlElement('w:tblHeader'); el.set(qn('w:val'),'true'); trPr.append(el) def set_cell_width(cell, inches): tcPr=cell._tc.get_or_add_tcPr(); w=tcPr.find(qn('w:tcW')) if w is None: w=OxmlElement('w:tcW'); tcPr.append(w) w.set(qn('w:w'),str(int(inches*1440))); w.set(qn('w:type'),'dxa') def set_row_height(row, inches): trPr=row._tr.get_or_add_trPr(); h=OxmlElement('w:trHeight'); h.set(qn('w:val'),str(int(inches*1440))); h.set(qn('w:hRule'),'atLeast'); trPr.append(h) def no_cell_borders(cell): tcPr=cell._tc.get_or_add_tcPr(); b=OxmlElement('w:tcBorders') for edge in ('top','left','bottom','right','insideH','insideV'): x=OxmlElement('w:'+edge); x.set(qn('w:val'),'nil'); b.append(x) tcPr.append(b) def set_col_widths(table, widths): for row in table.rows: for c,w in zip(row.cells,widths): set_cell_width(c,w) def add_run(p,text,bold=False,italic=False,color=None,size=8.4): r=p.add_run(text);r.bold=bold;r.italic=italic;r.font.name='Arial';r.font.size=Pt(size) if color:r.font.color.rgb=RGBColor.from_string(color) return r def para(cell,text='',size=8.4,bold=False,color='253858',space_after=2,align=None): p=cell.add_paragraph() if cell.paragraphs[0].text else cell.paragraphs[0] p.paragraph_format.space_after=Pt(space_after);p.paragraph_format.line_spacing=1.0 if align: p.alignment=align add_run(p,text,bold=bold,color=color,size=size) return p def title(cell,text): p=cell.add_paragraph() if cell.paragraphs[0].text else cell.paragraphs[0] p.paragraph_format.space_after=Pt(5);p.paragraph_format.line_spacing=0.9 add_run(p,text,True,False,'15324B',12) return p def sub(cell,text): p=cell.add_paragraph();p.paragraph_format.space_before=Pt(3);p.paragraph_format.space_after=Pt(1);p.paragraph_format.line_spacing=0.9 add_run(p,text,True,False,'008C95',9) def bullet(cell,text): p=cell.add_paragraph(style=None);p.paragraph_format.left_indent=Inches(.10);p.paragraph_format.first_line_indent=Inches(-.10);p.paragraph_format.space_after=Pt(1);p.paragraph_format.line_spacing=0.98 add_run(p,'• ',True,False,'E26D5A',8.2);add_run(p,text,False,False,'253858',8.2) def small(cell,text): para(cell,text,size=7.1,color='566573',space_after=1) doc=Document(); sec=doc.sections[0] sec.orientation=1; sec.page_width=Inches(11.69); sec.page_height=Inches(8.27) sec.top_margin=Inches(.30);sec.bottom_margin=Inches(.28);sec.left_margin=Inches(.27);sec.right_margin=Inches(.27) sec.header_distance=Inches(.12);sec.footer_distance=Inches(.12) styles=doc.styles styles['Normal'].font.name='Arial';styles['Normal'].font.size=Pt(8.5) # Footer footer=sec.footer.paragraphs[0];footer.alignment=WD_ALIGN_PARAGRAPH.CENTER add_run(footer,'Community nursing information leaflet | Prepared for Emily | October 2026',size=6.8,color='607080') def page_header(number, strap): h=doc.add_table(rows=1,cols=2);h.alignment=WD_TABLE_ALIGNMENT.CENTER;h.autofit=False;set_col_widths(h,[8.7,2.1]) for c in h.rows[0].cells: no_cell_borders(c); set_cell_margin(c,0,0,0,0) p=h.cell(0,0).paragraphs[0];p.paragraph_format.space_after=Pt(0) add_run(p,'CONSTIPATION: PRACTICAL SUPPORT FOR EMILY',True,False,'15324B',15) p=h.cell(0,1).paragraphs[0];p.alignment=WD_ALIGN_PARAGRAPH.RIGHT;p.paragraph_format.space_after=Pt(0) add_run(p,f'SIDE {number} OF 2',True,False,'008C95',8) p=doc.add_paragraph();p.paragraph_format.space_after=Pt(4);p.paragraph_format.space_before=Pt(0);p.paragraph_format.line_spacing=0.9 add_run(p,strap,False,True,'566573',8.5) def panels(): t=doc.add_table(rows=1,cols=3);t.alignment=WD_TABLE_ALIGNMENT.CENTER;t.autofit=False;set_col_widths(t,[3.67,3.67,3.67]) for c in t.rows[0].cells: c.vertical_alignment=WD_CELL_VERTICAL_ALIGNMENT.TOP;shade(c,'F9FCFC');borders(c);set_cell_margin(c) return t.rows[0].cells page_header(1,'A plain-language guide to your gut, constipation and what you can do today.') cells=panels() # P1 c=cells[0] title(c,'Your gastrointestinal (GI) tract') para(c,'Your GI tract is the route food takes through your body. It breaks food down, absorbs what you need and removes waste.',8.35) sub(c,'The journey of food') bullet(c,'Mouth and oesophagus: food is chewed and swallowed into the stomach.') bullet(c,'Stomach: mixes food into a soft liquid.') bullet(c,'Small intestine: digests food and absorbs most nutrients into the blood.') bullet(c,'Large intestine (colon): takes water from the remaining waste and forms poo.') bullet(c,'Rectum and anus: store and pass poo when it is time to open your bowels.') sub(c,'Why this matters') para(c,'If poo moves slowly through the colon, too much water is absorbed. This can make it hard, dry and difficult to pass.',8.35) small(c,'The colon normally absorbs most water from the contents that enter it; the rectum stores stool until it is passed (Hall, 2021).') # P2 c=cells[1] title(c,'What is constipation?') para(c,'Constipation means passing poo less often than is usual for you, or finding it hard to pass. Everyone has a different normal bowel pattern.',8.35) sub(c,'You may notice') bullet(c,'hard, dry or lumpy poo') bullet(c,'straining or pain when opening your bowels') bullet(c,'feeling that your bowel has not completely emptied') bullet(c,'bloating, cramps, wind, nausea or reduced appetite') sub(c,'Common reasons') bullet(c,'not drinking enough, or eating too little fibre') bullet(c,'putting off going to the toilet or a change in routine') bullet(c,'less movement or long periods of sitting') bullet(c,'stress, low mood, illness or reduced privacy') bullet(c,'some medicines, including strong painkillers (opioids), iron and some antidepressants') bullet(c,'an underlying condition. New or worsening constipation should be assessed.') small(c,'Medicines, systemic illness and bowel obstruction are secondary causes that should be considered in new-onset constipation (Bharucha and Lacy, 2021).') # P3 c=cells[2] title(c,'Emily: small changes that fit your day') para(c,'Shift work and caring for Stan can make regular meals, drinks and toilet breaks harder. Start with one or two manageable changes.',8.35) sub(c,'Try a simple plan') bullet(c,'Take a refillable bottle on shift. Aim for regular drinks through the day. Check with a clinician first if you have been advised to limit fluids.') bullet(c,'Do not skip meals where possible. Add fibre gradually: wholegrain cereal or bread, beans, lentils, vegetables, fruit, nuts and seeds.') bullet(c,'Make a regular toilet opportunity, often 15-20 minutes after breakfast or a hot drink. Do not ignore the urge to go.') bullet(c,'On the toilet, place feet on a small stool if safe, keep knees slightly above hips, lean forward and breathe out. Avoid prolonged straining.') bullet(c,'Build movement into your routine: a short walk or gentle activity most days, if safe for you.') bullet(c,'Keep a short bowel diary: stool type, frequency, fluids, food, activity and medicines. This can help the nurse, GP or pharmacist.') small(c,'Increase fibre slowly. More fibre without enough fluid can worsen symptoms. Lifestyle changes may take days to weeks to help.') # next page p=doc.add_paragraph();p.add_run().add_break(WD_BREAK.PAGE) page_header(2,'Self-help first, safe treatment choices and people who can support you.') cells=panels() # page2 P1 c=cells[0] title(c,'Self-help and initial treatment') para(c,'Start with the self-help steps on Side 1. If they are not enough, speak to a pharmacist, nurse or GP before choosing a laxative, especially if symptoms are new, severe or persistent.',8.25) sub(c,'Laxatives: what they do') bullet(c,'Bulk-forming laxatives add bulk and hold water in the stool. They need plenty of fluid and may not suit everyone.') bullet(c,'Osmotic laxatives draw water into the bowel to soften poo. Macrogol is an example.') bullet(c,'Stimulant laxatives encourage bowel movement. They can cause cramps or diarrhoea and are usually for short-term use or clinical advice.') bullet(c,'Rectal treatments such as suppositories or enemas should only be used following advice, particularly if you may be impacted.') sub(c,'Use medicines safely') bullet(c,'Read the label and follow the pharmacist, nurse or prescriber’s advice.') bullet(c,'Tell the pharmacist about every medicine, supplement and health condition. Do not stop prescribed medicines without advice.') bullet(c,'Do not take laxatives for a long time without review. Contact your GP if symptoms do not improve or keep returning.') small(c,'Diet, fluids, activity and toileting habits are usual first measures. Laxatives may be used when these do not work or while changes take effect (NICE, 2024).') # page2 p2 c=cells[1] title(c,'When to get help') sub(c,'Contact GP / NHS 111 promptly if you have') bullet(c,'new constipation that is persistent, getting worse or a clear change from your usual bowel habit') bullet(c,'blood in your poo, black stools, unexplained weight loss, tiredness or possible anaemia') bullet(c,'ongoing tummy pain, vomiting, fever, loss of appetite, or a swollen abdomen') bullet(c,'a feeling of blockage, inability to empty, or constipation that does not improve with self-help or treatment') bullet(c,'constipation after starting a new medicine, particularly an opioid painkiller') sub(c,'Urgent help') para(c,'Call 111 urgently, or 999 if you are severely unwell, for severe or worsening abdominal pain, repeated vomiting, a very swollen abdomen, or if you cannot pass poo or wind. These can be signs of bowel obstruction and need urgent assessment.',8.25) sub(c,'Please do not feel embarrassed') para(c,'Bowel symptoms are common and healthcare professionals discuss them every day. Asking early helps identify the cause and the right treatment.',8.25) small(c,'Rectal bleeding, change in bowel habit, abdominal symptoms, fatigue/anaemia and weight loss are warning features requiring assessment (NHS Ayrshire and Arran, 2024).') # page2 p3 c=cells[2] title(c,'Who can support you?') sub(c,'Community nurse / Nursing Associate') para(c,'Can discuss your bowel routine, assess symptoms and risks, provide self-care information, support a bowel diary and escalate concerns to the registered nurse or GP.',8.05) sub(c,'Community pharmacist') para(c,'Can review medicines that may cause constipation, advise on suitable over-the-counter laxatives and explain safe use. They can refer you onwards if needed.',8.05) sub(c,'GP / Advanced Nurse Practitioner') para(c,'Can assess for underlying causes, review prescribed medicines, arrange tests or prescribe treatment. They can refer to specialist services.',8.05) sub(c,'Dietitian') para(c,'Can give personalised food and fluid advice, including practical high-fibre options that suit shifts, budget and caring responsibilities.',8.05) sub(c,'Continence or bowel service') para(c,'Can assess persistent constipation, bowel-emptying problems and faecal impaction, and provide a tailored bowel-care plan.',8.05) sub(c,'Social prescriber / carers support') para(c,'Can connect you with local carer support, practical help and wellbeing services, so you have more capacity to look after your own health.',8.05) sub(c,'A shared next step') para(c,'Choose one change this week: ________________________________\nReview date / who to contact: _______________________________',8.05, color='15324B') # references page? need imbedded in 3rd panel as assignment shows reference list. Current sides p2 third has too much. Assign requirement says 6th references list. Need replace p2 third with references and professionals must p2 middle perhaps too much. Could panel 3 include roles shorter + refs? Must specifically reference list visual says 6th. Change 6th references only. P2 p2 incorporate roles short but reasonably. need modify? easiest rebuild? Current c stored. We can replace content in p2 P2 after red content? no. Need panel 3 ref list. And need roles in p2 P2 impossible, but can do concise roles at top p2 and lower redflags. Could text too much. Modify P2 page2 cell to clear and add roles mini then red flags. Cannot easily delete children and rebuild utility. do clear p. use xml remove all p/tbl. Let's define clear cell and rebuild both p2/ p3 at script before save. def clear(cell): tc=cell._tc for child in list(tc): if child.tag != qn('w:tcPr'): tc.remove(child) cell.add_paragraph() # re-create pages second set cells currently valid c=cells[1];clear(c);set_cell_margin(c) title(c,'When to get help and who can support you') sub(c,'Contact GP / NHS 111 promptly if you have') bullet(c,'new constipation that is persistent, getting worse or a clear change from your usual bowel habit') bullet(c,'blood in your poo, black stools, unexplained weight loss, tiredness or possible anaemia') bullet(c,'ongoing tummy pain, vomiting, fever, loss of appetite, or a swollen abdomen') bullet(c,'a feeling of blockage, inability to empty, or constipation that does not improve with self-help or treatment') bullet(c,'constipation after starting a new medicine, particularly an opioid painkiller') sub(c,'Urgent help') para(c,'Call 111 urgently, or 999 if you are severely unwell, for severe or worsening abdominal pain, repeated vomiting, a very swollen abdomen, or if you cannot pass poo or wind.',8.1) sub(c,'Your support team') bullet(c,'Community nurse / Nursing Associate: discusses symptoms, supports a bowel diary and escalates concerns to the registered nurse or GP.') bullet(c,'Pharmacist: reviews medicines and advises on safe over-the-counter treatment.') bullet(c,'GP / Advanced Nurse Practitioner: assesses causes, reviews prescriptions and arranges tests or referrals.') bullet(c,'Dietitian: gives tailored food and fluid advice. Continence / bowel service: supports persistent bowel problems or impaction.') bullet(c,'Social prescriber / carers service: connects you with carer support and practical wellbeing help.') small(c,'Warning features need assessment (NHS Ayrshire and Arran, 2024).') c=cells[2];clear(c);set_cell_margin(c) title(c,'References') para(c,'Harvard Cite Them Right style',8.6,True,'008C95',3) small(c,'Accessed 17 October 2026.') sub(c,'Books') para(c,'Bharucha, A.E. and Lacy, B.E. (2021) ‘Constipation’, in Feldman, M. et al. (eds.) Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 12th edn. Philadelphia: Elsevier, pp. 261-292.',7.25,space_after=3) para(c,'Hall, J.E. (2021) Guyton and Hall Textbook of Medical Physiology. 14th edn. Philadelphia: Elsevier.',7.25,space_after=3) sub(c,'Online guidance') para(c,'National Institute for Health and Care Excellence (NICE) (2024) Constipation: management of adults. Clinical Knowledge Summaries. Available at: https://cks.nice.org.uk/topics/constipation/management/adults/ (Accessed: 17 October 2026).',7.25,space_after=3) para(c,'NHS Ayrshire and Arran (2024) Constipation management guidance for community. Available at: https://www.rightdecisions.scot.nhs.uk/media/0ekdqcg4/v4-constipation-management-community-amended-306.pdf (Accessed: 17 October 2026).',7.25,space_after=3) para(c,'NHS (2024) Constipation. Available at: https://www.nhs.uk/conditions/constipation/ (Accessed: 17 October 2026).',7.25,space_after=3) sub(c,'Information note') para(c,'This leaflet supports, but does not replace, individual assessment. Speak to a healthcare professional for advice that is right for you.',7.6,True,'15324B',3) sub(c,'My agreed next step') para(c,'This week I will: _____________________________________\nI will contact: ________________________________________',7.8,color='15324B',space_after=3) # ensure non-splitting rows and no cell paragraph widows as much as possible for table in doc.tables: for row in table.rows: trPr=row._tr.get_or_add_trPr(); cant=OxmlElement('w:cantSplit');trPr.append(cant) doc.save(OUT) print(OUT) PY python3 - <<'PY' from docx import Document p='/tmp/workspace/constipation-leaflet/output/Emily_Constipation_Leaflet.docx' d=Document(p) print('pages via explicit page breaks:', sum(1 for para in d.paragraphs for run in para.runs if 'w:type="page"' in run._r.xml)+1) print('tables',len(d.tables),'paras',len(d.paragraphs)) print('size',__import__('os').path.getsize(p)) PY

python3 - <<'PY' from docx import Document from pathlib import Path p=Path('/tmp/workspace/constipation-leaflet/output/Emily_Constipation_Leaflet.docx') d=Document(str(p)) assert p.exists() and p.stat().st_size > 10000 assert len(d.tables) == 4 assert 'CONSTIPATION: PRACTICAL SUPPORT FOR EMILY' in '\n'.join(x.text for t in d.tables for row in t.rows for x in row.cells) assert 'References' in '\n'.join(x.text for t in d.tables for row in t.rows for x in row.cells) print(f'Verified {p.name}: {p.stat().st_size} bytes, {len(d.tables)} layout tables, required content and reference section present.') PY

"Constipation"[MeSH Terms] AND adults

NMC Code four themes prioritise people practise effectively preserve safety promote professionalism trust official

NHS constipation symptoms causes treatment adults self help

python3 - <<'PY' from docx import Document from docx.shared import Inches, Pt, RGBColor from docx.enum.text import WD_ALIGN_PARAGRAPH, WD_BREAK from docx.enum.table import WD_TABLE_ALIGNMENT, WD_CELL_VERTICAL_ALIGNMENT from docx.oxml import OxmlElement from docx.oxml.ns import qn from pathlib import Path base=Path('/tmp/workspace/constipation-revision-pack') (base/'output').mkdir(parents=True, exist_ok=True) out=base/'output'/'Emily_Constipation_Assessment_Revision_Pack.docx' def set_cell_shading(cell, fill): tcPr=cell._tc.get_or_add_tcPr(); shd=OxmlElement('w:shd');shd.set(qn('w:fill'),fill);tcPr.append(shd) def set_cell_margins(cell, top=100,start=120,bottom=100,end=120): tcPr=cell._tc.get_or_add_tcPr();tcMar=tcPr.first_child_found_in('w:tcMar') if tcMar is None:tcMar=OxmlElement('w:tcMar');tcPr.append(tcMar) for side,v in [('top',top),('start',start),('bottom',bottom),('end',end)]: e=tcMar.find(qn('w:'+side)) if e is None:e=OxmlElement('w:'+side);tcMar.append(e) e.set(qn('w:w'),str(v));e.set(qn('w:type'),'dxa') def set_border(cell,color='B6DDE0'): tcPr=cell._tc.get_or_add_tcPr(); b=OxmlElement('w:tcBorders') for edge in ('top','left','bottom','right'): e=OxmlElement('w:'+edge);e.set(qn('w:val'),'single');e.set(qn('w:sz'),'8');e.set(qn('w:color'),color);b.append(e) tcPr.append(b) def add_field(paragraph, instr): run=paragraph.add_run(); fldChar1=OxmlElement('w:fldChar');fldChar1.set(qn('w:fldCharType'),'begin') instrText=OxmlElement('w:instrText');instrText.set(qn('xml:space'),'preserve');instrText.text=instr fldChar2=OxmlElement('w:fldChar');fldChar2.set(qn('w:fldCharType'),'end');run._r.append(fldChar1);run._r.append(instrText);run._r.append(fldChar2) def run(p,text,bold=False,colour='253858',size=10,italic=False): r=p.add_run(text);r.bold=bold;r.italic=italic;r.font.name='Aptos';r.font.size=Pt(size);r.font.color.rgb=RGBColor.from_string(colour);return r def heading(doc,text,level=1): p=doc.add_paragraph();p.style=f'Heading {level}';p.paragraph_format.space_before=Pt(10 if level==1 else 6);p.paragraph_format.space_after=Pt(4) r=p.add_run(text);r.font.name='Aptos Display';r.font.color.rgb=RGBColor(21,50,75) return p def body(doc,text='',bold=False,space=4,size=10): p=doc.add_paragraph();p.paragraph_format.space_after=Pt(space);p.paragraph_format.line_spacing=1.08;run(p,text,bold,size=size);return p def bullet(doc,text,level=0): p=doc.add_paragraph(style='List Bullet' if level==0 else 'List Bullet 2');p.paragraph_format.space_after=Pt(2);p.paragraph_format.line_spacing=1.03;run(p,text,size=9.7);return p def note(doc, title, text, colour='E8F5F5'): t=doc.add_table(rows=1,cols=1);t.alignment=WD_TABLE_ALIGNMENT.CENTER;c=t.cell(0,0);set_cell_shading(c,colour);set_border(c);set_cell_margins(c) p=c.paragraphs[0];p.paragraph_format.space_after=Pt(2);run(p,title+' ',True,'008C95',10);run(p,text,False,'253858',9.5) doc=Document();sec=doc.sections[0];sec.top_margin=Inches(.55);sec.bottom_margin=Inches(.52);sec.left_margin=Inches(.65);sec.right_margin=Inches(.65) styles=doc.styles;styles['Normal'].font.name='Aptos';styles['Normal'].font.size=Pt(10) for n in ['Heading 1','Heading 2','Heading 3']: styles[n].font.name='Aptos Display';styles[n].font.color.rgb=RGBColor(21,50,75) styles['Heading 1'].font.size=Pt(17);styles['Heading 2'].font.size=Pt(13);styles['Heading 3'].font.size=Pt(11) # header/footer h=sec.header.paragraphs[0];h.alignment=WD_ALIGN_PARAGRAPH.RIGHT;run(h,'COMMUNITY PLACEMENT REVISION PACK',True,'008C95',8) f=sec.footer.paragraphs[0];f.alignment=WD_ALIGN_PARAGRAPH.CENTER;run(f,'Emily scenario | Constipation assessment preparation | Page ',False,'607080',8);add_field(f,'PAGE') # Title t=doc.add_table(rows=1,cols=1);c=t.cell(0,0);set_cell_shading(c,'E8F5F5');set_border(c,'008C95');set_cell_margins(c,180,180,180,180) p=c.paragraphs[0];p.alignment=WD_ALIGN_PARAGRAPH.CENTER;run(p,'CONSTIPATION ASSESSMENT',True,'15324B',23) p=c.add_paragraph();p.alignment=WD_ALIGN_PARAGRAPH.CENTER;run(p,'Revision pack for Tasks 2-4: knowledge, patient discussion and NMC Code reflection',False,'253858',11) body(doc,'Scenario: Emily, 54, works full-time as a university cleaner on shift work and provides care and support for her husband, Stan, who is retired because of ill health.',space=7) note(doc,'How to use this pack:','Practise speaking from the short prompts, not reading a script word-for-word. Keep your language respectful, plain and person-centred. Work within your student nurse / nursing associate role, local policy and supervision arrangements.') heading(doc,'Quick assessment aim',1) body(doc,'Show that you can give safe, understandable information about constipation, personalise it to Emily’s routine and recognise when you must escalate concerns.',space=2) # task 2 heading(doc,'2. Clinical knowledge revision guide',1) heading(doc,'The GI tract: a simple explanation',2) body(doc,'“The gastrointestinal tract is the route food takes through the body. Food goes from the mouth, down the oesophagus to the stomach, then through the small intestine and large intestine. The small intestine absorbs most nutrients. The large intestine absorbs water from what is left, forming stool. Stool is stored in the rectum until it is passed through the anus.”',size=10) body(doc,'When stool stays in the colon longer, more water is absorbed. This can make stool hard, dry and more difficult to pass. When the rectum fills, it triggers the urge to open the bowels (Hall, 2021; Bharucha and Lacy, 2021).',size=9.5) heading(doc,'Constipation: definition and symptoms',2) body(doc,'Constipation is a change from a person’s usual bowel habit. It can mean opening bowels less often, hard or lumpy stool, straining, pain, incomplete emptying or a sense of blockage. Some people also have bloating, abdominal discomfort, wind, nausea or reduced appetite.',size=10) # key table tab=doc.add_table(rows=1,cols=2);tab.style='Table Grid';tab.alignment=WD_TABLE_ALIGNMENT.CENTER for cell,txt in zip(tab.rows[0].cells,['What you may hear','What it can mean']):set_cell_shading(cell,'D8EFF0');run(cell.paragraphs[0],txt,True,'15324B',9.5);set_cell_margins(cell) for a,b in [('“My poo is hard and like pellets.”','Hard, dry stool is common in constipation.'),('“I have to push a lot.”','Straining may indicate hard stool or difficulty emptying.'),('“I still feel full afterwards.”','Possible incomplete evacuation.'),('“I am going less than normal.”','Frequency matters compared with the person’s normal pattern.')]: cells=tab.add_row().cells for cell,text in zip(cells,[a,b]):set_cell_margins(cell);run(cell.paragraphs[0],text,False,'253858',9) heading(doc,'Causes: think “routine, fluids, fibre, movement, medicines, illness”',2) for x in ['Low fluid intake or dehydration.','Low fibre intake, missed meals or a sudden routine/diet change.','Delaying the urge to go, lack of privacy or limited access to a toilet.','Reduced activity or prolonged sitting.','Stress, anxiety, low mood or caring pressures.','Medicines: for example opioid painkillers, iron and some antidepressants. Never advise stopping prescribed medicine without an appropriate prescriber review.','Underlying disease or obstruction. New, persistent or worsening constipation needs assessment.'] : bullet(doc,x) note(doc,'Personalise it to Emily:','Shift work can disrupt meals, drinks and planned toilet opportunities. Caring for Stan may mean Emily puts her own needs last. Ask rather than assume: “How do your shifts and caring responsibilities affect when you eat, drink or have time to use the toilet?”') heading(doc,'Self-help: explain the “why”',2) for x in ['Fluids: regular drinks can help keep stool soft. Check whether the person has any clinical fluid restriction before suggesting an increase.','Fibre: add fibre gradually through fruit, vegetables, beans, lentils, wholegrain cereals/bread, nuts and seeds. Increase fluids too, because suddenly increasing fibre without enough fluid may worsen bloating or constipation.','Movement: safe, regular activity can encourage bowel movement. A short walk may be realistic for Emily.','Toilet routine: do not ignore the urge. Allow unhurried time, often after breakfast or a warm drink. Feet supported on a low stool, knees slightly higher than hips and leaning forward may make opening bowels easier. Avoid prolonged straining.','Bowel diary: record usual frequency, stool consistency, pain, fluids, food, activity and medicines. This supports assessment and review.'] : bullet(doc,x) heading(doc,'Treatment: safe overview',2) body(doc,'Lifestyle measures are usually first. If they do not help enough, or while they take effect, a pharmacist, nurse prescriber or GP may advise a laxative. The choice depends on symptoms, other medicines and the person’s health needs. Do not select or recommend a product beyond your competence or local policy.',size=10) for x in ['Bulk-forming laxatives add bulk and retain fluid in stool. Adequate fluid is important.','Osmotic laxatives draw water into the bowel and soften stool. Macrogol is an example.','Stimulant laxatives stimulate bowel movement. They may cause cramps or diarrhoea and are commonly used short term or with professional advice.','Suppositories/enemas are rectal treatments. Escalate for advice, particularly when faecal impaction or obstruction is possible.'] : bullet(doc,x) heading(doc,'Red flags: stop, assess and escalate',2) note(doc,'Escalate today through your supervisor / local pathway if Emily reports:','blood in stool or black stool; unexplained weight loss; persistent or worsening change in bowel habit; ongoing or significant abdominal pain; vomiting; fever; abdominal swelling; new marked fatigue/possible anaemia; a possible blockage or inability to empty; constipation that does not improve; or constipation linked to a new medicine, especially opioid pain relief.','FCE9E4') body(doc,'Urgent escalation: severe or worsening abdominal pain, repeated vomiting, a very swollen abdomen, or inability to pass stool or wind can suggest bowel obstruction. Follow local urgent-care procedure. Do not offer self-help advice as a substitute for urgent assessment.',bold=True,size=9.6) # Task 3 new page doc.add_paragraph().add_run().add_break(WD_BREAK.PAGE) heading(doc,'3. Patient-discussion practice guide',1) body(doc,'The purpose is not to diagnose Emily. It is to listen, identify possible causes and warning signs, provide safe information, and agree the next appropriate action with the registered nurse / supervisor.',size=10) heading(doc,'A 7-step structure for the face-to-face assessment',2) steps=[ ('1. Prepare and introduce','Check privacy and minimise interruptions. Introduce yourself and your role honestly. “Hello Emily, I’m [name], a student nurse / nursing associate working with the community team. Is now still a good time to talk?”'), ('2. Explain purpose and obtain consent','“The nurse asked me to talk with you about constipation, what may be contributing to it and ways we can support you. Would you be happy to discuss this now?” Explain that she can pause, decline or ask questions. Gain consent before sharing the leaflet or asking personal bowel questions.'), ('3. Start with Emily’s experience','Use open questions: “Can you tell me what has changed for you?” “What does constipation mean for you?” “How is it affecting your comfort, sleep, work or caring role?” Listen without rushing or showing embarrassment.'), ('4. Assess safely','Ask about her usual and current bowel pattern, last bowel movement, stool consistency, straining, pain, bloating, nausea/vomiting, diet, fluids, activity, toilet access, changes in routine and all medicines. Ask directly but sensitively about blood, weight loss, fever, severe pain and inability to pass stool or wind.'), ('5. Explain in everyday language','Use short phrases. “The bowel takes water out of waste. If waste stays there longer, it becomes dry and harder to pass.” Use the leaflet as a prompt, not as something to read at Emily.'), ('6. Agree realistic actions','Ask permission first: “Would it be alright if we look at a couple of ideas that might fit around your shifts?” Link advice to her life, for example a water bottle on shift, a planned unhurried toilet time when possible, gradual fibre changes and a short walk. Agree one or two actions, not a long list.'), ('7. Check understanding and close','Use teach-back: “Just so I know I have explained this clearly, what are the two things you plan to try?” Confirm who to contact and when. Document factually and escalate findings promptly to the registered nurse / appropriate clinician.')] for a,b in steps: heading(doc,a,3);body(doc,b,size=9.6,space=3) heading(doc,'Questions to practise',2) qs=['“What is normal for your bowels, and when did you last open them?”','“What is the poo like: hard, lumpy, painful or difficult to pass?”','“Do you feel you can completely empty your bowel?”','“Have you noticed tummy pain, swelling, sickness, fever, blood in your poo, black poo or weight loss?”','“How much are you drinking on a typical shift? Has anyone told you to limit fluids?”','“Talk me through a typical shift: when do you eat, drink and get a toilet break?”','“What medicines, vitamins or supplements do you take, including anything bought over the counter?”','“What would make this advice manageable for you while you are also supporting Stan?”'] for q in qs: bullet(doc,q) heading(doc,'Useful communication choices',2) tab=doc.add_table(rows=1,cols=2);tab.style='Table Grid';tab.alignment=WD_TABLE_ALIGNMENT.CENTER for cell,txt in zip(tab.rows[0].cells,['Use','Avoid']):set_cell_shading(cell,'D8EFF0');run(cell.paragraphs[0],txt,True,'15324B',9.5);set_cell_margins(cell) for a,b in [('“Poo” or “bowels” if Emily uses these words','Unexplained jargon such as “defecation” or “faecal loading”'),('“What feels realistic for you?”','“You must do all of these things.”'),('“Can I check I explained that clearly?”','“Do you understand?” only'),('“Would you like Stan involved, or would you prefer privacy?”','Assuming her husband should be present')]: cells=tab.add_row().cells for cell,text in zip(cells,[a,b]):set_cell_margins(cell);run(cell.paragraphs[0],text,False,'253858',9) heading(doc,'Safety and scope reminders',2) for x in ['Maintain dignity, privacy and confidentiality. Use a private space and check whether Emily wants Stan present.','Do not undertake an examination, recommend a specific medicine or give a diagnosis unless trained, authorised and acting within local policy and supervision.','If red flags are present, do not delay escalation to finish the leaflet discussion.','Record what Emily said, your observations, information given, actions agreed and who you informed. Avoid judgemental language.'] : bullet(doc,x) # task4 heading(doc,'4. NMC Code reflection revision guide',1) body(doc,'The NMC Code applies to nurses, midwives and nursing associates. It describes four linked areas of professional practice: prioritise people, practise effectively, preserve safety, and promote professionalism and trust (NMC, 2018).',size=10) # Four themes table for name,what,example in [ ('Prioritise people','Treat Emily as an individual, preserve dignity, obtain consent and respond to her needs.','Ask about the impact of shifts and caring; offer a private discussion and choices about Stan’s involvement.'), ('Practise effectively','Communicate clearly, share information appropriately, work with colleagues and keep records.','Use plain language, teach-back, the leaflet and a clear handover to the registered nurse.'), ('Preserve safety','Recognise and work within competence, assess risk, escalate concerns and act without delay.','Ask about red flags, do not independently diagnose or prescribe, and escalate possible obstruction or bleeding.'), ('Promote professionalism and trust','Be honest about your role, maintain confidentiality, act with integrity and uphold public trust.','Introduce yourself accurately as a student; listen without judgement and document factually.')]: heading(doc,name,3);body(doc,f'{what} Example: {example}',size=9.4,space=2) heading(doc,'A strong reflection choice: Preserve safety',2) body(doc,'This is a suitable Code theme to demonstrate because constipation can sometimes indicate serious illness. You can show safety by asking relevant questions, recognising limits of competence, following local escalation procedures and acting on warning signs.',size=10) heading(doc,'A short reflection structure: What? So what? Now what?',2) for title_,text in [ ('What?','Describe the situation briefly and anonymously. Example: “During a planned community visit, I discussed constipation with Emily. I asked permission before discussing personal bowel symptoms and used a leaflet to explain the GI tract and self-care.”'), ('So what?','Explain why it matters. “I recognised that new or worsening constipation can have underlying causes. I asked about bowel change, pain, vomiting, bleeding, medication and weight loss. This supported timely escalation rather than assuming constipation was minor.”'), ('Now what?','Identify the benefit and a specific improvement. “Emily can receive advice matched to her shift work and caring role, while concerns are identified early. I will improve my confidence in asking sensitive bowel questions by practising open questions and reviewing the local bowel-care / escalation policy with my assessor.”')]: heading(doc,title_,3);body(doc,text,size=9.5,space=3) heading(doc,'Reflection planning template',2) tab=doc.add_table(rows=1,cols=2);tab.style='Table Grid';tab.alignment=WD_TABLE_ALIGNMENT.CENTER for cell,txt in zip(tab.rows[0].cells,['Prompt','Your notes']):set_cell_shading(cell,'D8EFF0');run(cell.paragraphs[0],txt,True,'15324B',9.5);set_cell_margins(cell) for a in ['Code theme and relevant behaviour','What did I do that shows this?','How did it benefit Emily?','What did I do well?','What would I do differently next time?','One specific learning action and date']: cells=tab.add_row().cells;set_cell_margins(cells[0]);set_cell_margins(cells[1]);run(cells[0].paragraphs[0],a,True,'253858',9);run(cells[1].paragraphs[0],'',False,'253858',9);cells[1].paragraphs[0].add_run('\n\n') heading(doc,'Final 60-second rehearsal',2) for x in ['“I will introduce myself, confirm privacy and gain consent.”','“I will ask about Emily’s usual and current bowel habits, symptoms, routine, fluids, diet, activity and medicines, including red flags.”','“I will explain simply that slower stool movement allows more water to be absorbed, making stool harder.”','“I will tailor practical advice to shift work and caring responsibilities, agree small goals and check understanding.”','“I will work within my role, document clearly and escalate any concerns promptly.”'] : bullet(doc,x) heading(doc,'References',1) body(doc,'Bharucha, A.E. and Lacy, B.E. (2021) ‘Constipation’, in Feldman, M. et al. (eds.) Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 12th edn. Philadelphia: Elsevier, pp. 261-292.',size=8.8) body(doc,'Hall, J.E. (2021) Guyton and Hall Textbook of Medical Physiology. 14th edn. Philadelphia: Elsevier.',size=8.8) body(doc,'Nursing and Midwifery Council (NMC) (2018) The Code: professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at: https://www.nmc.org.uk/standards/code/read-the-code-online/ (Accessed: 17 October 2026).',size=8.8) body(doc,'NHS (2024) Constipation. Available at: https://www.nhs.uk/conditions/constipation/ (Accessed: 17 October 2026).',size=8.8) body(doc,'National Institute for Health and Care Excellence (NICE) (2024) Constipation: management of adults. Clinical Knowledge Summaries. Available at: https://cks.nice.org.uk/topics/constipation/management/adults/ (Accessed: 17 October 2026).',size=8.8) body(doc,'Recent evidence note: a 2025 systematic review (PMID: 40516858) reviewed nutrition and physical-activity guidelines for adults with chronic constipation. It does not change the safety advice in this pack; use local and NICE guidance for practice.',size=8.4) doc.save(out) print(out) PY python3 - <<'PY' from docx import Document from pathlib import Path p=Path('/tmp/workspace/constipation-revision-pack/output/Emily_Constipation_Assessment_Revision_Pack.docx') d=Document(p) text='\n'.join(x.text for x in d.paragraphs)+'\n'+'\n'.join(c.text for t in d.tables for r in t.rows for c in r.cells) for s in ['Clinical knowledge revision guide','Patient-discussion practice guide','NMC Code reflection revision guide','References','Preserve safety']: assert s in text, s print('Verified',p.name,'bytes',p.stat().st_size,'tables',len(d.tables),'paras',len(d.paragraphs)) PY