April 2023 WOUND AND OSTOMY JOURNAL
Bowel care at End of Life
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Describe the method used by the author of the study
ReplyDeleteThis article used a person-centered approach to examine the management and treatment of bowel problems at the end of life. The author stated normal bowel function, age-related bowel problems, and management of bowel problems at the end of life and presented two case studies on hemorrhoids management and fecal incontinence. Individualized, patient-centered care is a vital part of end-of-life care. The person-centered approach provides a humanizing aspect in healthcare delivery and prioritizes the patient’s needs over tasks of care of other anonymous collective priorities. This approach allows the patients’ voices to be authentically heard, including their individual preferences, values, and beliefs, leading to active engagement and decision-making.
How does this research article compare to our practice, policy and/or procedure?
Healthcare professionals should be proficient at managing common symptoms as patient progress through the dying process. Proactive regimens that prevent symptoms should be used because prevention is generally easier than treating an acute symptom. Our hospital has an excellent palliative care team that is readily available to assist patients in managing end-of-life-associated symptoms and allow patients to progress through the dying process safely, dignifiedly, and comfortably. Common preventive regimens implemented by our palliative team to avoid constipation include a stimulant laxative with a stool softener, a suppository, or enemas as needed. The U.S. Food and Drug Administration approves Methylnaltrexone (Relistor) for the treatment of opiate-related constipation that does not respond to traditional preventive and treatment regimens.
Bethany Sobesto 7/25/23
DeleteHow does this research article compare to our practice, policy and/or procedure?
In this article they discuss bowel care at end of life. It is a common problem for end of life patients. Adequate fluid intake and fiber are encouraged. Activity is also encouraged if the person is able to. A stool softener can help them keep regular. If that stool softener does not work, then a laxative should be used. An enema and manual disimpaction may be necessary if those medications are not working. At PSJMC we follow similar procedures. Dr. Goldman and Dr. Treiu. have prescribed many of these same measures for end of life constipation.
Describe the method used by the author. Was the correct method used. Discuss the sample size used in the study.
This was not a clinical research article. It is an article in the British Journal of Community Nursing and is informative but does not have a sample size or design structure.
1. What are the advantages to the proposed recommendation?
ReplyDeleteThis article was a little different in that it was an examination or person-centered review of bowel issues at end of life. The article uses tables and charts to outline and organize the different barriers bedside nurses may encounter in an easy-to-understand way. Often times bowel habits are haphazard and left up to the bedside nurse to request a solution from the doctor about the subjective issue that varies from person to person. There is an appreciation in this article for troubleshooting bowel concerns that can be useful in the clinical setting.
2. Discuss the limitations of the article.
In reading this publication, I did get the sense that this was not a US based article because of the diction; therefore it is assumed that clinical bedside treatment may vary from country to country. One example of limitations can be seen with the drug availability which can be seen in Table 2. The table outline medications used in the UK versus the US. Furthermore, the article only addresses the bowel care at end of life for adults. It doesn't necessarily address newborns and children. Although the general gist of the article is applicable to a majority of care given in the PSJMC setting.
How dose this research article compare to our policy, practice and/or procedure.
ReplyDeleteThis article discusses end of life issues with bowel care and how to improve and manage symptoms to help patient. Things like adequate fluid intake and activity should be encouraged as much as possible. Medication like stool softener and laxative should be used as needed. Enema is another thing that we can do. Our hospital's hospice care provide excellent end of life care which is very similar to the article.
2) Describe the method used by the author of the study.
The method used by the author is person centered approach. This method allows us to use the things that works for end of life issues related to bowel care for specific person. This method allow us to care for the patient according to his/her needs and beliefs to make the patient as comfortable as possible.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe recommendations made for bowel care during the end of life in this article align very strongly with our practices put in place by our Palliative Care Team. We prevent and treat constipation and incontinence in our comfort care patients by utilizing laxatives and high fiber, flavorful foods of the patient's choosing. Its important to determine what the goals of care are and how we can best meet those goals. Comfort is crucial and bowel management plays a very important role in the comfort of our patients.
2. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
There are huge advantages to implementing these recommendations at our hospital. The better care we can provide for bowel management, the more comfortable our patients will be. In terms of end of life care, comfort is our top priority.
1. Describe the method used by the author of the study
ReplyDeleteThis study examined the management and treatment of gastrointestinal issues toward the end of life using a person-centered approach. The author discussed how the bowels normally function, age-related bowel issues, and how to treat bowel issues as people age. She also provided two case studies on how to handle hemorrhoids and fecal incontinence. End-of-life care must include individualized, patient-centered care. The person-centered approach adds a humanizing element to the delivery of healthcare and puts the patient's needs ahead of care chores and other anonymous communal interests. With this method, the patients' voices can be heard in their own words, together with their unique preferences, values, and beliefs, which promotes decision-making and active engagement.
2. How does this research article compare to our practice, policy and/or procedure?
The advice given for bowel care at the end of life in this article is remarkably similar to the procedures established by our palliative care team. By using laxatives and the patient's preferred high-fiber, savory diets, we prevent and cure constipation and incontinence in our comfort care patients. It's crucial to identify the objectives of care and the best way to achieve them. Bowel control is critical to our patients' comfort, which is why it is so important.
Luna Chowdhury
Describe the method used by the author of the study
ReplyDeleteThe author of this article describes a “person-centered approach” to examine how bowel problems at end of life can be best managed and treated. A “person-centered approach” allows the patient and family/caretaker a say in the decision making process when planning care and treatment. This approach gives the patient respect and dignity and allows them to be involved in their own care until their final days.
Was the correct method used?
I think the person centered approach was a good method to show how the patient should be involved in bowel care at the end of life. It is important to understand that the most common bowel problems experienced at end of life such as constipation, diarrhea, fecal loading and fecal incontinence. In addition, understanding the contributing factors that can affect bowel movement frequency and consistency; such as the aging process in the elderly, the frailty scale and how much a person can participate in their care, changes in appetite and types of food eaten, and the use of opioid medication for pain control, need to be taken into consideration. An assessment is made for the individual person and their bowel movement type and pattern so that an effective plan can be made that will meet the goals and expectations of the patient and also take into regard the family/caretakers capabilities, so that ultimately, the patient is provided dignity, compassion and respect at the end of life.
Above response was by Eileen Laureano
Delete1. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeletemplementing the article recommendations in our unit or hospital can offer several advantages. It can enhance patient comfort and quality of care by addressing end-of-life bowel care comprehensively. The focus on individual assessment, dietary adjustments, and proper use of laxatives can improve patient outcomes and overall well-being. However, challenges might arise due to varying patient preferences and medical conditions, requiring tailored approaches for each individual. Additionally, staff training may be necessary for successful implementation, potentially impacting workflow initially.
2. what are the advantages and disadvantages to the proposed recommendations in the article?
The proposed recommendations in the article offer distinct advantages. By prioritizing comfort and individual assessment, they can improve the quality of end-of-life care. Addressing dietary and fluid intake, stool characteristics, and appropriate laxative use can enhance patient well-being. However, challenges might arise from patient-specific variations, requiring different approaches, and potential resource allocation for training and implementation could affect operational efficiency.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThis article suggests that it is important to address constipation, especially at end of life, to promote ease and comfort for the patient. Recommendations include assessing defecation patterns, frequency, type, nutritional intake/output and activity level. Furthermore, the articles suggests treating constipation with bulk forming laxatives to stimulants to secretory laxatives depending on the cause of the constipation.
The advantages to using the recommended bowel program would include the patient not having abdominal discomfort or distension during end of life.
The disadvantages to using the recommended bowel program could include having to move the patient for bowel care during the end of life, which could cause further discomfort to the patient.
2. How does this research article compare to our practice, policy and/or procedure?
I don’t think PSJ has a specific bowel regimen for end of life. Although, MD’s utilize senna with docusate sodium frequently to manage constipation on end of life patients. Furthermore, I have seen laxatives from Miralax to Mag-Citrate used on other patients. For opioid related constipation, I have seen Relistor subcutaneously being given. It is important to focus on the patient's wellbeing and comfort while they transition towards end of life.
Describe the method used by the author of the study.
ReplyDeleteThis article discusses the most common bowel problems (constipation, diarrhea, fecal loading and fecal incontinence) experienced by individuals in the end-of-life stage and its management. Causes of these are multifactorial including age, comorbidities, diet, medications and changes in bowel anatomy and physiology. Successful choice of management is based on frailty, and end of life symptoms. Figure 2 provides a schematic diagram on how to manage constipation. Table 2 provides the types of laxatives, examples and their indications. Management is individualized as depicted in the case history examples.
How does this research article compare to our practice, policy and/or procedure?
Cancer pain specifically in patients at the end of stage of life is managed with opioids. Unfortunately, Opioid induced constipation (OIC) is a common side effect of this treatment. OIC in end of life
patients admitted at PSJMC are managed with stool softener, Colace ,
Senna or osmotic laxative Lactulose. Bulk-forming laxatives should be avoided. Relistor, Lubiprostone are also given. Increasing fluid intake and exercise are encouraged. A proactive approach can prevent constipation and enable patients to stay at home.
1. Describe the method used by the author of the study
ReplyDeleteThe article discusses some of the most common bowel problems such as constipation which is very common on individuals in the end-of-life stage. Some of the causes that the article describe are age, comorbidities, diet, medications. Choosing the right management is based on the individual and end of life symptoms.
2.How does this research article compare to our practice, policy and/or procedure?
I'm not sure if any of this apply to PSJMC but I know that the palliative team strives either inpatient or outpatient to manage any symptoms that arise. Making sure that the treatment is individualized to each individual needs. Prescribing pain meds with stool softeners.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteAlthough, on my unit managing end of life care is not very common, this research article compares to our practice in the hospital in many other ways. As a nurse working on a GI floor, many of the patients we receive have bowel difficulties or issues. As mentioned in the article, when patient’s are having diarrhea or constipation we do further assessment in order to pinpoint what may be the root of the problem. For example, constipation can be caused by poor oral intake, poor fluid intake, low fiber foods and frequent opioid use. The 1st line treatment for constipation discussed in the article is docusate sodium, a stool softener. Also known as Colace, this medication is frequently ordered for patients by doctors to treat constipation.
As mentioned before, end of life care is not something that I personally experience very often on my unit. When I did have a patient on end of life care, I didn’t think about bowel care as much as I did other things. I thought about the patient’s comfort and the patient’s family the most. But, after reading this article, considering bowel care at end of life is something I will give thought to when caring for a patient at end of life.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages of implementing bowel care at end of life is increasing comfort for the patient. It also eases unnecessary stresses for both the patient and the family.
A disadvantage of implementing this practice is the unpredictable status of the patient at the end of life. It may not work for all patients. For example, patient’s who are very unstable and are not eating much or at all. Giving them laxatives to ease constipation may cause more harm by moving them more than wanted and compromising a comfortable state.
- Alyssa Mendoza RN
1. Describe the method used by the author of the study.
ReplyDeleteThis article provides information on how age related can affect or change bowel functions. It also provides information on different category of lives that can affect bowel changes/function. Example: between a very fit person to a person that is frail or terminally ill. The main focus of this article is on end life bowel care and managing fecal incontinence.
2.How does this research article compare to our practice, policy and/or procedure?
With our patients at their end of life; the palliative team will order laxatives/dulcolax suppository to prevent constipation. They do their best to make sure patient will be free from constipation and comfortable.
1.Describe the method used by the author of the study
ReplyDeleteThe article uses a person-centred approach to examine how end of life bowel care can be managed.
2.How does this research article compare to our practice, policy and/or procedure?
Bowel problems at end of life are a daily occurrence on the unit. We give medications that often cause constipation & also the disease process often leads to irregularity. We combate constipation with stool softeners or laxatives.
-alexandria ordonez
1. Describe the method used by the author of the study:
ReplyDeleteThe study looks at the management of bowel care in end-of-life patients. It outlines the common problem of continence care in this population and the reasons behind this. Using the Rome IV criteria, it addresses the different causes of constipation and discusses different treatment modalities, such as different laxatives and their uses.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
I work on the Oncology unit and continence issues with end-of-life are common. This paper looked at the different laxatives and other treatments and which ones to use under what circumstances. The advantage to this would be more effective treatment of constipation, which our population would certainly benefit from. I can't think of any disadvantage and I plan to incorporate some of the suggestions into my practice.
Describe the method used by the author of the study:
ReplyDeleteThe author uses a person-centered approach. This method involves the patient and family members in deciding about their health and individualizing goals of care and treatment.
Was the correct method used?
I think that the patient-centered approach is an appropriate method used for bowel care at end of life, let alone, most care. It is important to approach each patient as an individual with unique needs. To determine goals of care in a “cookie cutter” fashion, does not convey dignity nor respect, especially during such a sensitive and vulnerable time. Each person’s psychological, physical and spiritual needs vary and easing their way is of utmost importance. Bowel care at end of life “can be the issue that can lead to a breakdown.” By using a patient-centered method, breakdown of care can be avoided.
How does the research article compare to our practice, policy and/or procedure?
ReplyDeleteIn our ministry we have an excellent palliative care team that manages our end-of-life patient population. They are great resources to our patients, their families, and to nurses. What the article described is what our palliative care team does for our patients. They are good about ordering a bowel regimen especially for those patients receiving narcotics.
In our oncology unit, all our end-of-life patients are unresponsive and unable to swallow therefore we do not administer stool softeners or laxatives anymore. We focus on comfort and provide support to families.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The article recommendations are beneficial to those patients who are having problems with constipation, fecal incontinence, and diarrhea. Our oncology unit deals with a lot of these patient population. Most are so severe that they are miserable and decreases their quality of life. The treatments described are very helpful and can provide a great deal of relief and comfort to these patients. These are valuable recommendations for caregivers to provide the best support and care to patients and their families.
In our unit, most of our end-of-life patients will not benefit from these treatments since they are already close to dying and are on drips. Bowel care may not be the priority since frequent moving or repositioning of patients causes more distress, and the ultimate goal is dying peacefully and comfortably.
1)Describe the method used by the author of the study
ReplyDeleteThis article is focused on the person-centered approach and the problems that can come at the end of life. The person may experience constipation, diarrhea , fecal incontinence.
2) How does this research article compare to our practice, policy and/or procedure?
My understanding PSJMC does not have a specific bowel bundle policy. Many times nurses do forget the basic assessment for bowel movement specially at the end of life stage. The article focuses in the education of bowel care at end of life is to promote comfort to the patients.
ReplyDelete1. How does this research article compare to our practice, policy and/or procedure?
This article applies to our current practice today at Providence St. Joseph with our palliative care team. The article states "it is important to assess dietary and fluid intake" or recommends "a stimulant laxative should be added." Here at our institution, an expert consultation is defered to a physician, a registered nurse, or any medical staff that provide relief from symptoms of constipation or serious bowel illness related. In such cases, the palliative care team meets with family or direct care giver and discuss a holistic and individualized care plan to promote approrpiate use of laxatives and effective management to meet the patient's needs.
2. Was the correct method used? Why or why not?
I strongly believe that the correct method was used during this study. The article discuss normal bowen fucntion, problems at end of life, distinguishing from being "too frail" or "cognitively impaired to make judgement," and bowel care at the end of life. The articile exemplies from individuals who are fit or whose medical problems are well controlled to severe frailty and terminally ill. Therefore, the article presented a diagnostic criteria for mangement of constipation from providing appropriate laxative usage, phosphate enema, and collaborating with the patient, family, and caregivers while managing their symptoms at home.
1. How does the research article compare to our practice, policy, and/or procedure:
ReplyDeleteWe have a dedicated palliative care team responsible for overseeing patients in the end-of-life stage. They serve as a valuable support for both patients and their families, and they take meticulous care in prescribing comfort medications, including narcotics, along with medications to address bowel-related issues for our patients.
2. What are the advantages and disadvantages of implementing the article recommendation on your unit and / or hospital:
a) The suggestions presented in the article are advantageous for individuals in the final stages of life, as they aid in maintaining their dignity during their last moments with loved ones. Fecal incontinence, constipation, or diarrhea can significantly disrupt the precious time patients and their families have together. The recommendations in the article are genuinely beneficial and offer relief and comfort to these patients.
b) In cases where patients are nearing the end of life, bowel preparation treatments may not be advantageous, as the primary goal is to ensure their comfort and alleviate distress.
ReplyDeletewhat are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
We see end-of-life patients throughout the ministry in all stages of this process. The suggested practices are beneficial to the patients that are having difficulty with constipation, fecal incontinence, and diarrhea. There can be a huge decrease in the quality of life when patients feel miserable and are unable to provide relief to this part of what should be normal elimination process. Providing a great deal of comfort in these last moments are what make the process easier.
How does this research article compare to our practice, policy and/or procedure?
Our ministry does have a palliative care team that participates in the end-of-life care for patients and families. This article discusses what our palliative care team does for our patients and families. In the bowel regimen area, they are especially in tuned with the need of patient elimination. The end-of-life patients receive pain management and with that the bowel regimen is taken into consideration.
1.Describe the method used by the author of the study:
ReplyDeleteThe article uses a person-centered approach to examine how end of life bowel care can be managed and treated.
2.How does this research article compare to our practice, policy and/or procedure?
Bowel problems at end of life are a daily issue. Usually there is a palliative team who can place orders for a bowel regime to make the patient as comfortable as possible. Unfortunately, at end of life, patients are on pain medications for comfort and narcotics can cause constipation. Our providers and nurses commonly will give laxatives' and stool softeners.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteDuring end of life, our palliative care team facilitates bowel regimens for our patients if they are constipated. They also provide comfort foods to hopefully increase nutritional needs. If diarrhea occurs then the doctor will order fecal collectors like rectal tubes to prevent skin damage and place foley catheters to decrease incontinence irritation.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
It didn't really include a sample size, or study method. They included two patient cases but end of life circumstances vary greatly. More of a suggestion of bowel care during end of life but it doesn't include care for those patients whose family refuse that.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteDuring the end-of-life stage, it is crucial to provide the best possible care for the patient; the focus is to provide them comfort. We have a very compassionate and devoted palliative team member who provides the best care to patients and family members. They ease patients' discomfort when constipated by prescribing stool softeners and modifying medications to prevent it. Providing patients with the best quality of life is the goal of the palliative team.
2. What are the advantages and disadvantages of implementing the article recommendation on your unit and / or hospital?
This article is advantageous to patients in their end-of-life stage because it aids in maintaining their dignity at the very last stage. Bowel problems such as constipation, incontinence, and diarrhea can be an issue that can also lead to skin breakdown, and it is vital to facilitate bowel regimen and provide comfort for best patient outcomes.
How does this research compare to our practice?
DeleteThis is what we do on med surg oncology. The research shows' that in order to provide comfort to our end of life patients we must address the bowel elimination. Most of our patents who are at the end of life are on pain medications. The pain medications cause constipation and sometimes impaction. To help patients have bowel movements will provide less pain and comfortability. Our palliative MD's always address this situation on our floor.
The advantage of this is the patient will not have any further pain or discomfort and less pain.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article addresses the effects that bowel pattern and care can have on the end of life. This article correlates well with how we practice and how we manage bowel care in our patients. Especially at the end of life, there is a lot of illness related changes in the bowel due to lack of mobility, pain medications, diet changes all leading to a decrease in motility. If bowels are not properly manages through both pharmacological and non-pharmacological interventions, the the patient can experience great pain and discomfort.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
One big advantage of implementation would be the quality of life impacted in a positive way. Working with the patient, family, and caregivers to determine the goals of care and how the patient would like to be cared for can make a huge difference. As a RN I make sure to include asking the patient about their bowels during the initial assessment and I make sure to ask any interventions the may use to manage their bowels.
1. Describe the method used by the author of the study
ReplyDeleteWithin this article, the author uses a person-centered approach, to appropriately come to decisions that the family and or patient has requested at end-of-life care.
2. How does this research compare to our practice?
Similar to the practices at Providence St. Joseph Medical Center, when a patient has approached end of life care, the palliative team is consulted to make sure these needs are not only heard but meet as well. The goal of end of life care is comfort, and a proper bowel regimen is no less important than any other request the patient and or family may have at this difficult time.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article delves into the impact of bowel patterns and care on end-of-life situations. It aligns seamlessly with our current clinical practices and our approach to managing bowel care in our patients. Particularly during the final stages of life, we often witness a multitude of bowel-related alterations due to factors such as reduced mobility, the administration of pain medications, and dietary adjustments, all of which can contribute to a decline in bowel motility. In cases where bowels are not adequately managed through a combination of pharmaceutical and non-pharmaceutical interventions, patients may endure significant pain and discomfort
2. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Providence Saint Joseph Medical center is fortunate to have a dedicated palliative care team that plays a pivotal role in providing comprehensive end-of-life care for both patients and their families. This article closely examines the scope of services offered by our palliative care team, shedding light on their efforts in addressing the critical aspect of patient elimination. In particular, when it comes to end-of-life patients, our team takes a holistic approach, ensuring effective pain management while also considering the crucial component of bowel regimen to enhance the overall quality of care.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeleteThere are many advantages to implementing this article’s recommendations; it can lead to less hospitalizations because care is being managed adequately at home with appropriate medications as well as reduce the stress on the family/caregiver and even the patient. The only disadvantage I can foresee happening is misuse of the recommendations at home – overusing/underusing medications thereby causing hospitalizations to continue due to skin breakdown/electrolyte imbalances. Proper education should be provided to patient’s and their familys as well as follow-ups.
How does this research article compare to our practice, policy and/or procedure?
Through my experience at PSJMC, I have seen our palliative care team focus on all of the patient’s goals of life - the 5 P’s; poop is one of them. We always try to establish a bowel regimen in ICU due to the use of medications that slow the bowel. Especially after having many elderly patients admitted with abdominal pain, no appetite, and failure to thrive. We assess bowel movements/GI system every shift and address these issues early on in ICU. When discharging patients, I feel nurses educate patient’s on the importance of bowel regimens however I have noticed that most times physicians do not prescribe or continue to the same medications on their discharge plan. This usually is addressed by nurses at discharge frequently.