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For documents located in SharePoint Site (CA SJ Wound and Ostomy) look for the article and click it to open. May 2026- Preventing faecal incontinence in patients with functional GI disorders. Don't forget to write your name with each posting.
1) Describe the method used by the author of the study
The author, Yohei Okawa, conducted a narrative review to summarise existing knowledge on preventing faecal incontinence in patients with functional gastrointestinal disorders. He searched major databases including PubMed, Zentralblatt für die gesamte Medizin, and Ichushi Web for English-language articles published between January 1983 and December 2024. Search terms focused on “faecal incontinence,” “nursing care,” and “preventive measures.” Relevant studies were critically reviewed, with emphasis on those useful for nurses, while studies on organic gastrointestinal diseases were mostly excluded. This exploratory approach allowed the author to present background information, research trends, challenges, and practical nursing recommendations without following the strict rules of a systematic review.
2) Discuss the research question or main problem discussed in the study
The main problem addressed in the article is the high prevalence and negative impact of faecal incontinence among patients with functional gastrointestinal disorders, such as irritable bowel syndrome. Many patients struggle with daily activities due to involuntary loss of stool, which affects their dignity, skin health, and quality of life. The central research question is whether nursing care can effectively prevent or improve fecal incontinence in these patients. The author explores this by examining dietary therapy, bowel habit training, skin care, pelvic floor muscle exercises, and proper use of continence products, highlighting that timely nursing interventions can reduce symptoms and help patients maintain independence and comfort.
1. Describe the method used by the author of the study.
This study's method uses a narrative review which gathers prior research but is not bound by specific criteria, rather the review uses the background and research for a particular subject, summarizes it and provides a new and subjective perspective of the topic. Narrative reviews are not limited by strict research criteria or methodology and therefore can give more of a general overview of its subject matter. Specifically, the study is reviewing research on nursing care that may help to prevent or improve fecal incontinence using prior knowledge, challenges and future efforts.
2. Discuss the sample size used in the study.
This study relies only on reviews of scientific knowledge and consensus statements without regard to sample size, study design or patient age restrictions. Only English language publications from PubMed, Zentralblatt für die gesammte Medizin and Ichushi Web databases from January 1983 to December 2024 were used. Key words used to narrow the search were 'fecal incontinence', 'nursing care', and 'preventative measures'. Also, studies must include functional gastrointestinal disorders such as IBS, functional diarrhea and constipation. Exclusion criteria were patients with underlying organic GI disorders like ulcerative colitis and Crohn's disease, both of which would be difficult to prevent solely through factors like lifestyle changes and diet.
Discuss the method used by the author of the study The study design was a narrative review, which aimed to comprehensively summarize previous research. These reviews are not bound by strict methodology, but instead aim to present the background of a topic, the course of research and new perspectives, incorporating the subjective judgements and interpretations of the researchers. The focus of this review was to identify aspects that are useful for nurses, other health professionals and patients. This narrative review was conducted to investigate what types of nursing care are needed to prevent or improve fecal incontinence through a review of existing knowledge, challenges and future prospects.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias. Narrative reviews can have multiple limitations. These literature reviews tell a story about research in a particular field and interprets and integrates it from an expert’s unique perspective. Unlike systematic reviews, which involve strict search criteria, a narrative review aims to organize a wide range of background knowledge, ideas, and research trends on a specific research topic and present a persuasive argument. Some areas may be perceived as lacking in academic discussion or transparency.
Describe the method used by the author of the study.
The author used a narrative review to examine existing research on preventing faecal incontinence in patients with functional gastrointestinal disorders. Unlike a systematic review, a narrative review provides a broad overview of the available literature and allows the author to interpret findings from an expert perspective. The author searched the PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web databases for English-language studies published between January 1983 and December 2024 using the keywords "fecal incontinence," "nursing care," and "preventive measures." The review included studies relevant to functional gastrointestinal disorders and excluded research on organic gastrointestinal diseases such as Crohn's disease and ulcerative colitis because those conditions require different treatment approaches. There were no restrictions on publication date, sample size, study design, or patient age.
Discuss the research question or main problem discussed in the study.
The main research question was whether nursing care can help prevent or improve faecal incontinence in patients with functional gastrointestinal disorders. The author sought to identify evidence-based nursing interventions by reviewing existing research on the topic. The study addressed the problem that, despite the high prevalence of faecal incontinence, there is still no clearly established nursing care protocol for its prevention and management. The review concluded that nurses play a critical role in preventing or reducing faecal incontinence by providing dietary and lifestyle advice, bowel habit instruction, pelvic floor muscle training, skin care, and individualized continence care plans to improve patients' quality of life.
1. Discuss the research question or main problem discussed in the study?
The study focuses on how bowel problems in people with functional gastrointestinal disorders can lead to fecal incontinence. This condition can affect a person’s daily life, comfort, and quality of life. The researchers looked at ways to identify risks early and find better ways to prevent fecal incontinence through proper care and management.
2.what are the advantages and disadvantages to the proposed recommendations in the article?
Advantages The recommendations can help prevent fecal incontinence by finding problems early and giving patients the right care. They can help people manage their symptoms, feel better, and improve their daily lives. Teaching patients about diet, bowel habits, and healthy choices can also help them take better care of their condition. Disadvantages Some recommendations may be hard to follow because changing habits takes time and effort. Treatment may not work the same for everyone because each person has different symptoms. Some patients may need extra support from healthcare providers, which may not always be available. More research is needed to find the best ways to prevent fecal incontinence.
Discuss the research question or main problem discussed in the study. In this article the researcher’s goal was to figure out where or not nurses can prevent fecal incontinence, specifically in patients with functional GI disorders. In the practical setting, the nurse not only becomes a key component of patient care specifically with cleaning soiled patients and providing incontinence care, but also with utilizing ancillary resources. Examples of that are implementing recommendation from departments such as pharmacy, dietary and wound care and exploring incontinence care products. Interestingly enough, this article concludes there are no clear evidence-based specific guidelines in place for nursing despite this disorder being common amongst many patients.
Describe the method used by the author of the study. The researcher used a narrative review of literature which is summarizing previously publicized research articles. The author does explain that the purpose of the narrative review is to be “exploratory” to discuss the topic of fecal incontinence and the role of nursing. The goal was to provide purposeful insight for the nursing staff and other health professionals specifically for this population of patients with “functional incontinence.”
Discuss the research question or main problem discussed in the study?
The main problem addressed in this study is the high prevalence and profound negative impact of fecal incontinence in patients suffering from GI disorders, such as IBS and functional diarrhea,. It’s critical to highlight that this condition significantly affects a patient’s dignity, skin health, and overall quality of life but there's currently no clearly established nursing care protocol for its prevention and management. The main question sought to determine whether proactive nursing care, including dietary therapy, bowel habit training, and pelvic floor muscle exercises, could effectively prevent or improve fecal incontinence in these patients. The author aimed to address a significant gap in clinical guidelines by exploring how timely nursing interventions can reduce symptoms and help patients maintain their independence,. This problem is especially relevant to nursing because we're often the primary caregivers responsible for providing care and managing the daily life challenges associated with this condition.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The biggest limitation of this article is its design as a narrative review, which lacks the strict methodology and rigorous search criteria required for a systematic review. I think this creates a risk of the author being biased because the findings and recommendations are based on subjective judgments and perspectives of the researcher rather than a thorough evaluation of all available evidence,. The author openly acknowledges that because the review is exploratory, some areas may be perceived as lacking in transparency or depth. Also, the exclusion of patients with organic GI diseases, such as Crohn’s or ulcerative colitis, represents a potential design flaw that limits the application of the results to a wider patient population that also suffers from incontinence, The decision to search only English language publications across a limited number of databases restricts the scope of the study and leaving out relevant international research. In the end, because this review only sums up what experts already agree on instead of studying a specific group of patients, we still don’t know for sure how well these nursing interventions work. Big, real‑world studies are still needed to prove their effectiveness.
1. What are the advantages and disadvantages of the proposed recommendations in the article? One advantage is that the recommendations focus on simple nursing care, such as improving diet, skin care, bowel habits, and pelvic floor exercises, which may help reduce or prevent fecal incontinence. These treatments are also less invasive than surgery and can improve a patient's comfort and quality of life. Another advantage is that the care plans can be adjusted to fit each patient's needs. A disadvantage is that not all of the recommendations have strong evidence to prove they work for every patient, and some people with severe cases may need more advanced treatments.
2. Discuss the research question or main problem discussed in the study. The main research question was whether nursing care can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. The author reviewed previous studies to identify the most effective nursing interventions and summarize current knowledge. The article found that nursing care, including dietary advice, bowel training, skin care, and pelvic floor muscle exercises, may help manage symptoms. It also pointed out that more research is needed because there is still limited high-quality evidence for some of these treatments.
1. Describe the method used by the author of the study.
This study utilized a narrative review design to offer a thorough evaluation of the existing literature on nursing care and fecal incontinence prevention. A narrative review, unlike a systematic review, is exploratory in nature, allowing researchers to integrate evidence while also including their professional interpretation and judgment. Relevant studies were located by searching the PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web databases. The search includes English-language literature published between January 1983 and December 2024 that used the keywords fecal incontinence, nursing care, and preventive measures. Retrieved publications were critically reviewed, and research that met the stated inclusion and exclusion criteria were included. The research sought to discover information that could help nurses, other healthcare providers, and patients prevent and manage fecal incontinence.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One disadvantage of this study is its narrative review design, which is based on the authors' interpretation and synthesis of the literature rather than a standardised, systematic technique. As a result, the review may contain selection bias and lack clarity in how the studies were reviewed and included. Although the authors conducted a thorough literature search and critically analyzed the available information, some significant studies may have been overlooked, and certain subjects may not have been covered in depth. As a result, the findings should be read with caution, keeping in mind that the conclusions are based on the authors' professional opinion rather than a systematic review of all data.
Discuss the research question or main problem discussed in the study:
The aim of this study was to investigate if nursing care can prevent fecal incontinence in patients with functional gastrointestinal disorders. The authors define fecal incontinence as the involuntary loss of feces that is a social or hygienic problem, which has multiple contributory factors for an individual patient. A narrative review was conducted to investigate exactly what types of nursing care are needed to prevent or improve this type of incontinence.
This research topic is interesting because it focuses on the nursing interventions related to fecal incontinence instead of solely the causes of the incontinence. The nursing interventions that were explored include skin care, continence care, product selection, and other additional care practices. While many of these interventions are inter-disciplinary in our ministry, it is important to remember that nursing plays a very large role in the prevention or improvement of incontinence.
How does this research article compare to our practice, policy, and/or procedure?:
The article’s recommended nursing interventions are centered around the prompt cleaning of fecal excrement and the prevention of incontinence associated dermatitis. Our practice here also focuses on cleaning soiled patients quickly, and minimizing wetness related to incontinence. We frequently participate in the suggested skin care practices including using our “purple wipes” and utilizing moisturizing cream to hydrate the skin. We also regularly use a barrier cream (zinc or desitin) for patients who are at a high-risk of skin breakdown from irritants. We utilize the recommended incontinence products like chux pads, and also assess stool characteristics that may indicate that a problem should be addressed. Nursing staff partners with dieticians to ensure that patients are receiving appropriate amounts of fiber and water. Some patients require low FODMAP diets to help avoid triggers that increase the risk of fecal incontinence.
One recommendation from the article that we do not use as regularly in the in-patient setting is bowel rhythm practices like defecation induction (sitting a patient on the toilet 30 minutes after each meal), or adjusting daily patterns of sleep, eating, and bowel movements for the patient. We typically require that patients adhere to our timing and tempo. While we do complete some education with patients relating to improving diet and lifestyle habits, we do not offer in-patient pelvic floor muscle training which can be beneficial to those dealing with fecal incontinence.
Discuss the main problem in the study. The main problem is fecal incontinence- unintentional leakage of stool in people with functional gastrointestinal disorders. In these patients, altered bowel habits, particularly diarrhea with urgency or constipation with overflow leakage, can make bowel control difficult. The study emphasizes helping patients manage their everyday life through dietary and lifestyle advise to improve stool consistency and identify triggers, bowel habits instructions and timely toileting routines, skin care to prevent moisture-associated irritation and breakdown after leakage, and pelvic floor muscle training effectiveness for bowel control.
Limitation of the article. The paper is useful as a practical, patient-centered nursing overview; but it's recommendations should be individualized and complemented by clinical evaluation for treatable causes of fecal incontinence, particularly when symptoms are new, severe, or persistent. Fecal incontinence can arise from conditions beyond functional GI disorders such as neurological, inflammatory bowel disease, medications effects, and structural problems like rectal prolapse. At the same time, there is difficulty separating interventions that would identify which component in the recommended approach produces any observed benefits.
Discuss the research question or main problem discussed in the study?
The study addresses the high prevalence of fecal incontinence among patients with functional gastrointestinal disorders and highlights the lack of a standardized nursing care protocol for its prevention and management. The aim of the review was to identify nursing interventions that may prevent or reduce fecal incontinence and lessen its impact on patients' quality of life. Key interventions examined included dietary modifications, bowel habit training, skin care management, and pelvic floor muscle training. The findings emphasize the vital role of nurses in providing individualized education, support, and symptom management strategies to help patients improve continence, maintain dignity, and enhance their overall quality of life.
discuss the limitations of the article: limited sample size, design flaws, and/or author bias One limitation of this study is that it did not include a specific patient sample size because it was a narrative review of previously published research. Narrative reviews are generally considered less rigorous than systematic reviews because the selection and interpretation of studies may be influenced by the author's judgment. Additionally, the review included studies with varying sample sizes, research designs, and patient populations, making it difficult to compare findings or identify the most effective nursing intervention. Furthermore, limiting the review to English-language publications may have introduced language and selection bias, potentially excluding relevant research published in other languages.
The method of this study was to use a narrative review on types of nursing interventions needed to prevent and/or improve fecal incontinence. This type of review uses a thematic interpretation of studies on a specific topic, in this case, fecal incontinence, to research the topic, rather than specific statistical protocols. This puts importance on the author’s expertise on the issue to identify patterns and relevant literature to include in their study. The author, Dr. Yohei Okawa, seems to have credibility in this area, as other articles published include “A Literature Review of Dietary Habits, Defecation Habits and Skill Care to Prevent Fecal Incontinence in Elderly Individuals with Irritable Bowel Syndrome” and “Feasibility of the Constipation Point-of-Care Ultrasound Educational Program in Observing Fecal Retention in the Colorectum: A Descriptive Study.”
How does this research article compare to our practice, policy and/or procedure?
The article reflects some similarities to our practice at PSJMC. One includes the use of medicines like loperamide to reduce incidents of diarrhea. Another practice is to encourage regular rectal emptying using suppositories and enemas.
1. Discuss the method use by the author of the study.
The article used a literature review method and did not conduct a new clinical experiment; instead, they examined previously published research to identify evidence about fecal incontinence associated with functional gastrointestinal disorders, particularly irritable bowel syndrome.
2. Discuss the limitations of the article: limited sample size, design flaws and/or author bias.
The major limitation of the article is its literature-review design rather than an original clinical study. Because the author did not recruit a defined patient sample or test an intervention, the recommendation cannot establish cause and effect. The research was also limited to PubMed and English-language studies, which may have excluded relevant evidence. In addition, the use of subjective criteria for IBS diagnosis may make it difficult to objectively identify patients at risk for fecal incontinence. Therefore, while the article provides useful information about dietary management, bowel habits and patient education, additional well-designed clinical studies with larger and more diverse patient populations are needed to determine the effectiveness of these preventive strategies.
The article found that fecal incontinence can often be improved through simple changes in daily care. Diet changes, getting enough fiber and fluids, and developing regular bowel habits can help control bowel movements. Pelvic floor muscle exercises may also help patients strengthen the muscles needed for bowel control. The article also explains that good skin care is important because frequent stool exposure can cause irritation and skin damage. Overall, care should be based on each patient’s individual needs and the cause of their incontinence.
2. How can the findings of this study be applied to patient care?
Nurses can use these findings by helping patients develop a regular bowel routine and making changes to their diet and fluid intake when needed. Patients can also be taught pelvic floor exercises to improve bowel control. Nurses should regularly check and clean the skin to prevent irritation and incontinence-associated dermatitis. They can also help patients choose appropriate incontinence products and monitor their bowel movements. These interventions may help patients have fewer episodes of incontinence and improve their comfort and quality of life.
4. Preventing Faecal Incontinence in Patients With Functional Gastrointestinal Disorders
How does this research article compare to our practice, policy and/or procedure?
Although this article is not primarily a pressure-injury study, it is relevant to skin integrity because repeated stool exposure can contribute to moisture-associated skin damage and complicate wound prevention. The review emphasizes bowel management, diet and lifestyle education, skin care, and pelvic-floor muscle training. These strategies complement a hospital skin-integrity program by addressing an important source of moisture and contamination (Okawa, 2026; Providence, 2026a).
What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages. The recommendations are largely noninvasive and nursing-friendly. Nurses can reinforce bowel routines, dietary and lifestyle measures, perineal skin care, and pelvic-floor education. Improved continence may also improve comfort, dignity, hygiene, and reduce exposure of vulnerable skin to stool.
Disadvantages. The recommendations require patient participation and may be difficult for patients with cognitive impairment, severe illness, mobility limitations, or complex gastrointestinal disease. Some interventions also require individualized evaluation, and results may not occur quickly.
Describe the method used by the author(s) of the study.
The author conducted a narrative review. PubMed, the German-language ZB MED/Zentralblatt database, and Ichushi Web were searched for relevant literature, with emphasis on English-language articles. The review synthesized existing evidence rather than enrolling a new patient cohort (Okawa, 2026).
Discuss the research question or main problem discussed in the study.
The review asked what types of nursing care are needed to prevent or improve fecal incontinence, using existing evidence to identify practical nursing strategies and remaining challenges.
Discuss the sample size used in the study.
There was no single patient sample because this was a narrative review. The article drew on previously published studies involving different populations, designs, and sample sizes (Okawa, 2026).
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Narrative reviews are more vulnerable to selection and author interpretation than systematic reviews with prespecified methods. The included evidence was heterogeneous, and the first page indicates no restrictions on publication date, sample size, study design, or patient age. These differences make it harder to determine the strength of evidence for each individual recommendation.
Overall Comparison With Providence Internal Policies
The four articles address different parts of prevention, but together they support a broader approach to skin integrity: reduce avoidable pressure and shear from equipment, assess skin in a way that is appropriate across skin tones, recognize patient-specific tissue vulnerability, and manage moisture from incontinence. The Providence Skin Integrity policy states that its purpose is to establish guidelines for identification, prevention, and care of patients at risk for or with altered skin integrity (Providence, 2026a). The visible first page of the Providence inpatient nutrition policy also requires nutrition screening within 24 hours of admission and use of the NRS-2002 process to identify nutritional risk (Providence, 2026b). Nutrition is another relevant component of wound prevention and healing. Because only the first page of each internal policy was provided, a line-by-line determination of whether the articles match every Providence procedure would require the remaining policy pages.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
- The recommendations have several advantages because the focus on conservative, low-risk interventions such as dietary changes, fiber, bowel training, and pelvic floor exercises. These strategies can be individualized to the patient, may reduce episodes of fecal incontinence, and can improve quality of life without immediately requiring invasive treatments. They also encourage patients to take an active role in managing their symptoms. A disadvantage is that these interventions may not work for every patient often require consistent participation and lifestyle changes. Some treatments, such as pelvic floor therapy or biofeedback, may also be difficult to access. Overall, the recommendations are practical and relatively safe, but more research is needed to determine which interventions are most effective for individual patients.
2. Describe the method used by the author of the study.
- The author used a systematic review method following the PRISMA 2020 framework. The author searched PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025 related to fecal incontinence and functional GI disorders. Studies were selected based on specific inclusion and exclusion criteria and were evaluated for quality. A total of 103 studies were included. Because the studies varied in their design, interventions, and outcomes, the author used a narrative approach to compare and summarize the findings rather than combining the results into one statistical analysis.
1. What are the advantages and disadvantages of implementing the article's recommendations in your unit and/or hospital? One advantage of implementing the article’s recommendations in our hospital is that they could improve care for patients with fecal incontinence and help prevent complications such as skin irritation and incontinence-associated dermatitis. Simple interventions such as proper skin care, regular toileting, monitoring stool patterns, dietary changes, and using the appropriate incontinence products can make patients more comfortable and help maintain their dignity. These interventions also give nurses a more consistent approach to managing fecal incontinence, rather than responding only after an episode occurs.
One disadvantage is that these recommendations may take additional time and effort from nursing staff, especially when caring for patients who require frequent toileting and skin care. Some recommendations may also be difficult to follow depending on the patient’s condition, mobility, cognitive status, or willingness to participate.
2. Discuss the research question or main problem discussed in the study. The main problem discussed in the article is how nurses can better prevent and manage fecal incontinence in patients with functional gastrointestinal disorders. Even though fecal incontinence is common and can greatly affect a patient’s comfort and quality of life, there is still no clear standard nursing care approach for managing it. The author reviewed existing research to identify nursing interventions that may help prevent or improve fecal incontinence. The article mainly focuses on practical interventions such as dietary and lifestyle changes, bowel habit training, proper skin care, and pelvic floor muscle exercises.
1. Discuss the method use by the author of the study?
The study method was a narrative review which summarizes previous research. The aim of the study is to present the background of a topic, the course of research and new perspective incorporating the subjective judgements and interpretations of the researchers. The use of narrative reviews are more exploratory.
The literature research was conducted using the PubMed, Zentralblatt fur die gesammte, Medizin and Ichushi Web databases. The search period was from January 1983 to December 2024. The search articles and retrieved studies were reviewed and those relevant were included.
The study review focused on how to identify aspects that useful for nurses, other health professionals and patients. The review covers a specific topic and includes only published articles that reports scientific knowledge and consensus statements.
2. Discuss the limitations of the article? limited sample, size, design flaws, and/or author bias?
Narrative reviews like this article have several limitations. Narrative reviews is a type of literature review that tells a story about research in a particular field and interprets the article from an expert's unique perspective.
Narrative review aims to organize a wide range of background knowledge, ideas, and research on a specific topic, and presents a persuasive argument unlike systematic reviews which uses strict research criteria.
The article has limitations on the basis of the retrieved information and some areas maybe lacking in academic discussions and transparency. The study reviews lacks formal, standardized research, and protocols making it vulnerable to selection bias, limited subjective interpretations of the author. The conclusion rely heavily on the author's viewpoints rather than objective evidence.
Q: Describe the method used by the author of the study A: The author conducted a narrative review to comprehensively summarize previous knowledge. The author was, therefore, not bound by strict methodology and was, instead, free to present background on the topic, new perspectives, subjective judgments, interpretations and an exploratory overview. He searched major English language databases and articles published between January 1983 and December 2024. The search focused on three terms, “fecal incontinence,” “nursing care,” and “preventive measures.” Relevant studies were critically reviewed. Usefulness for nurses was of particular importance in the search. Studies on specific gastrointestinal diseases were not the focus of research. The author was able to identify research trends, challenges, and practical nursing recommendations.
Q: How can the findings of this study be applied to patient care? A: The usefulness of this study is that it initiates important conversations about basic patient care in the acute care environment. The development of regular, individual, bowel routines and hygiene is in accordance with the basic principles of nursing. Though limitations for care exist due to staffing shortages, safety protocols, etc., simple steps, like screening for dietary restrictions, making minor changes to diet (reducing sugar, increasing bulky and dietary fiber, and increasing fluid intake when appropriate), as well as developing toileting routines when needed can make significant differences in patient experiences and outcomes. Close coordination with pharmacy, dietary, therapy, wound care and GI departments can not only help reduce factors that increase incontinence in the hospital setting, but provide patients with the education, tools and strategies they will need after discharge, improving their health and quality of life overall.
Discuss the research question or main problem discussed in the study?
This review study focuses on fecal incontinence being a significantly underaddressed quality-of-life issue among patients with functional gastrointestinal disorders. The author seeks to investigate whether evidence-based nursing interventions could help prevent or reduce fecal incontinence in these patients. The review concluded that nursing care to help prevent fecal incontinence should include dietary and lifestyle education, bowel habit instructions, and pelvic floor muscle training.
Describe the method used by the author of the study.
The author of this study conducted a narrative review of recent literature to help bridge existing research evidence with actionable bedside nursing practice. Database search engines used include PubMed, Zentralblatt für die gesammte Medizin, and Ichushi. Articles were narrowed down to English-language publications from January 1983 to December 2024 using the keywords "fecal incontinence," "nursing care," and "preventive measures."
Q. How does this research article compare to our practice, policy and/or procedure? A. Fecal incontinence management is one of the basic nursing skill. A good fecal incontinence management can prevent complications like skin breakdown and thus lead to longer hospital stays. Early detection of cause of fecal incontinence can lead to a better outcome. Collaboration with the Dietitian is very important if food intake is deemed found to be once of the cause of fecal incontinence. Dietary changes may be needed to optimize stool characteristic and frequency.
Once diarrhea is noted testing of stool for c.diff is collected and thus early administrative of appropriate medications like antibiotics or anti diarrheal medications.
Q. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? A. The advantages and disadvantages in the article recommendations. Early detection and implementation of fecal incontinence management. Bowel training by scheduling patient to use bathroom at certain times can train your body with normal bowel movement but this may not be appropriate for patients with spinal cord injury. Collaboration with other disciplines like dietary to make food intake or supplements to have better outcomes in stool management. Pelvic floor muscle training helps improve urinary function and alleviate fecal incontinence by strengthening the pelvic muscles thus increased contractile strength. This exercises needs to be done correctly to be effective. In severe cases, improvement is limited and needs to be combined with other treatment methods.
1. Discuss the research question or main problem discussed in the study? The Study that was performed concentrates on common occurrences of fecal incontinence in patients with functional gastrointestinal disorders and how consistency is key in nursing protocols to help stop or decrease the condition. The article's goal was to help pinpoint nursing interventions that can help lower the episodes of fecal incontinence and lower the impact on patients' wellbeing. The approaches recommended in the study consist of pelvic floor exercises to strengthen the pelvic wall, changing one's diet, developing a consistent bowel regiment, and performing proper skin treatment. The research emphasizes how important it is for a nurse to educate patients to reduce the conditions that were listed in the article. Additionally, the nurse helps manage a patient's condition by creating strategies tailored to each patient. All in all, the interventions listed can assist in controlling a patient's control over their bowels, enhance the quality of life and uphold their dignity in a challenging time.
2. Describe the method used by the author of the study. The scholar used a narrative review of literature that examined previously published research on fecal incontinence. The intention of the article was to provide an exploratory discussion on fecal incontinence and the importance of a nurse's role in caring for patients with these disorders. The primary goal of the article was to provide helpful material and counseling to nurses and other healthcare professionals that are caring for patients with fecal incontinence
1. Discuss the research question or main problem discussed in the study? Nurses are the primary caregivers for patients especially with assisting of the patient's basic daily needs such as using the restroom. The main problem discussed in this study is to identify whether nursing care can help prevent from fecal incontinence occurring. This article looked at various different aspects of fecal incontinence and how healthcare workers can integrate better protocols to help improve patient care by preventing from fecal incontinence situations occurring as it can affect the patient's quality of life. The article deep dives on topics such as dietary adjustments, pelvic floor muscle training, bowel training, etc.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The recommendations of this article can be very beneficial in helping improve the patient's quality of life. Unfortunately often times fecal incontinence is under reported due to embarrassment. By working on preventing fecal incontinence from occurring it can help improve patient's skin integrity. As a result, on our unit we can also concentrate on implementing better skin care habits such as using preventative ointments. Additionally, implementing this research study in our unit can also help patient's have better involvement in their care and can help participate. The disadvantages of this study is that as nurses we nee to consider patient's acceptance in regards to this topic as it can be sensitive subject for some patients. Additionally, depending on the interventions, if there is dietary restrictions it can cause inadequate nutrition for patient's.
1. Discuss the research question or main problem discussed in the study.
The main focus of this article was whether nursing care can help prevent or improve fecal incontinence. This is an important issue because nurses are often directly involved with bowel care and helping patients manage their daily needs. The article discusses several things nurses can help with, including diet, bowel routines, skin care, and pelvic floor exercises. Overall, it shows that good nursing care and patient education can make this condition easier for patients to manage.
2. Describe the method used by the author.
For this article, the author reviewed research that had already been done about fecal incontinence instead of conducting a new study with patients. The author searched different medical databases and looked for studies about nursing care and ways to prevent or improve this condition. The information from those studies was reviewed to see which approaches could be helpful in patient care. This allowed the author to bring together what is already known and discuss how nurses can use that information in practice.
Discuss the research question or main problem discussed in the study? In this article fecal incontinence is being defined as the involuntary loss of rectal flatus, feces, and mucus for a period of at least one month in a person that was previously continent. There are many causes of fecal incontinence from IBS, various drugs like antibiotics, and consumption of stomach irritants like caffeine and alcohol. The article’s goal was to investigate if nursing care can prevent fecal incontinence. Some of the methods to help with fecal incontinence are dietary supplements, bowel training, and proper hygiene and skin care. Dietary fiber like psyllium has been shown to improve patient’s stool consistency and reduce the incidence of fecal incontinence, although the article states there is little evidence of this, I have cared for many patients in the acute care setting that also use psyllium and report no episodes of incontinence and overall healthy bowel movement patterns. Nurses play a crucial role in providing care for patient with fecal incontinence, from cleaning to assisting with timed toileting.
How does this research article compare to our practice, policy and/or procedure? In our ministry the recommendations/practices that this article is discussing are already in practice. Timed toileting time is a practice that I have seen implemented, especially in the rehabilitation unit, however the times that I have seen timed toileting being used, it has mostly been for urinary incontinence. The bedside nurse along with the help of the wound care team ensure proper skin care and hygiene practices are being followed, skin check procedure have been put in place to ensure that proper skin care is being followed when a patient is having incontinence episodes to prevent skin breakdown. The use of the “.skinassessment” phrase is used to assess a patient’s skin for pressure injuries, but within that checklist things like nutrition consult is included. When nutrition consults are done I have not seen psyllium fiber be recommended but other vitamins and supplements to support skin health are recommended
Preventing Faecal Incontinence in Patients with Functional Gastrointestinal Disorders
1. Discuss the research question or main problem discussed in the study.
This article addresses whether nursing interventions would help minimize fecal incontinence in patients with functional gastrointestinal disorders. Some of these nursing interventions included skin care, bowel training, lifestyle changes, and pelvic floor muscle training. Nursing interventions and education are important and can help prevent and or alleviate incontinence episodes in patients with functional gastrointestinal disorders.
2. How does this research article compare to our practice, police, and procedure?
At Providence St Joseph's, the nursing care helps recognize and help prevent incontinence episodes by having a proper timed bowel regimen for the patient. Furthermore, educating the patient on timely use of the call light to alert a staff member to assist in the ease of a bowel movement. Nurses also diligently assess proper skin care to help prevent moisture damage or pressure injuries from developing due to fecal incontinence. When appropriate and with an MD order, some patients are alleviated from fecal incontinence repercussions with the use of a rectal tube as a skin protection preventative measure.
1. Discuss the research question or main problem discussed in the study. The main problem discussed in this study is how nursing care can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. Nurses play an important role in assisting patients with daily needs and providing care that can improve hygiene, comfort, and quality of life. The article examines different nursing interventions, including dietary adjustments, bowel habit training, skin care, and pelvic floor muscle training. The goal was to identify effective approaches that nurses can use to better manage and prevent fecal incontinence.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital. Implementing the recommendations from this article can be beneficial because it may improve patients’ quality of life, protect skin integrity, and encourage patients to become more involved in their care. Since fecal incontinence can be an embarrassing and sensitive topic, better nursing care and prevention strategies may also encourage patients to report their symptoms and receive appropriate treatment. However, nurses must consider each patient’s acceptance of the interventions, and some recommendations, such as dietary changes, may be difficult to follow or could affect adequate nutrition if not properly individualized. Implementing these recommendations may also require additional nursing time, education, and resources to provide consistent and effective care.
Discuss the limitations of the article: Limited sample size, design flaws, and or author bias
One limitation of this article is that it is a narrative review, unlike an experimental study in which they would be collecting and interpreting their own data. Because of this, the study reviews many different studies, which can help to increase generalized data and results. The studies varied greatly in regards to factors such as sample size and how each study was performed. The issue with a narrative review is that the author can be selective in which studies they are reviewing, allowing the possibility for author bias. Another issue of the review is that there were no limits/restrictions placed on the studies themselves that were being selected. This can create many variables when attempting to compare data and use to back a certain outcome.
Describe the method used by the author of the study?
The author used a narrative literature review of multiple research studies to evaluate data. The author used reliable sources from PubMed, Zentrealblatt fur die gesammte Medizin and Ichushi Web to obtain data to review. Search results were limited to studies that had keywords such as fecal incontinence, nursing care and preventive measures to help specify and narrow results that would be relevant to the review. There were no restrictions placed on sample size or study design within the studies reviewed. Lastly the author chose to focus the narrative review on topics such as functional gastrointestinal disorders rather than organic gastrointestinal diseases.
How does this research article compare to our practice, policy and/or procedure?
This research article compares to our practice, policy, and/or procedure because we are always dealing with patients with fecal incontinence and are managing ways to prevent their skin from breaking down. This article discusses nursing interventions such as skin care, continence care, incontinence product selection. Our practice requires us to assess and then implement ways to prevent skin breakdown from fecal incontinence.
Describe the method used by the author of the study
The method used in this study was described as a narrative review, which states that it summarizes previous research. It appears that they are using this method to educate the reader on the background of the topic in order to prevent new opinions and judgement. A narrative methodology is used to explore the topic versus evaluating. The main focus of this review was to provide data that was useful for health care professionals.
Discuss the research question or main problem discussed in the study? The main problem of this article is to investigate what types of nursing care that can help prevent or improve fecal incontinence for patients with gastrointestinal disorders. It discusses recommendations for diets, exercise, bowel habit and skin management that can improve bowel incontinence. This provides nurses the knowledge to advise and educate patients on how to manage fecal incontinence.
Describe the method used by the author of the study. The method use by the author was narrative review. The author used previously written literature, searched on PubMed, Zentralblatt and Ichusi Web databases, key words used were fecal incontinence, nursing care, and preventive measures. The author collected and reviewed the studies to identify aspects that can be applied and provide education by nurses to patients with gastrointestinal disorders and manage fecal incontinence in their daily activities.
1. Describe the method used by the author of the study. The author, Yohei Okawa of St. Luke's International University in Japan, conducted a narrative review of more than 40 studies published over a 40-year period. Literature was gathered from PubMed, Zentralblatt für die gesammte Medizin, and the Ichushi Web databases. The review focused on strategies to prevent fecal incontinence in patients with functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), diarrhea, and constipation, rather than those with organic diseases such as Crohn's disease or ulcerative colitis. The author examined the various types of fecal incontinence, nursing interventions that may help prevent incontinence and associated skin breakdown, and measures that can be implemented to protect patients when incontinence occurs. The goal was to identify evidence-based approaches that support both symptom management and skin integrity.
2. How does this research article compare to our practice, policy and/or procedure? The study highlighted several strategies for preventing fecal incontinence, including daily fiber supplementation to promote soft, formed stools, the use of antidiarrheal medications when appropriate, dietary modifications such as the low-FODMAP diet, and assisted bowel training programs. While most of these interventions are not currently incorporated into our standard practice for managing fecal incontinence, the findings offer valuable insight into potential approaches for improving patient outcomes. Further exploration of these strategies may help reduce episodes of incontinence, minimize skin maceration, and enhance patient comfort and quality of life. Evaluating the applicability of these interventions within our patient population could help inform future practice improvements.
Describe the method that was used by the author of the study: The method that was used by the author of the study is called the narrative review, which aimed to comprehensively summarize previous research. It is a type of review that do not adhere to a strict methodology but instead aim to present a topic based on the subjective interpretations of the researchers. It is more of an exploratory and provides an overview, or background of a particular topic and interprets and integrates it from an expert's unique perspective and present a persuasive argument. The narrative review was used in this study was used to investigate what types of nursing care are needed to prevent or improve fecal incontinence .
Discuss the research question or main problem discussed in the study The aim of the study is to find out if nursing care can prevent or improve fecal incontinence. With the exception of patients with gastrointestinal disorders, the study discussed different nursing interventions that may help patients eliminate or improve fecal incontinence. Although the sample subjects is only limited to older women, the study showed several interventions that helped to improve fecal incontinence on these subjects. Therefore concludes that certain nursing care or interventions play a big role in managing, improving or even eliminating fecal incontinence.
David Kahn 5 south 1. Research question or main problem discussed in the study: The main problem this study looks at is how to actually prevent fecal incontinence in people who have functional GI disorders. The author points out that fecal incontinence is super common, but nursing care for it is kind of all over the place and not clearly defined. So the big question they’re trying to answer is basically: what nursing interventions actually help, and how can nurses support patients through diet changes, lifestyle habits, bowel routines, and skin care. The whole goal of the article is to compile known nujrsing strategies and figure out what nurses should realistically be doing to help patients manage or prevent these symptoms.
2. Advantages and disadvantages of the proposed recommendations: Advantages would be that the recommendations in the article are pretty practical things like giving patients dietary advice, helping them build better bowel habits, teaching pelvic floor exercises, and keeping their skin clean and protected. These are all simple, everyday things nurses can help with, and they don’t require fancy equipment or complicated treatments. A lot of the suggestions like fiber intake, low FODMAP diets, regular toileting, and good skin care are evidence based, so they can actually make a noticeable difference for patients.
On the downside, some of these recommendations take time and consistency, which can be tough for patients and nurses. many patients probably wont stick to diet changes or daily exercises, and some patients may have physical or cognitive limitations that make these routines harder. Plus, even though its evidence based, the recomendations arent super strict or standardized which would probably be more helpful if that was changed before preventing to a patient.
1. Discuss the research question or main problem discussed in the study The main problem discussed in the article is fecal incontinence among patients with functional gastrointestinal disorders and the lack of clear nursing care protocols for preventing or improving this condition. Okawa's main research question was essentially what types of nursing care can be provided to prevent fecal incontinence or reduce its symptoms in patients with gastrointestinal disorders. The article discusses practical approaches such as dietary and lifestyle advice, bowel-habit education, skin care, and pelvic-floor muscle training. The author emphasizes that nurses can play an important role because they regularly assist patients with daily activities and bowel care.
1. Discuss the limitations of the article A limitation of Okawa’s article is that it is a narrative literature review rather than an original research study. The author relied on previously published research instead of collecting new data directly from patients with functional gastrointestinal disorders. As a result, the findings depend on the quality, consistency, and availability of the existing literature. Another limitation is that the literature search was limited to English-language publications, which means relevant studies published in other languages may have been excluded.
Valerie Dressman 1. Discuss the research questions or main problem discussed in the study?
This article reviews causes of fecal incontinence, and ways to minimize it. The goal of this study is to find ways to prevent fecal incontinence in order to protect the skin and avoid incontinence associated dermatitis (IAD). Diet and pelvic floor exercises were among the ways proposed to help with fecal incontinence. The main question being, can these practices help prevent fecal incontinence?
2. Discuss the limitation of the article: limited sample size, design flaws, and/or author bias.
The author for this article used a narrative review. They used prior research in order to provide a summary of findings on the subject. This could be seen as a limitation, as it uses prior research and does not offer new information. A narrative review is not as specific as other types of reviews/studies, it ultimately is an overview of the subject. Even though this article is thorough, there may be more information on the subject.
1. Discuss the research questions or main problem discussed in the study? The main problem discussed in the study was that the older patient is at risk for skin tear who is receiving endoscopy care. The older adults often have fragile skin, which can be easily injured during activities such as transferring, repositioning, or removing adhesives. The study wanted to see whether educating endoscopy nurses and implementing a skin-tear prevention intervention would improve nurses knowledge and help reduce skin tears. 2. Describe the method used by the author of the study. The author used two type of test; pretest and post test. The nurses completed a test to measure their knowledge about skin-tear prevention. They then received education on how to prevent skin tears in older patients. Their knowledge was tested again after 1 month and 3 months. The researchers compared the results to determine whether the nurses knowledge improved and whether the number of skin tears decreased.
1. what are the advantages and disadvantages to the proposed recommendations in the article? Some reccomendtions for the issue of fecal incontinence in this article that stuck out to me the most in this article are these: Improve stool form, Pelvic floor muscle exercises ,GI consult to figure out cause, Regulating excretory rhythm. A couple of advantages would be improving the stool form; there are different interventions I can think of to reach that goal. Medications of course to slow down diarrhea or solidify stool are available. Foods such as fiber if allowed in a patient diet would be helpful as well. Disadvantages in these recommendations would be pelvic floor exercises and regulating the excretory rhythm. A lot of the patient population on my specific unit are unable to follow direction and are very limited in mobility. Trying to teach them how to flex a muscle wouldn’t be possible. Regulation in an acute setting would be difficult as well because we’re with the patient for such a small amount of time; there would be a lot of inconsistencies unfortunately in care.
2. Discuss the research question or main problem discussed in the study? The main problem in this study is preventing fecal incontinence in patients with functional gastrointestinal disorders. This study was mainly to see what changes can be done to better nursing care for this population of patients. The research gathered in this study is from gathering relevant articles to this topic and comparing the information found in them. For example the types of preventative measures used in acute care settings for fecal incontinence.
Discuss the research question or main problem discussed in the study.
Fecal incontinence are condition when body involuntary releases solid or liquid feces. The article is focuses on patients who have gastrointestinal disorders that can result in incontinence which can negatively impact their quality of life. Part of nursing tasks is to assist and teach patients about prevention and improvement of these symptoms. The article focuses on finding a nursing protocol and set of interventions to help prevent and improve incontinence by providing dietary and lifestyle advice’s, skin care and healthy habits.The article discusses dietary therapy, bowel habit instructions, care plans and medications as well as pelvic floor muscle training can be effective in managing these episodes.
How does this research article compare to our practice , policy and procedure ?
This is great article and as I nurse I can relate to this article. We come in contact with patients who have incontinence almost every shift. Fortunately, we have all the support we need from our hospital to care for these patients. For example if we have a patient who has been diagnosed with diarrhea we can consult out dietitians for better dietary plan. We can offer specific diets such as BRAN diet. If patient is receiving tube feeding we can always add banana flakes to their tube feeding. We can consult wound care nurses for their feedback if patient develops skin irritation and skin breakdown from constant moisture. There interventions are a great resource for nurses to implement and improve incontinence and skin breakdown.
1, How does this research article compare to our practice, policy and/or procedure?
Fecal incontinence is also an important issue on our unit because we often see skin problems related to both fecal and urinary incontinence. In our current practice, we clean the patient as soon as possible after an incontinent episode to protect the skin. For patients with ongoing diarrhea and pressure injuries, we may use a rectal tube to prevent further skin breakdown. We also reposition patients with a Braden Scale score below 18 every two hours, and patients with a score below 16 require closer attention. The article supports our current practice of providing immediate skin care after fecal incontinence. It emphasizes removing stool from the skin promptly and protecting the skin from moisture and irritation to prevent incontinence-associated dermatitis (IAD). Even though we already provide these interventions, we still see skin problems, so additional preventive measures may be helpful. One practice from the article that interests me is diet management. The article discusses improving stool consistency through dietary changes, including fiber such as psyllium and possibly a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet for patients with loose stools. We could consider working with a dietitian to determine appropriate dietary changes for individual patients. Another intervention we could consider is bowel habit training. The article recommends planned toileting, such as assisting some patients in the toilet about 30 minutes after meals. This may be especially helpful for older patients or those with decreased rectal sensation and may help prevent fecal impaction and overflow incontinence. Overall, the article is similar to our current practice in focusing on skin protection and prompt incontinence care, but it also provides additional ideas, especially diet management and planned bowel habits, that could be considered to improve our current practice.
2, Describe the method used by the author of the study?
The author used a narrative review method. He searched three medical databases to find previous studies about fecal incontinence. The keywords included “fecal incontinence,” “nursing care,” and “preventive measures.” The studies were published between January 1983 and December 2024. The PubMed, Zentralblatt für die gesammte Medizin and Ichushi Web databases were searched to identify relevant articles. The author reviewed the studies and selected information that could be useful for nurses, other healthcare workers, and patients. There were no limits on sample size, study design, or patient age. The author mainly focused on patients with functional GI disorders, such as IBS, functional diarrhea, and functional constipation.
1.Describe the method used by the author of the study?
The investigator opted for a narrative review approach to synthesize the existing literature. To map out previous research on bowel incontinence, he executed a comprehensive literature search across three major clinical databases. The search strategy relied on targeted indexing terms, specifically pairing “fecal incontinence” with “nursing care” and “preventive measures.” The scope of the search was temporally bounded, capturing literature published over a multi-decade span from January 1983 through December 2024.
Upon retrieving the literature, the investigator meticulously appraised the datasets to extract actionable insights tailored for clinical nurses, multidisciplinary healthcare teams, and the patients themselves. To ensure a broad thematic sweep, the methodology imposed no restrictive parameters regarding sample size, original study design, or subject age demographics. Instead, the analytical focus was intentionally narrowed to populations experiencing functional gastrointestinal disorders, with a primary emphasis on irritable bowel syndrome (IBS), functional diarrhea, and functional constipation
2.How does this research article compare to our practice, policy and procedure?
As a frontline clinician, this paper really hits home for me because managing bowel accidents is a core part of our daily workflow on the floor. Luckily, our facility backs us up with excellent interdisciplinary resources to handle these exact challenges. When we are dealing with a patient experiencing acute loose stools, we immediately loop in our clinical dietitians to overhaul their nutritional regimen, often initiating binding options like a high-fiber BRAN diet or mixing banana flakes directly into enteral tube feeds. Furthermore, if the constant moisture starts causing localized dermatitis or skin excoriation, we can instantly trigger a wound care consult for expert staging and specialized barrier recommendations. Having these collaborative pathways ready to deploy makes a massive difference in preserving skin integrity and improving patient comfort.
Discuss the research question or main problem discussed in the study.
The article examines nursing care that can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. It focuses on interventions such as dietary and lifestyle changes, skin care, bowel habit education, and pelvic floor muscle training. These interventions may improve bowel control and the patient’s quality of life.
What are the advantages and disadvantages of the recommendations?
An advantage is that many of the recommended interventions are noninvasive and can be incorporated into routine nursing care. They may help reduce episodes of fecal incontinence and improve patient comfort and independence. A disadvantage is that success may depend on patient participation and consistent adherence to dietary, lifestyle, and exercise recommendations.
Discuss the research or main problem discussed in the study:
The article focuses on gastrointestinal disorder that contributes to fecal incontinence. A condition that essentially can impact patients' quality of life. It is our role as nurses to help support patients in preventing and managing their symptoms. The article also focuses on different interventions to manage fecal incontinence such as preventions. The article highlights healthy bowel habits, proper skin care, dietary and life changes, and medication management.
How does this research article compare to our practice, policy, and procedure?
In our hospital, nurses are expected to complete a full skin assessment. For patients with fecal incontinence, nurses provide protocols to maintain skin integrity including but not limited to proper hygiene and scheduled toileting, providing interventions to prevent skin irritation and breakdown. Many of the recommendations in the article is also being implemented in our hospital such us providing bowel regimens to prevent and manage fecal incontinence. Consults are also made to dietary and wound department when appropriate.
Discuss the research question or main problem discussed in the study.
This study evaluates nursing protocols aimed at preventing and managing fecal incontinence in patients with functional gastrointestinal disorders (FGIDs). Primary interventions include tailored dietary and lifestyle modifications, structured bowel habit retraining, pelvic floor muscle rehabilitation, and proactive perineal skin care. Evidence indicates these targeted nursing strategies significantly enhance bowel continence and measurably improve patient quality of life.
How does this research article compare to our practice, policy, and procedure?
This article resonates deeply with my daily practice, as managing fecal incontinence is a critical aspect of our clinical workflow. Our facility utilizes a robust interdisciplinary approach to address these complex challenges. When managing patients with acute diarrhea, we promptly consult clinical dietitians to adjust nutritional regimens, often initiating binding interventions such as high-fiber diets or the addition of banana flakes to enteral nutrition. Furthermore, should moisture-associated skin impairment or dermatitis occur, we immediately engage our wound care team to provide expert assessment and specialized barrier recommendations. These collaborative pathways are essential for maintaining skin integrity and ensuring optimal patient comfort.
How does this research article compare to our practice, policy and/or procedure? Most of our patients in ICU have fecal incontinence due to their critical conditions including multiple drug-use such as sedation, pressors, and antibiotics etc. Honestly we don't much contribute for preventing fecal incontinence since our patients are in the acute phase of illness. We do prevent constipation asking Intensivist for bowel regimen for patients who don't have BM after 3-4 days or improve diarrhea giving banana flake after ruling out infection or starting antibiotics. We also do careful skin assessment and meticulous skin care especially after soiled. As for diet, our patients are rarely on diet because most of them are on enteral feedings due to their NPO status; our enteral feedings can cause loose stool or diarrhea; they have several kinds of diet without a low-FODMAP one. We cannot work for regularly emptying the rectum/the bladder if the other patient becomes critical, such as hypotension, their needs for bathroom become our lower priority causing them to wait. There is no opportunities to teach pelvic floor muscle training in our ICU.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantage would be that our ICU becomes the first miraculous ICU implementing prevention of fecal incontinence if we would work for the article recommendations. I mean, we have a lot of disadvantage of preventing fecal incontinence because it is not for ICU. As I mentioned above, our current contribution of preventing fecal incontinence is very limited because, I think, most of our patients have organic fecal incontinence due to their critical illness, such as septic shock, altered mental status intentionally or unintentionally, and on multiple drugs such as sedation, antibiotics, and vasopressors. Enteral feeding can cause diarrhea. As the article mentions, organic fecal incontinence “is difficult to relieve through lifestyle changes, dietary therapy, or pelvic floor muscle training.” Thus, it's not a phase of focusing preventing fecal incontinence in ICU. I don't deny the prevention, but our contribution is minimal, which is ok. I dream we would work for preventing fecal incontinence in floors of telemetry, med-surg, and rehabilitation in the future. In order to do so, we need more nursing staffs to deal with patient's urgency of defecation/urination for sure.
This article did not have a specific sample size because it was a narrative review instead of a study with its own participants. The author reviewed previous research about preventing and managing fecal incontinence. There were no limits placed on the sample size, study design, or age of the patients in the studies that were included. This allowed the author to look at different types of research and provide a broad overview of ways nurses can help patients with fecal incontinence.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation is that this was a narrative review, which is less structured than a systematic review. The author chose which studies were considered relevant, so personal judgment could have affected which information was included. The article also states that some areas may not have been discussed in enough detail. Another limitation is that only articles published in English were searched, so useful research in other languages may have been missed. Because of these limitations, the findings should be interpreted carefully.
Describe the method used by the author of the study Discussions in this study on the improvement and prevention of fecal incontinence among patients with gastrointestinal (GI) disorders were described as a narrative review which summarizes and condenses previous research already established on this area of focus. The author of the study clarified this was to present more information on GI disorders and present already known research findings and provide new perspectives on the subject. The author provided a literature review through discovery of research articles on a variety of different databases, such as PubMed. The author refined the search to only include the dates of January 1983 to December 2024 and English-only publications with key words "fecal incontinence," "nursing care", and "preventive measures." All were critically reviewed and those that met the author's criteria were included in this narrative review.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias Since the author conducted a narrative review, there are several limitations discussed. The first and foremost, is the format of the research. By discipline, narrative reviews explains knowledge that is already established on a specific topic or field and then interprets the already known findings from a new perspective. The study is not qualitative or quantitative in nature and there is no sample size because the design study is not appropriate. Although the author did conduct a literature search, the author themselves acknowledged a limitation lies in the literature that was retrieved as well because some literature that was spoken about may have lacked adequate interpretations.
Describe the method used by the author of the study
This study used a narrative review method to look at the results of previous research. It used a literature review search to find other related studies about fecal incontinence, nursing care, and preventative measures. These other studies were reviewed and summarized to be able to provide a comprehensive look at how fecal incontinence is affected by nursing care.
Discuss the research question or main problem discussed in the study?
The primary goal of this study was to use a comprehensive literature review to determine whether fecal incontinence can be prevented by using care. The researchers looked at the physiological causes and factors that influence fecal incontinence in patients and the current care standards that are used by nurses to manage fecal incontinence. The study goes on to look at preventative measures/regimens that can be taken to address the issue and what role nurses play in providing that specialized care.
1). Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
This one-author narrative review is not original research and thus has no sample size of its own; the papers it draws on mix small trials with large observational studies of mixed quality, and no formal quality check or limits on design or sample size were used. Compared with a systematic review its methods are weaker: the search covered only English articles in three databases using loose keywords, study selection (including the decision to drop organic GI disease) was judgment-based, and the author himself states that narrative reviews can lack transparency and allow interpretive bias. Recommendations also show a Japanese clinical lens—white rice, bidets, and a typical Japanese diet—which may tilt the advice away from more general evidence.
2). Discuss the research question or main problem discussed in the study?
The main problem addressed is that fecal incontinence is frequent in patients with functional gastrointestinal disorders, yet nurses lack a clear, evidence-based protocol for preventing or improving it while they assist with everyday excretion care. The review therefore asks whether, and which, nursing interventions—dietary and lifestyle advice, bowel-habit instruction, skin care, product selection, and pelvic-floor muscle training—can reduce symptoms or their impact on daily life. It surveys published knowledge, remaining challenges, and future prospects to answer that question and to guide practical nursing care.
Discuss the research question or main problem discussed in the study: - The main problem discussed in the study is fecal incontinence. The author acknowledges that there are multiple ways that fecal incontinence can occur such as IBS, functional diarrhea, radiation enteritis, malabsorption syndrome, etc. The study was intended to identify whether or not nursing care can prevent fecal incontinence.
Describe the method used by the author of the study: - Unlike typical studies that are bound by strict methodology, this study took a narrative review approach. Doing so, the study comprehensively summarized previous research. This entailed presenting the background of a topic, the course of research and new perspectives, as well ass including the subjective interpretations of the researchers. Since this specific study is not under any strict methodology, it was allowed to present a more exploratory perspective. The review focused on identifying elements from other narratives that can be useful to nurses, patients, and other members of healthcare.
Describe the method used by the author of the study. The author did a narrative review so no new data was collected. The author looked through existing research on fecal incontinence and summarized what is says about nursing care. Three search engines were used such as PubMed, Ichushi Web, and Zntralblatt fur die gessammte Medizin. They searched for key words "fecal incontinence", "nursing care", and "preventive measures". Only study on bowel problems like IBS, functional diarrhea, and constipation were included. There were no limits on the study design, sample size, or patient age.
Discuss the limitations of the article; limited sample size, design flaws, and/or author bias. As this was a narrative review, there was no sample size in this study. The author picked studies based on choice rather than strict criteria that a systematic review would follow. There was also only one author so there's a chance of bias for which studies were chosen. The article does not state how many studies were included which make it hard to decide how reliable the evidence is. Some recommendations include eating more white rice and using bidet toilets, which were based on Japanese habits, and might not fit every patient culture.
What are the advantages and disadvantages to the proposed recommendations in the article?
The recommendations, such as dietary changes, skin care, bowel training, and pelvic floor exercises, can help prevent or improve fecal incontinence and are generally practical for nursing care. However, some recommendations may be difficult for patients to follow consistently, and the evidence supporting some interventions is limited.
Describe the method used by the author of the study.
The author used a narrative literature review to examine existing research on preventing fecal incontinence. Studies were searched in PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web from 1983–2024. The relevant literature was reviewed to identify nursing interventions that could prevent or improve fecal incontinence.
What are the advantages and disadvantages to the proposed recommendations in the article?
The recommendations include dietary and lifestyle changes, skin care, bowel-habit training, and pelvic-floor exercises, which can be practical and other noninvasive ways to help prevent or reduce fecal incontinence. However, these recommendations may require consistent patient participation and may not work the same for everyone. Another disadvantage is that the evidence comes from a narrative review, so the recommendations are based on studies that have been previously established, rather than a new clinical trial conducted by the author.
1) Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation of this article is that it was a narrative review, so it did not have its own patient sample. The author reviewed studies that had different sample sizes, patient ages, and research designs. The review also included only published articles and searched only English-language publications. Because narrative reviews are not as strict as systematic reviews, the author’s judgment was used to decide which studies were relevant and how the findings were interpreted. This could introduce some author bias. The author also acknowledged that some areas of the review may lack academic discussion or transparency.
2. Discuss the research question or main problem discussed in the study.
The main problem this article addresses is that fecal incontinence is common, but effective nursing care to prevent or improve it remains unclear. The author wanted to determine whether nursing care could help prevent fecal incontinence and identify which nursing interventions may be helpful. The review found that nurses can help patients by providing dietary and lifestyle advice, skin care, bowel habit education, and pelvic floor muscle training. These interventions may help prevent fecal incontinence or improve patients' symptoms and quality of life.
How does this research article compare to our practice, policy and/or procedure? • Screening and Early Triggers: Does your nursing or clinical assessment explicitly screen FGID patients for early signs of leakage (such as minor stool seepage, staining, or near-accidents)? The research emphasizes treating these early indicators proactively rather than waiting for a full diagnosis of faecal incontinence. • Interdisciplinary Referral Pathways: Do your procedures include a clear, automated pathway to refer functional bowel patients to specialized Pelvic Floor Physical Therapy or Biofeedback? If your policy relies heavily on medication alone, adding a physical therapy referral pipeline would bridge a common gap. • Dietary Documentation: Does your current policy support structured tracking, like a shared bowel and food diary? The article highlights fiber optimization and strict avoidance of gut irritants (like artificial sweeteners and caffeine) as primary preventative care.
what are the advantages and disadvantages to the proposed recommendations in the article? Advantages • High Safety Profile and Low Risk: Unlike surgical or pharmacological interventions, conservative therapies—such as dietary adjustments, bowel scheduling, and pelvic floor exercises—carry virtually no risk of severe adverse side effects. • Addresses the Root Functional Cause: Rather than just masking symptoms, therapies like biofeedback and pelvic floor muscle training (PFMT) directly retrain neuromuscular coordination and stool consistency. • Empowers Patient Autonomy: Using food diaries and establishing predictable bowel habits shifts a significant portion of care into the patient's hands, improving long-term self-management and quality of life. • Cost-Effective First-Line Care: Behavioral modifications and dietary shifts are low-cost interventions that can drastically reduce the need for expensive medications, medical devices, or invasive procedures down the line. • Catches Symptoms Early: Focusing on early triggers (like minor stool seepage or staining) prevents the progression to severe FI, protecting skin integrity and reducing psychological distress before it escalates.
Disadvantages • Requires High Patient Adherence and Cognition: Behavioral training, dietary logging, and daily physical exercises require strict, long-term commitment from the patient. This approach may fail if the patient has cognitive impairments, severe fatigue, or low motivation. • Delayed Therapeutic Effects: Dietary changes and pelvic floor retraining take time to show measurable results (often several weeks to months). Patients expecting immediate relief may become discouraged and abandon the protocol. • Resource and Access Constraints: Specialized biofeedback and pelvic floor physical therapy require trained clinicians. These services are often limited by geographic availability, long waitlists, or a lack of health insurance coverage. • Limited Efficacy for Severe Structural Damage: While highly effective for functional disorders, these recommendations provide limited benefit if the patient has underlying, unrecognized structural damage, such as a severe external anal sphincter tear. • High Burden of Clinical Staff Time: Teaching bowel retraining, analyzing food diaries, and conducting preventative screenings demand significant time from nursing and therapy staff during outpatient or inpatient visits.
1) Describe the method used by the author of the study
ReplyDeleteThe author, Yohei Okawa, conducted a narrative review to summarise existing knowledge on preventing faecal incontinence in patients with functional gastrointestinal disorders. He searched major databases including PubMed, Zentralblatt für die gesamte Medizin, and Ichushi Web for English-language articles published between January 1983 and December 2024. Search terms focused on “faecal incontinence,” “nursing care,” and “preventive measures.” Relevant studies were critically reviewed, with emphasis on those useful for nurses, while studies on organic gastrointestinal diseases were mostly excluded. This exploratory approach allowed the author to present background information, research trends, challenges, and practical nursing recommendations without following the strict rules of a systematic review.
2) Discuss the research question or main problem discussed in the study
The main problem addressed in the article is the high prevalence and negative impact of faecal incontinence among patients with functional gastrointestinal disorders, such as irritable bowel syndrome. Many patients struggle with daily activities due to involuntary loss of stool, which affects their dignity, skin health, and quality of life. The central research question is whether nursing care can effectively prevent or improve fecal incontinence in these patients. The author explores this by examining dietary therapy, bowel habit training, skin care, pelvic floor muscle exercises, and proper use of continence products, highlighting that timely nursing interventions can reduce symptoms and help patients maintain independence and comfort.
1. Describe the method used by the author of the study.
ReplyDeleteThis study's method uses a narrative review which gathers prior research but is not bound by specific criteria, rather the review uses the background and research for a particular subject, summarizes it and provides a new and subjective perspective of the topic. Narrative reviews are not limited by strict research criteria or methodology and therefore can give more of a general overview of its subject matter.
Specifically, the study is reviewing research on nursing care that may help to prevent or improve fecal incontinence using prior knowledge, challenges and future efforts.
2. Discuss the sample size used in the study.
This study relies only on reviews of scientific knowledge and consensus statements without regard to sample size, study design or patient age restrictions. Only English language publications from PubMed, Zentralblatt für die gesammte Medizin and Ichushi Web databases from January 1983 to December 2024 were used. Key words used to narrow the search were 'fecal incontinence', 'nursing care', and 'preventative measures'. Also, studies must include functional gastrointestinal disorders such as IBS, functional diarrhea and constipation. Exclusion criteria were patients with underlying organic GI disorders like ulcerative colitis and Crohn's disease, both of which would be difficult to prevent solely through factors like lifestyle changes and diet.
Discuss the method used by the author of the study
ReplyDeleteThe study design was a narrative review, which aimed to
comprehensively summarize previous research. These reviews
are not bound by strict methodology, but instead aim to present
the background of a topic, the course of research and new
perspectives, incorporating the subjective judgements and
interpretations of the researchers. The focus of this review was to identify aspects that are useful for nurses, other health professionals and patients. This narrative review was conducted to investigate what types of nursing care are needed to prevent or improve fecal incontinence through a review of existing knowledge, challenges and future prospects.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Narrative reviews can have multiple limitations. These literature reviews tell a story about research in a particular field and interprets and integrates it from an expert’s unique perspective. Unlike systematic reviews, which involve strict search criteria, a narrative review aims
to organize a wide range of background knowledge, ideas,
and research trends on a specific research topic and present a
persuasive argument. Some areas may be perceived as lacking in academic discussion or transparency.
Describe the method used by the author of the study.
ReplyDeleteThe author used a narrative review to examine existing research on preventing faecal incontinence in patients with functional gastrointestinal disorders. Unlike a systematic review, a narrative review provides a broad overview of the available literature and allows the author to interpret findings from an expert perspective. The author searched the PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web databases for English-language studies published between January 1983 and December 2024 using the keywords "fecal incontinence," "nursing care," and "preventive measures." The review included studies relevant to functional gastrointestinal disorders and excluded research on organic gastrointestinal diseases such as Crohn's disease and ulcerative colitis because those conditions require different treatment approaches. There were no restrictions on publication date, sample size, study design, or patient age.
Discuss the research question or main problem discussed in the study.
The main research question was whether nursing care can help prevent or improve faecal incontinence in patients with functional gastrointestinal disorders. The author sought to identify evidence-based nursing interventions by reviewing existing research on the topic. The study addressed the problem that, despite the high prevalence of faecal incontinence, there is still no clearly established nursing care protocol for its prevention and management. The review concluded that nurses play a critical role in preventing or reducing faecal incontinence by providing dietary and lifestyle advice, bowel habit instruction, pelvic floor muscle training, skin care, and individualized continence care plans to improve patients' quality of life.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study focuses on how bowel problems in people with functional gastrointestinal disorders can lead to fecal incontinence. This condition can affect a person’s daily life, comfort, and quality of life. The researchers looked at ways to identify risks early and find better ways to prevent fecal incontinence through proper care and management.
2.what are the advantages and disadvantages to the proposed recommendations in the article?
Advantages
The recommendations can help prevent fecal incontinence by finding problems early and giving patients the right care. They can help people manage their symptoms, feel better, and improve their daily lives. Teaching patients about diet, bowel habits, and healthy choices can also help them take better care of their condition.
Disadvantages
Some recommendations may be hard to follow because changing habits takes time and effort. Treatment may not work the same for everyone because each person has different symptoms. Some patients may need extra support from healthcare providers, which may not always be available. More research is needed to find the best ways to prevent fecal incontinence.
by Cindy Wein RN
ReplyDeleteDiscuss the research question or main problem discussed in the study.
In this article the researcher’s goal was to figure out where or not nurses can prevent fecal incontinence, specifically in patients with functional GI disorders. In the practical setting, the nurse not only becomes a key component of patient care specifically with cleaning soiled patients and providing incontinence care, but also with utilizing ancillary resources. Examples of that are implementing recommendation from departments such as pharmacy, dietary and wound care and exploring incontinence care products. Interestingly enough, this article concludes there are no clear evidence-based specific guidelines in place for nursing despite this disorder being common amongst many patients.
Describe the method used by the author of the study.
The researcher used a narrative review of literature which is summarizing previously publicized research articles. The author does explain that the purpose of the narrative review is to be “exploratory” to discuss the topic of fecal incontinence and the role of nursing. The goal was to provide purposeful insight for the nursing staff and other health professionals specifically for this population of patients with “functional incontinence.”
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem addressed in this study is the high prevalence and profound negative impact of fecal incontinence in patients suffering from GI disorders, such as IBS and functional diarrhea,. It’s critical to highlight that this condition significantly affects a patient’s dignity, skin health, and overall quality of life but there's currently no clearly established nursing care protocol for its prevention and management. The main question sought to determine whether proactive nursing care, including dietary therapy, bowel habit training, and pelvic floor muscle exercises, could effectively prevent or improve fecal incontinence in these patients. The author aimed to address a significant gap in clinical guidelines by exploring how timely nursing interventions can reduce symptoms and help patients maintain their independence,. This problem is especially relevant to nursing because we're often the primary caregivers responsible for providing care and managing the daily life challenges associated with this condition.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The biggest limitation of this article is its design as a narrative review, which lacks the strict methodology and rigorous search criteria required for a systematic review. I think this creates a risk of the author being biased because the findings and recommendations are based on subjective judgments and perspectives of the researcher rather than a thorough evaluation of all available evidence,. The author openly acknowledges that because the review is exploratory, some areas may be perceived as lacking in transparency or depth. Also, the exclusion of patients with organic GI diseases, such as Crohn’s or ulcerative colitis, represents a potential design flaw that limits the application of the results to a wider patient population that also suffers from incontinence, The decision to search only English language publications across a limited number of databases restricts the scope of the study and leaving out relevant international research. In the end, because this review only sums up what experts already agree on instead of studying a specific group of patients, we still don’t know for sure how well these nursing interventions work. Big, real‑world studies are still needed to prove their effectiveness.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteOne advantage is that the recommendations focus on simple nursing care, such as improving diet, skin care, bowel habits, and pelvic floor exercises, which may help reduce or prevent fecal incontinence. These treatments are also less invasive than surgery and can improve a patient's comfort and quality of life. Another advantage is that the care plans can be adjusted to fit each patient's needs. A disadvantage is that not all of the recommendations have strong evidence to prove they work for every patient, and some people with severe cases may need more advanced treatments.
2. Discuss the research question or main problem discussed in the study.
The main research question was whether nursing care can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. The author reviewed previous studies to identify the most effective nursing interventions and summarize current knowledge. The article found that nursing care, including dietary advice, bowel training, skin care, and pelvic floor muscle exercises, may help manage symptoms. It also pointed out that more research is needed because there is still limited high-quality evidence for some of these treatments.
1. Describe the method used by the author of the study.
ReplyDeleteThis study utilized a narrative review design to offer a thorough evaluation of the existing literature on nursing care and fecal incontinence prevention. A narrative review, unlike a systematic review, is exploratory in nature, allowing researchers to integrate evidence while also including their professional interpretation and judgment. Relevant studies were located by searching the PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web databases. The search includes English-language literature published between January 1983 and December 2024 that used the keywords fecal incontinence, nursing care, and preventive measures. Retrieved publications were critically reviewed, and research that met the stated inclusion and exclusion criteria were included. The research sought to discover information that could help nurses, other healthcare providers, and patients prevent and manage fecal incontinence.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One disadvantage of this study is its narrative review design, which is based on the authors' interpretation and synthesis of the literature rather than a standardised, systematic technique. As a result, the review may contain selection bias and lack clarity in how the studies were reviewed and included. Although the authors conducted a thorough literature search and critically analyzed the available information, some significant studies may have been overlooked, and certain subjects may not have been covered in depth. As a result, the findings should be read with caution, keeping in mind that the conclusions are based on the authors' professional opinion rather than a systematic review of all data.
Ronit Malamud
Discuss the research question or main problem discussed in the study:
ReplyDeleteThe aim of this study was to investigate if nursing care can prevent fecal incontinence in patients with functional gastrointestinal disorders. The authors define fecal incontinence as the involuntary loss of feces that is a social or hygienic problem, which has multiple contributory factors for an individual patient. A narrative review was conducted to investigate exactly what types of nursing care are needed to prevent or improve this type of incontinence.
This research topic is interesting because it focuses on the nursing interventions related to fecal incontinence instead of solely the causes of the incontinence. The nursing interventions that were explored include skin care, continence care, product selection, and other additional care practices. While many of these interventions are inter-disciplinary in our ministry, it is important to remember that nursing plays a very large role in the prevention or improvement of incontinence.
How does this research article compare to our practice, policy, and/or procedure?:
The article’s recommended nursing interventions are centered around the prompt cleaning of fecal excrement and the prevention of incontinence associated dermatitis. Our practice here also focuses on cleaning soiled patients quickly, and minimizing wetness related to incontinence. We frequently participate in the suggested skin care practices including using our “purple wipes” and utilizing moisturizing cream to hydrate the skin. We also regularly use a barrier cream (zinc or desitin) for patients who are at a high-risk of skin breakdown from irritants. We utilize the recommended incontinence products like chux pads, and also assess stool characteristics that may indicate that a problem should be addressed. Nursing staff partners with dieticians to ensure that patients are receiving appropriate amounts of fiber and water. Some patients require low FODMAP diets to help avoid triggers that increase the risk of fecal incontinence.
One recommendation from the article that we do not use as regularly in the in-patient setting is bowel rhythm practices like defecation induction (sitting a patient on the toilet 30 minutes after each meal), or adjusting daily patterns of sleep, eating, and bowel movements for the patient. We typically require that patients adhere to our timing and tempo. While we do complete some education with patients relating to improving diet and lifestyle habits, we do not offer in-patient pelvic floor muscle training which can be beneficial to those dealing with fecal incontinence.
Discuss the main problem in the study.
ReplyDeleteThe main problem is fecal incontinence- unintentional leakage of stool in people with functional gastrointestinal disorders. In these patients, altered bowel habits, particularly diarrhea with urgency or constipation with overflow leakage, can make bowel control difficult.
The study emphasizes helping patients manage their everyday life through dietary and lifestyle advise to improve stool consistency and identify triggers, bowel habits instructions and timely toileting routines, skin care to prevent moisture-associated irritation and breakdown after leakage, and pelvic floor muscle training effectiveness for bowel control.
Limitation of the article.
The paper is useful as a practical, patient-centered nursing overview; but it's recommendations should be individualized and complemented by clinical evaluation for treatable causes of fecal incontinence, particularly when symptoms are new, severe, or persistent. Fecal incontinence can arise from conditions beyond functional GI disorders such as neurological, inflammatory bowel disease, medications effects, and structural problems like rectal prolapse.
At the same time, there is difficulty separating interventions that would identify which component in the recommended approach produces any observed benefits.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study addresses the high prevalence of fecal incontinence among patients with functional gastrointestinal disorders and highlights the lack of a standardized nursing care protocol for its prevention and management. The aim of the review was to identify nursing interventions that may prevent or reduce fecal incontinence and lessen its impact on patients' quality of life. Key interventions examined included dietary modifications, bowel habit training, skin care management, and pelvic floor muscle training. The findings emphasize the vital role of nurses in providing individualized education, support, and symptom management strategies to help patients improve continence, maintain dignity, and enhance their overall quality of life.
discuss the limitations of the article: limited sample size, design flaws, and/or author bias
One limitation of this study is that it did not include a specific patient sample size because it was a narrative review of previously published research. Narrative reviews are generally considered less rigorous than systematic reviews because the selection and interpretation of studies may be influenced by the author's judgment. Additionally, the review included studies with varying sample sizes, research designs, and patient populations, making it difficult to compare findings or identify the most effective nursing intervention. Furthermore, limiting the review to English-language publications may have introduced language and selection bias, potentially excluding relevant research published in other languages.
Describe the method used by this study.
ReplyDeleteThe method of this study was to use a narrative review on types of nursing interventions needed to prevent and/or improve fecal incontinence. This type of review uses a thematic interpretation of studies on a specific topic, in this case, fecal incontinence, to research the topic, rather than specific statistical protocols. This puts importance on the author’s expertise on the issue to identify patterns and relevant literature to include in their study. The author, Dr. Yohei Okawa, seems to have credibility in this area, as other articles published include “A Literature Review of Dietary Habits, Defecation Habits and Skill Care to Prevent Fecal Incontinence in Elderly Individuals with Irritable Bowel Syndrome” and “Feasibility of the Constipation Point-of-Care Ultrasound Educational Program in Observing Fecal Retention in the Colorectum: A Descriptive Study.”
How does this research article compare to our practice, policy and/or procedure?
The article reflects some similarities to our practice at PSJMC. One includes the use of medicines like loperamide to reduce incidents of diarrhea. Another practice is to encourage regular rectal emptying using suppositories and enemas.
1. Discuss the method use by the author of the study.
ReplyDeleteThe article used a literature review method and did not conduct a new clinical experiment; instead, they examined previously published research to identify evidence about fecal incontinence associated with functional gastrointestinal disorders, particularly irritable bowel syndrome.
2. Discuss the limitations of the article: limited sample size, design flaws and/or author bias.
The major limitation of the article is its literature-review design rather than an original clinical study. Because the author did not recruit a defined patient sample or test an intervention, the recommendation cannot establish cause and effect. The research was also limited to PubMed and English-language studies, which may have excluded relevant evidence. In addition, the use of subjective criteria for IBS diagnosis may make it difficult to objectively identify patients at risk for fecal incontinence. Therefore, while the article provides useful information about dietary management, bowel habits and patient education, additional well-designed clinical studies with larger and more diverse patient populations are needed to determine the effectiveness of these preventive strategies.
1. What are the main findings of the study?
ReplyDeleteThe article found that fecal incontinence can often be improved through simple changes in daily care. Diet changes, getting enough fiber and fluids, and developing regular bowel habits can help control bowel movements. Pelvic floor muscle exercises may also help patients strengthen the muscles needed for bowel control. The article also explains that good skin care is important because frequent stool exposure can cause irritation and skin damage. Overall, care should be based on each patient’s individual needs and the cause of their incontinence.
2. How can the findings of this study be applied to patient care?
Nurses can use these findings by helping patients develop a regular bowel routine and making changes to their diet and fluid intake when needed. Patients can also be taught pelvic floor exercises to improve bowel control. Nurses should regularly check and clean the skin to prevent irritation and incontinence-associated dermatitis. They can also help patients choose appropriate incontinence products and monitor their bowel movements. These interventions may help patients have fewer episodes of incontinence and improve their comfort and quality of life.
4. Preventing Faecal Incontinence in Patients With Functional Gastrointestinal Disorders
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
Although this article is not primarily a pressure-injury study, it is relevant to skin integrity because repeated stool exposure can contribute to moisture-associated skin damage and complicate wound prevention. The review emphasizes bowel management, diet and lifestyle education, skin care, and pelvic-floor muscle training. These strategies complement a hospital skin-integrity program by addressing an important source of moisture and contamination (Okawa, 2026; Providence, 2026a).
What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages. The recommendations are largely noninvasive and nursing-friendly. Nurses can reinforce bowel routines, dietary and lifestyle measures, perineal skin care, and pelvic-floor education. Improved continence may also improve comfort, dignity, hygiene, and reduce exposure of vulnerable skin to stool.
Disadvantages. The recommendations require patient participation and may be difficult for patients with cognitive impairment, severe illness, mobility limitations, or complex gastrointestinal disease. Some interventions also require individualized evaluation, and results may not occur quickly.
Describe the method used by the author(s) of the study.
The author conducted a narrative review. PubMed, the German-language ZB MED/Zentralblatt database, and Ichushi Web were searched for relevant literature, with emphasis on English-language articles. The review synthesized existing evidence rather than enrolling a new patient cohort (Okawa, 2026).
Discuss the research question or main problem discussed in the study.
The review asked what types of nursing care are needed to prevent or improve fecal incontinence, using existing evidence to identify practical nursing strategies and remaining challenges.
Discuss the sample size used in the study.
There was no single patient sample because this was a narrative review. The article drew on previously published studies involving different populations, designs, and sample sizes (Okawa, 2026).
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
Narrative reviews are more vulnerable to selection and author interpretation than systematic reviews with prespecified methods. The included evidence was heterogeneous, and the first page indicates no restrictions on publication date, sample size, study design, or patient age. These differences make it harder to determine the strength of evidence for each individual recommendation.
Overall Comparison With Providence Internal Policies
The four articles address different parts of prevention, but together they support a broader approach to skin integrity: reduce avoidable pressure and shear from equipment, assess skin in a way that is appropriate across skin tones, recognize patient-specific tissue vulnerability, and manage moisture from incontinence. The Providence Skin Integrity policy states that its purpose is to establish guidelines for identification, prevention, and care of patients at risk for or with altered skin integrity (Providence, 2026a). The visible first page of the Providence inpatient nutrition policy also requires nutrition screening within 24 hours of admission and use of the NRS-2002 process to identify nutritional risk (Providence, 2026b). Nutrition is another relevant component of wound prevention and healing. Because only the first page of each internal policy was provided, a line-by-line determination of whether the articles match every Providence procedure would require the remaining policy pages.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDelete- The recommendations have several advantages because the focus on conservative, low-risk interventions such as dietary changes, fiber, bowel training, and pelvic floor exercises. These strategies can be individualized to the patient, may reduce episodes of fecal incontinence, and can improve quality of life without immediately requiring invasive treatments. They also encourage patients to take an active role in managing their symptoms. A disadvantage is that these interventions may not work for every patient often require consistent participation and lifestyle changes. Some treatments, such as pelvic floor therapy or biofeedback, may also be difficult to access. Overall, the recommendations are practical and relatively safe, but more research is needed to determine which interventions are most effective for individual patients.
2. Describe the method used by the author of the study.
- The author used a systematic review method following the PRISMA 2020 framework. The author searched PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2025 related to fecal incontinence and functional GI disorders. Studies were selected based on specific inclusion and exclusion criteria and were evaluated for quality. A total of 103 studies were included. Because the studies varied in their design, interventions, and outcomes, the author used a narrative approach to compare and summarize the findings rather than combining the results into one statistical analysis.
1. What are the advantages and disadvantages of implementing the article's recommendations in your unit and/or hospital?
ReplyDeleteOne advantage of implementing the article’s recommendations in our hospital is that they could improve care for patients with fecal incontinence and help prevent complications such as skin irritation and incontinence-associated dermatitis. Simple interventions such as proper skin care, regular toileting, monitoring stool patterns, dietary changes, and using the appropriate incontinence products can make patients more comfortable and help maintain their dignity. These interventions also give nurses a more consistent approach to managing fecal incontinence, rather than responding only after an episode occurs.
One disadvantage is that these recommendations may take additional time and effort from nursing staff, especially when caring for patients who require frequent toileting and skin care. Some recommendations may also be difficult to follow depending on the patient’s condition, mobility, cognitive status, or willingness to participate.
2. Discuss the research question or main problem discussed in the study.
The main problem discussed in the article is how nurses can better prevent and manage fecal incontinence in patients with functional gastrointestinal disorders. Even though fecal incontinence is common and can greatly affect a patient’s comfort and quality of life, there is still no clear standard nursing care approach for managing it. The author reviewed existing research to identify nursing interventions that may help prevent or improve fecal incontinence. The article mainly focuses on practical interventions such as dietary and lifestyle changes, bowel habit training, proper skin care, and pelvic floor muscle exercises.
1. Discuss the method use by the author of the study?
ReplyDeleteThe study method was a narrative review which summarizes previous research. The aim of the study is to present the background of a topic, the course of research and new perspective incorporating the subjective judgements and interpretations of the researchers. The use of narrative reviews are more exploratory.
The literature research was conducted using the PubMed, Zentralblatt fur die gesammte, Medizin and Ichushi Web databases. The search period was from January 1983 to December 2024. The search articles and retrieved studies were reviewed and those relevant were included.
The study review focused on how to identify aspects that useful for nurses, other health professionals and patients. The review covers a specific topic and includes only published articles that reports scientific knowledge and consensus statements.
2. Discuss the limitations of the article? limited sample, size, design flaws, and/or author bias?
Narrative reviews like this article have several limitations. Narrative reviews is a type of literature review that tells a story about research in a particular field and interprets the article from an expert's unique perspective.
Narrative review aims to organize a wide range of background knowledge, ideas, and research on a specific topic, and presents a persuasive argument unlike systematic reviews which uses strict research criteria.
The article has limitations on the basis of the retrieved information and some areas maybe lacking in academic discussions and transparency. The study reviews lacks formal, standardized research, and protocols making it vulnerable to selection bias, limited subjective interpretations of the author. The conclusion rely heavily on the author's viewpoints rather than objective evidence.
Q: Describe the method used by the author of the study
ReplyDeleteA: The author conducted a narrative review to comprehensively summarize previous knowledge. The author was, therefore, not bound by strict methodology and was, instead, free to present background on the topic, new perspectives, subjective judgments, interpretations and an exploratory overview. He searched major English language databases and articles published between January 1983 and December 2024. The search focused on three terms, “fecal incontinence,” “nursing care,” and “preventive measures.” Relevant studies were critically reviewed. Usefulness for nurses was of particular importance in the search. Studies on specific gastrointestinal diseases were not the focus of research. The author was able to identify research trends, challenges, and practical nursing recommendations.
Q: How can the findings of this study be applied to patient care?
A: The usefulness of this study is that it initiates important conversations about basic patient care in the acute care environment. The development of regular, individual, bowel routines and hygiene is in accordance with the basic principles of nursing. Though limitations for care exist due to staffing shortages, safety protocols, etc., simple steps, like screening for dietary restrictions, making minor changes to diet (reducing sugar, increasing bulky and dietary fiber, and increasing fluid intake when appropriate), as well as developing toileting routines when needed can make significant differences in patient experiences and outcomes. Close coordination with pharmacy, dietary, therapy, wound care and GI departments can not only help reduce factors that increase incontinence in the hospital setting, but provide patients with the education, tools and strategies they will need after discharge, improving their health and quality of life overall.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThis review study focuses on fecal incontinence being a significantly underaddressed quality-of-life issue among patients with functional gastrointestinal disorders. The author seeks to investigate whether evidence-based nursing interventions could help prevent or reduce fecal incontinence in these patients. The review concluded that nursing care to help prevent fecal incontinence should include dietary and lifestyle education, bowel habit instructions, and pelvic floor muscle training.
Describe the method used by the author of the study.
The author of this study conducted a narrative review of recent literature to help bridge existing research evidence with actionable bedside nursing practice. Database search engines used include PubMed, Zentralblatt für die gesammte Medizin, and Ichushi. Articles were narrowed down to English-language publications from January 1983 to December 2024 using the keywords "fecal incontinence," "nursing care," and "preventive measures."
Q. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteA. Fecal incontinence management is one of the basic nursing skill.
A good fecal incontinence management can prevent complications like skin breakdown and thus lead to longer hospital stays.
Early detection of cause of fecal incontinence can lead to a better outcome.
Collaboration with the Dietitian is very important if food intake is deemed found to be once of the cause of fecal incontinence. Dietary changes may be needed to optimize stool characteristic and frequency.
Once diarrhea is noted testing of stool for c.diff is collected and thus early administrative of appropriate medications like antibiotics or anti diarrheal medications.
Q. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
A. The advantages and disadvantages in the article recommendations.
Early detection and implementation of fecal incontinence management.
Bowel training by scheduling patient to use bathroom at certain times can train your body with normal bowel movement but this may not be appropriate for patients with spinal cord injury.
Collaboration with other disciplines like dietary to make food intake or supplements to have better outcomes in stool management.
Pelvic floor muscle training helps improve urinary function and alleviate fecal incontinence by strengthening the pelvic muscles thus increased contractile strength. This exercises needs to be done correctly to be effective. In severe cases, improvement is limited and needs to be combined with other treatment methods.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe Study that was performed concentrates on common occurrences of fecal incontinence in patients with functional gastrointestinal disorders and how consistency is key in nursing protocols to help stop or decrease the condition. The article's goal was to help pinpoint nursing interventions that can help lower the episodes of fecal incontinence and lower the impact on patients' wellbeing. The approaches recommended in the study consist of pelvic floor exercises to strengthen the pelvic wall, changing one's diet, developing a consistent bowel regiment, and performing proper skin treatment. The research emphasizes how important it is for a nurse to educate patients to reduce the conditions that were listed in the article. Additionally, the nurse helps manage a patient's condition by creating strategies tailored to each patient. All in all, the interventions listed can assist in controlling a patient's control over their bowels, enhance the quality of life and uphold their dignity in a challenging time.
2. Describe the method used by the author of the study.
The scholar used a narrative review of literature that examined previously published research on fecal incontinence. The intention of the article was to provide an exploratory discussion on fecal incontinence and the importance of a nurse's role in caring for patients with these disorders. The primary goal of the article was to provide helpful material and counseling to nurses and other healthcare professionals that are caring for patients with fecal incontinence
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteNurses are the primary caregivers for patients especially with assisting of the patient's basic daily needs such as using the restroom. The main problem discussed in this study is to identify whether nursing care can help prevent from fecal incontinence occurring. This article looked at various different aspects of fecal incontinence and how healthcare workers can integrate better protocols to help improve patient care by preventing from fecal incontinence situations occurring as it can affect the patient's quality of life. The article deep dives on topics such as dietary adjustments, pelvic floor muscle training, bowel training, etc.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The recommendations of this article can be very beneficial in helping improve the patient's quality of life. Unfortunately often times fecal incontinence is under reported due to embarrassment. By working on preventing fecal incontinence from occurring it can help improve patient's skin integrity. As a result, on our unit we can also concentrate on implementing better skin care habits such as using preventative ointments. Additionally, implementing this research study in our unit can also help patient's have better involvement in their care and can help participate. The disadvantages of this study is that as nurses we nee to consider patient's acceptance in regards to this topic as it can be sensitive subject for some patients. Additionally, depending on the interventions, if there is dietary restrictions it can cause inadequate nutrition for patient's.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main focus of this article was whether nursing care can help prevent or improve fecal incontinence. This is an important issue because nurses are often directly involved with bowel care and helping patients manage their daily needs. The article discusses several things nurses can help with, including diet, bowel routines, skin care, and pelvic floor exercises. Overall, it shows that good nursing care and patient education can make this condition easier for patients to manage.
2. Describe the method used by the author.
For this article, the author reviewed research that had already been done about fecal incontinence instead of conducting a new study with patients. The author searched different medical databases and looked for studies about nursing care and ways to prevent or improve this condition. The information from those studies was reviewed to see which approaches could be helpful in patient care. This allowed the author to bring together what is already known and discuss how nurses can use that information in practice.
Discuss the research question or main problem discussed in the study?
ReplyDeleteIn this article fecal incontinence is being defined as the involuntary loss of rectal flatus, feces, and mucus for a period of at least one month in a person that was previously continent. There are many causes of fecal incontinence from IBS, various drugs like antibiotics, and consumption of stomach irritants like caffeine and alcohol. The article’s goal was to investigate if nursing care can prevent fecal incontinence. Some of the methods to help with fecal incontinence are dietary supplements, bowel training, and proper hygiene and skin care. Dietary fiber like psyllium has been shown to improve patient’s stool consistency and reduce the incidence of fecal incontinence, although the article states there is little evidence of this, I have cared for many patients in the acute care setting that also use psyllium and report no episodes of incontinence and overall healthy bowel movement patterns. Nurses play a crucial role in providing care for patient with fecal incontinence, from cleaning to assisting with timed toileting.
How does this research article compare to our practice, policy and/or procedure?
In our ministry the recommendations/practices that this article is discussing are already in practice. Timed toileting time is a practice that I have seen implemented, especially in the rehabilitation unit, however the times that I have seen timed toileting being used, it has mostly been for urinary incontinence. The bedside nurse along with the help of the wound care team ensure proper skin care and hygiene practices are being followed, skin check procedure have been put in place to ensure that proper skin care is being followed when a patient is having incontinence episodes to prevent skin breakdown. The use of the “.skinassessment” phrase is used to assess a patient’s skin for pressure injuries, but within that checklist things like nutrition consult is included. When nutrition consults are done I have not seen psyllium fiber be recommended but other vitamins and supplements to support skin health are recommended
Preventing Faecal Incontinence in Patients with Functional Gastrointestinal Disorders
ReplyDelete1. Discuss the research question or main problem discussed in the study.
This article addresses whether nursing interventions would help minimize fecal incontinence in patients with functional gastrointestinal disorders. Some of these nursing interventions included skin care, bowel training, lifestyle changes, and pelvic floor muscle training. Nursing interventions and education are important and can help prevent and or alleviate incontinence episodes in patients with functional gastrointestinal disorders.
2. How does this research article compare to our practice, police, and procedure?
At Providence St Joseph's, the nursing care helps recognize and help prevent incontinence episodes by having a proper timed bowel regimen for the patient. Furthermore, educating the patient on timely use of the call light to alert a staff member to assist in the ease of a bowel movement. Nurses also diligently assess proper skin care to help prevent moisture damage or pressure injuries from developing due to fecal incontinence. When appropriate and with an MD order, some patients are alleviated from fecal incontinence repercussions with the use of a rectal tube as a skin protection preventative measure.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in this study is how nursing care can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. Nurses play an important role in assisting patients with daily needs and providing care that can improve hygiene, comfort, and quality of life. The article examines different nursing interventions, including dietary adjustments, bowel habit training, skin care, and pelvic floor muscle training. The goal was to identify effective approaches that nurses can use to better manage and prevent fecal incontinence.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital.
Implementing the recommendations from this article can be beneficial because it may improve patients’ quality of life, protect skin integrity, and encourage patients to become more involved in their care. Since fecal incontinence can be an embarrassing and sensitive topic, better nursing care and prevention strategies may also encourage patients to report their symptoms and receive appropriate treatment. However, nurses must consider each patient’s acceptance of the interventions, and some recommendations, such as dietary changes, may be difficult to follow or could affect adequate nutrition if not properly individualized. Implementing these recommendations may also require additional nursing time, education, and resources to provide consistent and effective care.
Discuss the limitations of the article: Limited sample size, design flaws, and or author bias
ReplyDeleteOne limitation of this article is that it is a narrative review, unlike an experimental study in which they would be collecting and interpreting their own data. Because of this, the study reviews many different studies, which can help to increase generalized data and results. The studies varied greatly in regards to factors such as sample size and how each study was performed. The issue with a narrative review is that the author can be selective in which studies they are reviewing, allowing the possibility for author bias. Another issue of the review is that there were no limits/restrictions placed on the studies themselves that were being selected. This can create many variables when attempting to compare data and use to back a certain outcome.
Describe the method used by the author of the study?
The author used a narrative literature review of multiple research studies to evaluate data. The author used reliable sources from PubMed, Zentrealblatt fur die gesammte Medizin and Ichushi Web to obtain data to review. Search results were limited to studies that had keywords such as fecal incontinence, nursing care and preventive measures to help specify and narrow results that would be relevant to the review. There were no restrictions placed on sample size or study design within the studies reviewed. Lastly the author chose to focus the narrative review on topics such as functional gastrointestinal disorders rather than organic gastrointestinal diseases.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article compares to our practice, policy, and/or procedure because we are always dealing with patients with fecal incontinence and are managing ways to prevent their skin from breaking down. This article discusses nursing interventions such as skin care, continence care, incontinence product selection. Our practice requires us to assess and then implement ways to prevent skin breakdown from fecal incontinence.
Describe the method used by the author of the study
The method used in this study was described as a narrative review, which states that it summarizes previous research. It appears that they are using this method to educate the reader on the background of the topic in order to prevent new opinions and judgement. A narrative methodology is used to explore the topic versus evaluating. The main focus of this review was to provide data that was useful for health care professionals.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem of this article is to investigate what types of nursing care that can help prevent or improve fecal incontinence for patients with gastrointestinal disorders. It discusses recommendations for diets, exercise, bowel habit and skin management that can improve bowel incontinence. This provides nurses the knowledge to advise and educate patients on how to manage fecal incontinence.
Describe the method used by the author of the study.
The method use by the author was narrative review. The author used previously written literature, searched on PubMed, Zentralblatt and Ichusi Web databases, key words used were fecal incontinence, nursing care, and preventive measures. The author collected and reviewed the studies to identify aspects that can be applied and provide education by nurses to patients with gastrointestinal disorders and manage fecal incontinence in their daily activities.
1. Describe the method used by the author of the study.
ReplyDeleteThe author, Yohei Okawa of St. Luke's International University in Japan, conducted a narrative review of more than 40 studies published over a 40-year period. Literature was gathered from PubMed, Zentralblatt für die gesammte Medizin, and the Ichushi Web databases. The review focused on strategies to prevent fecal incontinence in patients with functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), diarrhea, and constipation, rather than those with organic diseases such as Crohn's disease or ulcerative colitis.
The author examined the various types of fecal incontinence, nursing interventions that may help prevent incontinence and associated skin breakdown, and measures that can be implemented to protect patients when incontinence occurs. The goal was to identify evidence-based approaches that support both symptom management and skin integrity.
2. How does this research article compare to our practice, policy and/or procedure?
The study highlighted several strategies for preventing fecal incontinence, including daily fiber supplementation to promote soft, formed stools, the use of antidiarrheal medications when appropriate, dietary modifications such as the low-FODMAP diet, and assisted bowel training programs. While most of these interventions are not currently incorporated into our standard practice for managing fecal incontinence, the findings offer valuable insight into potential approaches for improving patient outcomes. Further exploration of these strategies may help reduce episodes of incontinence, minimize skin maceration, and enhance patient comfort and quality of life. Evaluating the applicability of these interventions within our patient population could help inform future practice improvements.
Describe the method that was used by the author of the study:
ReplyDeleteThe method that was used by the author of the study is called the narrative review, which aimed to comprehensively summarize previous research. It is a type of review that do not adhere to a strict methodology but instead aim to present a topic based on the subjective interpretations of the researchers. It is more of an exploratory and provides an overview, or background of a particular topic and interprets and integrates it from an expert's unique perspective and present a persuasive argument. The narrative review was used in this study was used to investigate what types of nursing care are needed to prevent or improve fecal incontinence .
Discuss the research question or main problem discussed in the study
ReplyDeleteThe aim of the study is to find out if nursing care can prevent or improve fecal incontinence. With the exception of patients with gastrointestinal disorders, the study discussed different nursing interventions that may help patients eliminate or improve fecal incontinence. Although the sample subjects is only limited to older women, the study showed several interventions that helped to improve fecal incontinence on these subjects.
Therefore concludes that certain nursing care or interventions play a big role in managing, improving or even eliminating fecal incontinence.
David Kahn 5 south
ReplyDelete1. Research question or main problem discussed in the study:
The main problem this study looks at is how to actually prevent fecal incontinence in people who have functional GI disorders. The author points out that fecal incontinence is super common, but nursing care for it is kind of all over the place and not clearly defined. So the big question they’re trying to answer is basically: what nursing interventions actually help, and how can nurses support patients through diet changes, lifestyle habits, bowel routines, and skin care. The whole goal of the article is to compile known nujrsing strategies and figure out what nurses should realistically be doing to help patients manage or prevent these symptoms.
2. Advantages and disadvantages of the proposed recommendations:
Advantages would be that the recommendations in the article are pretty practical things like giving patients dietary advice, helping them build better bowel habits, teaching pelvic floor exercises, and keeping their skin clean and protected. These are all simple, everyday things nurses can help with, and they don’t require fancy equipment or complicated treatments. A lot of the suggestions like fiber intake, low FODMAP diets, regular toileting, and good skin care are evidence based, so they can actually make a noticeable difference for patients.
On the downside, some of these recommendations take time and consistency, which can be tough for patients and nurses. many patients probably wont stick to diet changes or daily exercises, and some patients may have physical or cognitive limitations that make these routines harder. Plus, even though its evidence based, the recomendations arent super strict or standardized which would probably be more helpful if that was changed before preventing to a patient.
1. Discuss the research question or main problem discussed in the study
ReplyDeleteThe main problem discussed in the article is fecal incontinence among patients with functional gastrointestinal disorders and the lack of clear nursing care protocols for preventing or improving this condition. Okawa's main research question was essentially what types of nursing care can be provided to prevent fecal incontinence or reduce its symptoms in patients with gastrointestinal disorders. The article discusses practical approaches such as dietary and lifestyle advice, bowel-habit education, skin care, and pelvic-floor muscle training. The author emphasizes that nurses can play an important role because they regularly assist patients with daily activities and bowel care.
1. Discuss the limitations of the article
A limitation of Okawa’s article is that it is a narrative literature review rather than an original research study. The author relied on previously published research instead of collecting new data directly from patients with functional gastrointestinal disorders. As a result, the findings depend on the quality, consistency, and availability of the existing literature. Another limitation is that the literature search was limited to English-language publications, which means relevant studies published in other languages may have been excluded.
Valerie Dressman
ReplyDelete1. Discuss the research questions or main problem discussed in the study?
This article reviews causes of fecal incontinence, and ways to minimize it. The goal of this study is to find ways to prevent fecal incontinence in order to protect the skin and avoid incontinence associated dermatitis (IAD). Diet and pelvic floor exercises were among the ways proposed to help with fecal incontinence. The main question being, can these practices help prevent fecal incontinence?
2. Discuss the limitation of the article: limited sample size, design flaws, and/or author bias.
The author for this article used a narrative review. They used prior research in order to provide a summary of findings on the subject. This could be seen as a limitation, as it uses prior research and does not offer new information. A narrative review is not as specific as other types of reviews/studies, it ultimately is an overview of the subject. Even though this article is thorough, there may be more information on the subject.
1. Discuss the research questions or main problem discussed in the study?
ReplyDeleteThe main problem discussed in the study was that the older patient is at risk for skin tear who is receiving endoscopy care. The older adults often have fragile skin, which can be easily injured during activities such as transferring, repositioning, or removing adhesives. The study wanted to see whether educating endoscopy nurses and implementing a skin-tear prevention intervention would improve nurses knowledge and help reduce skin tears.
2. Describe the method used by the author of the study.
The author used two type of test; pretest and post test. The nurses completed a test to measure their knowledge about skin-tear prevention. They then received education on how to prevent skin tears in older patients. Their knowledge was tested again after 1 month and 3 months. The researchers compared the results to determine whether the nurses knowledge improved and whether the number of skin tears decreased.
1. what are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteSome reccomendtions for the issue of fecal incontinence in this article that stuck out to me the most in this article are these: Improve stool form, Pelvic floor muscle exercises ,GI consult to figure out cause, Regulating excretory rhythm. A couple of advantages would be improving the stool form; there are different interventions I can think of to reach that goal. Medications of course to slow down diarrhea or solidify stool are available. Foods such as fiber if allowed in a patient diet would be helpful as well. Disadvantages in these recommendations would be pelvic floor exercises and regulating the excretory rhythm. A lot of the patient population on my specific unit are unable to follow direction and are very limited in mobility. Trying to teach them how to flex a muscle wouldn’t be possible. Regulation in an acute setting would be difficult as well because we’re with the patient for such a small amount of time; there would be a lot of inconsistencies unfortunately in care.
2. Discuss the research question or main problem discussed in the study?
The main problem in this study is preventing fecal incontinence in patients with functional gastrointestinal disorders. This study was mainly to see what changes can be done to better nursing care for this population of patients. The research gathered in this study is from gathering relevant articles to this topic and comparing the information found in them. For example the types of preventative measures used in acute care settings for fecal incontinence.
Discuss the research question or main problem discussed in the study.
ReplyDeleteFecal incontinence are condition when body involuntary releases solid or liquid feces. The article is focuses on patients who have gastrointestinal disorders that can result in incontinence which can negatively impact their quality of life. Part of nursing tasks is to assist and teach patients about prevention and improvement of these symptoms. The article focuses on finding a nursing protocol and set of interventions to help prevent and improve incontinence by providing dietary and lifestyle advice’s, skin care and healthy habits.The article discusses dietary therapy, bowel habit instructions, care plans and medications as well as pelvic floor muscle training can be effective in managing these episodes.
How does this research article compare to our practice , policy and procedure ?
This is great article and as I nurse I can relate to this article. We come in contact with patients who have incontinence almost every shift. Fortunately, we have all the support we need from our hospital to care for these patients. For example if we have a patient who has been diagnosed with diarrhea we can consult out dietitians for better dietary plan. We can offer specific diets such as BRAN diet. If patient is receiving tube feeding we can always add banana flakes to their tube feeding. We can consult wound care nurses for their feedback if patient develops skin irritation and skin breakdown from constant moisture. There interventions are a great resource for nurses to implement and improve incontinence and skin breakdown.
1, How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteFecal incontinence is also an important issue on our unit because we often see skin problems related to both fecal and urinary incontinence. In our current practice, we clean the patient as soon as possible after an incontinent episode to protect the skin. For patients with ongoing diarrhea and pressure injuries, we may use a rectal tube to prevent further skin breakdown. We also reposition patients with a Braden Scale score below 18 every two hours, and patients with a score below 16 require closer attention.
The article supports our current practice of providing immediate skin care after fecal incontinence. It emphasizes removing stool from the skin promptly and protecting the skin from moisture and irritation to prevent incontinence-associated dermatitis (IAD).
Even though we already provide these interventions, we still see skin problems, so additional preventive measures may be helpful.
One practice from the article that interests me is diet management. The article discusses improving stool consistency through dietary changes, including fiber such as psyllium and possibly a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet for patients with loose stools. We could consider working with a dietitian to determine appropriate dietary changes for individual patients.
Another intervention we could consider is bowel habit training. The article recommends planned toileting, such as assisting some patients in the toilet about 30 minutes after meals. This may be especially helpful for older patients or those with decreased rectal sensation and may help prevent fecal impaction and overflow incontinence.
Overall, the article is similar to our current practice in focusing on skin protection and prompt incontinence care, but it also provides additional ideas, especially diet management and planned bowel habits, that could be considered to improve our current practice.
2, Describe the method used by the author of the study?
The author used a narrative review method. He searched three medical databases to find previous studies about fecal incontinence. The keywords included “fecal incontinence,” “nursing care,” and “preventive measures.” The studies were published between January 1983 and December 2024. The PubMed, Zentralblatt für die gesammte Medizin and Ichushi Web databases were searched to identify relevant articles. The author reviewed the studies and selected information that could be useful for nurses, other healthcare workers, and patients. There were no limits on sample size, study design, or patient age. The author mainly focused on patients with functional GI disorders, such as IBS, functional diarrhea, and functional constipation.
1.Describe the method used by the author of the study?
ReplyDeleteThe investigator opted for a narrative review approach to synthesize the existing literature. To map out previous research on bowel incontinence, he executed a comprehensive literature search across three major clinical databases. The search strategy relied on targeted indexing terms, specifically pairing “fecal incontinence” with “nursing care” and “preventive measures.” The scope of the search was temporally bounded, capturing literature published over a multi-decade span from January 1983 through December 2024.
Upon retrieving the literature, the investigator meticulously appraised the datasets to extract actionable insights tailored for clinical nurses, multidisciplinary healthcare teams, and the patients themselves. To ensure a broad thematic sweep, the methodology imposed no restrictive parameters regarding sample size, original study design, or subject age demographics. Instead, the analytical focus was intentionally narrowed to populations experiencing functional gastrointestinal disorders, with a primary emphasis on irritable bowel syndrome (IBS), functional diarrhea, and functional constipation
2.How does this research article compare to our practice, policy and procedure?
As a frontline clinician, this paper really hits home for me because managing bowel accidents is a core part of our daily workflow on the floor. Luckily, our facility backs us up with excellent interdisciplinary resources to handle these exact challenges. When we are dealing with a patient experiencing acute loose stools, we immediately loop in our clinical dietitians to overhaul their nutritional regimen, often initiating binding options like a high-fiber BRAN diet or mixing banana flakes directly into enteral tube feeds. Furthermore, if the constant moisture starts causing localized dermatitis or skin excoriation, we can instantly trigger a wound care consult for expert staging and specialized barrier recommendations. Having these collaborative pathways ready to deploy makes a massive difference in preserving skin integrity and improving patient comfort.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThe article examines nursing care that can help prevent or improve fecal incontinence in patients with functional gastrointestinal disorders. It focuses on interventions such as dietary and lifestyle changes, skin care, bowel habit education, and pelvic floor muscle training. These interventions may improve bowel control and the patient’s quality of life.
What are the advantages and disadvantages of the recommendations?
An advantage is that many of the recommended interventions are noninvasive and can be incorporated into routine nursing care. They may help reduce episodes of fecal incontinence and improve patient comfort and independence. A disadvantage is that success may depend on patient participation and consistent adherence to dietary, lifestyle, and exercise recommendations.
Discuss the research or main problem discussed in the study:
ReplyDeleteThe article focuses on gastrointestinal disorder that contributes to fecal incontinence. A condition that essentially can impact patients' quality of life. It is our role as nurses to help support patients in preventing and managing their symptoms. The article also focuses on different interventions to manage fecal incontinence such as preventions. The article highlights healthy bowel habits, proper skin care, dietary and life changes, and medication management.
How does this research article compare to our practice, policy, and procedure?
In our hospital, nurses are expected to complete a full skin assessment. For patients with fecal incontinence, nurses provide protocols to maintain skin integrity including but not limited to proper hygiene and scheduled toileting, providing interventions to prevent skin irritation and breakdown. Many of the recommendations in the article is also being implemented in our hospital such us providing bowel regimens to prevent and manage fecal incontinence. Consults are also made to dietary and wound department when appropriate.
Discuss the research question or main problem discussed in the study.
ReplyDeleteThis study evaluates nursing protocols aimed at preventing and managing fecal incontinence in patients with functional gastrointestinal disorders (FGIDs). Primary interventions include tailored dietary and lifestyle modifications, structured bowel habit retraining, pelvic floor muscle rehabilitation, and proactive perineal skin care. Evidence indicates these targeted nursing strategies significantly enhance bowel continence and measurably improve patient quality of life.
How does this research article compare to our practice, policy, and procedure?
This article resonates deeply with my daily practice, as managing fecal incontinence is a critical aspect of our clinical workflow. Our facility utilizes a robust interdisciplinary approach to address these complex challenges. When managing patients with acute diarrhea, we promptly consult clinical dietitians to adjust nutritional regimens, often initiating binding interventions such as high-fiber diets or the addition of banana flakes to enteral nutrition. Furthermore, should moisture-associated skin impairment or dermatitis occur, we immediately engage our wound care team to provide expert assessment and specialized barrier recommendations. These collaborative pathways are essential for maintaining skin integrity and ensuring optimal patient comfort.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteMost of our patients in ICU have fecal incontinence due to their critical conditions including multiple drug-use such as sedation, pressors, and antibiotics etc. Honestly we don't much contribute for preventing fecal incontinence since our patients are in the acute phase of illness. We do prevent constipation asking Intensivist for bowel regimen for patients who don't have BM after 3-4 days or improve diarrhea giving banana flake after ruling out infection or starting antibiotics. We also do careful skin assessment and meticulous skin care especially after soiled. As for diet, our patients are rarely on diet because most of them are on enteral feedings due to their NPO status; our enteral feedings can cause loose stool or diarrhea; they have several kinds of diet without a low-FODMAP one. We cannot work for regularly emptying the rectum/the bladder if the other patient becomes critical, such as hypotension, their needs for bathroom become our lower priority causing them to wait. There is no opportunities to teach pelvic floor muscle training in our ICU.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantage would be that our ICU becomes the first miraculous ICU implementing prevention of fecal incontinence if we would work for the article recommendations. I mean, we have a lot of disadvantage of preventing fecal incontinence because it is not for ICU. As I mentioned above, our current contribution of preventing fecal incontinence is very limited because, I think, most of our patients have organic fecal incontinence due to their critical illness, such as septic shock, altered mental status intentionally or unintentionally, and on multiple drugs such as sedation, antibiotics, and vasopressors. Enteral feeding can cause diarrhea. As the article mentions, organic fecal incontinence “is difficult to relieve through lifestyle changes, dietary therapy, or pelvic floor muscle training.” Thus, it's not a phase of focusing preventing fecal incontinence in ICU. I don't deny the prevention, but our contribution is minimal, which is ok. I dream we would work for preventing fecal incontinence in floors of telemetry, med-surg, and rehabilitation in the future. In order to do so, we need more nursing staffs to deal with patient's urgency of defecation/urination for sure.
Discuss the sample size used in the study.
ReplyDeleteThis article did not have a specific sample size because it was a narrative review instead of a study with its own participants. The author reviewed previous research about preventing and managing fecal incontinence. There were no limits placed on the sample size, study design, or age of the patients in the studies that were included. This allowed the author to look at different types of research and provide a broad overview of ways nurses can help patients with fecal incontinence.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
One limitation is that this was a narrative review, which is less structured than a systematic review. The author chose which studies were considered relevant, so personal judgment could have affected which information was included. The article also states that some areas may not have been discussed in enough detail. Another limitation is that only articles published in English were searched, so useful research in other languages may have been missed. Because of these limitations, the findings should be interpreted carefully.
Describe the method used by the author of the study
ReplyDeleteDiscussions in this study on the improvement and prevention of fecal incontinence among patients with gastrointestinal (GI) disorders were described as a narrative review which summarizes and condenses previous research already established on this area of focus. The author of the study clarified this was to present more information on GI disorders and present already known research findings and provide new perspectives on the subject. The author provided a literature review through discovery of research articles on a variety of different databases, such as PubMed. The author refined the search to only include the dates of January 1983 to December 2024 and English-only publications with key words "fecal incontinence," "nursing care", and "preventive measures." All were critically reviewed and those that met the author's criteria were included in this narrative review.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Since the author conducted a narrative review, there are several limitations discussed. The first and foremost, is the format of the research. By discipline, narrative reviews explains knowledge that is already established on a specific topic or field and then interprets the already known findings from a new perspective. The study is not qualitative or quantitative in nature and there is no sample size because the design study is not appropriate. Although the author did conduct a literature search, the author themselves acknowledged a limitation lies in the literature that was retrieved as well because some literature that was spoken about may have lacked adequate interpretations.
Describe the method used by the author of the study
ReplyDeleteThis study used a narrative review method to look at the results of previous research. It used a literature review search to find other related studies about fecal incontinence, nursing care, and preventative measures. These other studies were reviewed and summarized to be able to provide a comprehensive look at how fecal incontinence is affected by nursing care.
Discuss the research question or main problem discussed in the study?
The primary goal of this study was to use a comprehensive literature review to determine whether fecal incontinence can be prevented by using care. The researchers looked at the physiological causes and factors that influence fecal incontinence in patients and the current care standards that are used by nurses to manage fecal incontinence. The study goes on to look at preventative measures/regimens that can be taken to address the issue and what role nurses play in providing that specialized care.
1). Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
ReplyDeleteThis one-author narrative review is not original research and thus has no sample size of its own; the papers it draws on mix small trials with large observational studies of mixed quality, and no formal quality check or limits on design or sample size were used. Compared with a systematic review its methods are weaker: the search covered only English articles in three databases using loose keywords, study selection (including the decision to drop organic GI disease) was judgment-based, and the author himself states that narrative reviews can lack transparency and allow interpretive bias. Recommendations also show a Japanese clinical lens—white rice, bidets, and a typical Japanese diet—which may tilt the advice away from more general evidence.
2). Discuss the research question or main problem discussed in the study?
The main problem addressed is that fecal incontinence is frequent in patients with functional gastrointestinal disorders, yet nurses lack a clear, evidence-based protocol for preventing or improving it while they assist with everyday excretion care. The review therefore asks whether, and which, nursing interventions—dietary and lifestyle advice, bowel-habit instruction, skin care, product selection, and pelvic-floor muscle training—can reduce symptoms or their impact on daily life. It surveys published knowledge, remaining challenges, and future prospects to answer that question and to guide practical nursing care.
Discuss the research question or main problem discussed in the study:
ReplyDelete- The main problem discussed in the study is fecal incontinence. The author acknowledges that there are multiple ways that fecal incontinence can occur such as IBS, functional diarrhea, radiation enteritis, malabsorption syndrome, etc. The study was intended to identify whether or not nursing care can prevent fecal incontinence.
Describe the method used by the author of the study:
- Unlike typical studies that are bound by strict methodology, this study took a narrative review approach. Doing so, the study comprehensively summarized previous research. This entailed presenting the background of a topic, the course of research and new perspectives, as well ass including the subjective interpretations of the researchers. Since this specific study is not under any strict methodology, it was allowed to present a more exploratory perspective. The review focused on identifying elements from other narratives that can be useful to nurses, patients, and other members of healthcare.
Describe the method used by the author of the study.
ReplyDeleteThe author did a narrative review so no new data was collected. The author looked through existing research on fecal incontinence and summarized what is says about nursing care. Three search engines were used such as PubMed, Ichushi Web, and Zntralblatt fur die gessammte Medizin. They searched for key words "fecal incontinence", "nursing care", and "preventive measures". Only study on bowel problems like IBS, functional diarrhea, and constipation were included. There were no limits on the study design, sample size, or patient age.
Discuss the limitations of the article; limited sample size, design flaws, and/or author bias.
As this was a narrative review, there was no sample size in this study. The author picked studies based on choice rather than strict criteria that a systematic review would follow. There was also only one author so there's a chance of bias for which studies were chosen. The article does not state how many studies were included which make it hard to decide how reliable the evidence is. Some recommendations include eating more white rice and using bidet toilets, which were based on Japanese habits, and might not fit every patient culture.
What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteThe recommendations, such as dietary changes, skin care, bowel training, and pelvic floor exercises, can help prevent or improve fecal incontinence and are generally practical for nursing care. However, some recommendations may be difficult for patients to follow consistently, and the evidence supporting some interventions is limited.
Describe the method used by the author of the study.
The author used a narrative literature review to examine existing research on preventing fecal incontinence. Studies were searched in PubMed, Zentralblatt für die gesammte Medizin, and Ichushi Web from 1983–2024. The relevant literature was reviewed to identify nursing interventions that could prevent or improve fecal incontinence.
What are the advantages and disadvantages to the proposed recommendations in the article?
DeleteThe recommendations include dietary and lifestyle changes, skin care, bowel-habit training, and pelvic-floor exercises, which can be practical and other noninvasive ways to help prevent or reduce fecal incontinence. However, these recommendations may require consistent patient participation and may not work the same for everyone. Another disadvantage is that the evidence comes from a narrative review, so the recommendations are based on studies that have been previously established, rather than a new clinical trial conducted by the author.
1) Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
ReplyDeleteOne limitation of this article is that it was a narrative review, so it did not have its own patient sample. The author reviewed studies that had different sample sizes, patient ages, and research designs. The review also included only published articles and searched only English-language publications. Because narrative reviews are not as strict as systematic reviews, the author’s judgment was used to decide which studies were relevant and how the findings were interpreted. This could introduce some author bias. The author also acknowledged that some areas of the review may lack academic discussion or transparency.
2. Discuss the research question or main problem discussed in the study.
The main problem this article addresses is that fecal incontinence is common, but effective nursing care to prevent or improve it remains unclear. The author wanted to determine whether nursing care could help prevent fecal incontinence and identify which nursing interventions may be helpful. The review found that nurses can help patients by providing dietary and lifestyle advice, skin care, bowel habit education, and pelvic floor muscle training. These interventions may help prevent fecal incontinence or improve patients' symptoms and quality of life.
How does this research article compare to our practice, policy and/or procedure?
ReplyDelete• Screening and Early Triggers: Does your nursing or clinical assessment explicitly screen FGID patients for early signs of leakage (such as minor stool seepage, staining, or near-accidents)? The research emphasizes treating these early indicators proactively rather than waiting for a full diagnosis of faecal incontinence.
• Interdisciplinary Referral Pathways: Do your procedures include a clear, automated pathway to refer functional bowel patients to specialized Pelvic Floor Physical Therapy or Biofeedback? If your policy relies heavily on medication alone, adding a physical therapy referral pipeline would bridge a common gap.
• Dietary Documentation: Does your current policy support structured tracking, like a shared bowel and food diary? The article highlights fiber optimization and strict avoidance of gut irritants (like artificial sweeteners and caffeine) as primary preventative care.
what are the advantages and disadvantages to the proposed recommendations in the article?
Advantages
• High Safety Profile and Low Risk: Unlike surgical or pharmacological interventions, conservative therapies—such as dietary adjustments, bowel scheduling, and pelvic floor exercises—carry virtually no risk of severe adverse side effects.
• Addresses the Root Functional Cause: Rather than just masking symptoms, therapies like biofeedback and pelvic floor muscle training (PFMT) directly retrain neuromuscular coordination and stool consistency.
• Empowers Patient Autonomy: Using food diaries and establishing predictable bowel habits shifts a significant portion of care into the patient's hands, improving long-term self-management and quality of life.
• Cost-Effective First-Line Care: Behavioral modifications and dietary shifts are low-cost interventions that can drastically reduce the need for expensive medications, medical devices, or invasive procedures down the line.
• Catches Symptoms Early: Focusing on early triggers (like minor stool seepage or staining) prevents the progression to severe FI, protecting skin integrity and reducing psychological distress before it escalates.
Disadvantages
• Requires High Patient Adherence and Cognition: Behavioral training, dietary logging, and daily physical exercises require strict, long-term commitment from the patient. This approach may fail if the patient has cognitive impairments, severe fatigue, or low motivation.
• Delayed Therapeutic Effects: Dietary changes and pelvic floor retraining take time to show measurable results (often several weeks to months). Patients expecting immediate relief may become discouraged and abandon the protocol.
• Resource and Access Constraints: Specialized biofeedback and pelvic floor physical therapy require trained clinicians. These services are often limited by geographic availability, long waitlists, or a lack of health insurance coverage.
• Limited Efficacy for Severe Structural Damage: While highly effective for functional disorders, these recommendations provide limited benefit if the patient has underlying, unrecognized structural damage, such as a severe external anal sphincter tear.
• High Burden of Clinical Staff Time: Teaching bowel retraining, analyzing food diaries, and conducting preventative screenings demand significant time from nursing and therapy staff during outpatient or inpatient visits.