Nursing Assignment: Nurse Intervention in Treating Constipation

Question

Task: Scenario 1
You attend clinical placement at an aged care home where the Nurse Unit Manager tells you they are wanting to find out best practice for preventing constipation in residents. The research question they want you to answer is: “In adults, what nurse-initiated interventions are effective for treating constipation?”

Nursing Assignment Task
You are to APPLY evidence that is categorized by the National Health and Medical Research Council as Level I (systematic reviews/meta-analyses of randomized controlled trials) or Level II (randomized controlled trials) to answer your research question. This means, you are to include:

1. A table of included studies with the following information summarized from each study (Author, Year, Study Design, Population, Intervention Type, Comparison/Control, Outcome)
2. APPLY the findings from Level I-II evidence to your scenario, clearly answering your chosen research question.

Answer

Introduction
The current nursing assignment is focused on one of the most common digestive disorders “Constipation” observed worldwide. The disorder is determined by the difficulty in the rare passage of stool. It has been observed that the prevalence rate of constipation is increasing with every passing year. Some several factors or parameters tend to increase the prevalence rate such as type of diet, colonic motility, predisposition, social-economic status, biological and pharmaceutical factors (Forootan, Bagheri&Darvishi, 2018). Though the occurrence of constipation is quite common among individuals of all ages, the prevalence rate especially among old age people is increasing at exponential growth. It has been estimated that more than 50% of people over 80 years of age experience this irregular bowel issue regularly (Emmanuel et al., 2017). The impacts of constipation among older people are severe among those who are frail. In such cases, nursing helps older people to either avoid or recover from these types of issues.

The primary aim of the report is to discuss the nursing interventions that are effective for treating constipation for the aged care adults living in residents. To answer the research question the below discussion consists of the PICO question with an extraction table which consists of methods and finding of the extracted pieces of literature.

Acquired
Evaluating researchable questions is one of the challenging factors for a researcher while initiating a project. The PICO is a format that helps to simplify the entire research question approach into a segment, making it easier to construct a question for the research. The word "PICO" consists of the patient or population (P) to the address, intervention or indicator (I), control or comparison (C), and last “O” stands for Outcome (Walters, 2019). Therefore the research question that has been developed considering the benefit of the PICO format, hence the research question is

Table 1: PICO question

Research question:“In adults, what nurse-initiated interventions are effective for treating constipation?”
To respond to the above-mentioned research question, some of the important literature that can provide relatable and required answers has been considered. These pieces of literature have been extracted from different databases such as PubMed, CINAHL, and google scholar with various search terms mentioned below. To precise the search, some keywords have been considered and Boolean operators (AND, OR, NOT) have been also used.

Table 2: Search strategy

Considering the above search strategy, five pieces of literature have been considered. Before getting the 5 pieces of literature, more than 52 pieces of literature have been evaluated by applying the search strategy, though to precise the pieces of literature and stick to the research question, some inclusion and exclusion criteria have been incorporated. The inclusion and exclusion criteria help to extract only those pieces of literature that will evaluate the research question in a better way. Hence the criteria that have been considered are as following,

Inclusion criteria

• The piece of literature that has been considered belongs to the range of 6 years before 2021.
• The articles that are being considered are in English.
• The pieces of literature are fully accessed papers.
• They all are providing direction solutions for preventing constipation in adults.

Exclusion Criteria:

• The piece of literature that provides information for young and middle-aged people has been excluded.
• The pieces of literature that are having ambiguous results are being excluded.

Considering the inclusion and exclusion criteria along with the search strategy, 5 articles have been discussed below. The below table consists of the method and findings of the collected research.

Table 3: Pieces of study

Appraise
Critical appraisal definition: The procedure that has been incorporated to review the research articles. It is done to evaluate the reliability and validity of the articles based on the method, findings, and other criteria of the articles.

Importance of Evidence-based practices: Evidence-based practices in nursing is one of the most effective tools that help to provide the latest and effective care to the patient by evaluating several kinds of literature. It also helps in the validation of the factors or interventions that can be used to care for any individual (Brown, 2020).

NHMRC level of evidence explanation
NHMRC stands for National health and medical research council (NHMRC) which characterizes the study based on its method and divided among different levels of evidence. This is considered as the best way to evaluate the studythat can help to answer the research question, whether it is an intervention, causes, diagnostic accuracy, or prognosis (Zhuravleva, Shubina&Sukhorukikh, 2019). This consist of the level of evidence which is as follows:

Level I: A systematic review of level II studies
Level II: Study where randomized controls trail using the literature review has been considered in the research.
Level III (I): A pseudo-randomized controlled trail (Zhuravleva, Shubina&Sukhorukikh, 2019).
Level III (II): A comparative study with the concurrent controls:

• Non-randomized experimental trail.
  
• Cohort study
• Case-control study
• Interrupted time series with a control group.

Level III (III): A comparative study without concurrent controls:

• Historical control study.
• Two or more single-arm studies.
• Interrupted time series without a parallel control group.

Level IV: Evidence of case series with either post-test or pre-test outcomes (Zhuravleva, Shubina&Sukhorukikh, 2019).

Study 1 covers level III-II as there a qualitative survey has been considered, study 2 and 3 belong to the level-I of the NHMRC level of pieces of evidence, while the study 4 and 5 belong to level II of the NHMRC.

The above evidence-based practices will help the nurses to treat the patient suffering from constipation. The outcome of the literature that has been evaluated with the help of the evidence-based approach, states that self-management, changes in the diet, observing the frequency of the stool, and having light exercise can be helpful for the individual facing constipation. Hence, the nurse should use the above-mentioned method to treat older individuals suffering from constipation or bowel complications.

Conclusion
From the above discussion, it can be concluded that evidence-based intervention is one of the important factors that help in providing adequate provide care with a justification. It helps the nurse to intervene the new practices on the patients and allow the individual to have better knowledge about the different factors. From the above decision, it has been observed that to implement evidence-based practice in nursing, one needs to evaluate literature that contains adequate information regarding the issue. It can be done with the help of a search strategy that includes, keywords, Boolean operators, and inclusion and exclusion criteria. To make sure that all the evidence that has been collected is reliable, literature should be extracted from the authentic database and the NHMRC level will be considered. In this case, the evidence-based result assisted to evaluatenursing assisted intervention such as encouraging self-management, observing the diet pattern, light exercise, noticing the change in the stools, and many other things to treat the older individual suffering constipation.

Reference
Blekken, L. E., Nakrem, S., Vinsnes, A. G., Norton, C., Mørkved, S., Salvesen, Ø.,&Gjeilo, K. H. (2016). Constipation and laxative use among nursing home patients: prevalence and associations derived from the residents' assessment instrument for long-term care facilities (interRAI LTCF). Gastroenterology research and practice, 2016.

Brown, D. (2020). A review of the PubMed PICO tool: using evidence-based practice in health education. Health promotion practice, 21(4), 496-498. Collins, B. R., & O'Brien, L. (2015).Prevention and management of constipation in adults. Nursing Standard, 29(32), 49–58. doi:10.7748/ns.29.32.49.e9571

Emmanuel, A., Mattace?Raso, F., Neri, M. C., Petersen, K. U., Rey, E., & Rogers, J. (2017). Constipation in older people: a consensus statement. International journal of clinical practice, 71(1), e12920.

Forootan, M., Bagheri, N., &Darvishi, M. (2018). Chronic constipation: A review of the literature. Medicine, 97(20).

Munch, L., Tvistholm, N., Trosborg, I., &Konradsen, H. (2016). Living with constipation—older people's experiences and strategies with constipation before and during hospitalization. International journal of qualitative studies on health and well-being, 11(1), 30732.

Serra, J., Mascort-Roca, J., Marzo-Castillejo, M., Delgado Aros, S., Ferrándiz Santos, J., Diaz Rubio, E. R., &MearinManrique, F. (2017).Clinical practice guidelines for the management of constipation in adults. Part 2: Diagnosis and treatment. Gastroenterología y Hepatología (English Edition), 40(4), 303–316. doi:10.1016/j.gastre.2017.03.013

Takaoka, M., Igarashi, A., Futami, A., & Yamamoto-Mitani, N. (2020).Management of constipation in long-term care hospitals and its ward manager and organization factors.BMC nursing, 19(1), 1-10. Walters, B. C. (2019). Commentary: Writing a Clinical Research Question. Neurosurgery, 84(1), 17-18.

Zhuravleva, N. I., Shubina, L. C., &Sukhorukikh, O. A. (2019). The use of the level of evidence and grade of recommendations scales in developing clinical guidelines in the Russian Federation. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology, 12(1), 34-41.