Authors (including presenting author) :
Fan WK (1)
Affiliation :
(1) Haematology and Oncology, Hong Kong Children's Hospital
Introduction :
Constipation is the third most frequent symptom in palliative medicine with many impacts. It is not a normal physiological phenomenon, but mostly treatment-induced side effects such as use of opioids and certain chemotherapy (vincristine, carboplatin) or antiemetic, patient inactivity due to fatigue and poor oral intake. Treatment-induced constipation could be severe and jeopardize their health and quality of life, financial burden to family and increase the medical cost of the healthcare system. In viewing data from the pharmacy Clinical Data Analysis & Reporting System of Hong Kong Children Hospital (HKCH) within the period of July 2021-December 2021, six hundred and five prescriptions of laxatives were found among one thousand one hundred seventy-seven inpatient admission.
Nevertheless, it is often unrecognized and untreated by healthcare providers. Patients rely on laxatives as the only method for resolving the condition, neither nursing guidelines nor standardized education material are available. No measurement tool applied for assessing the severity of the constipation or the degree of quality of life of patients being impaired. Role of oncology nurse including assessment, providing intervention, developing education program for promoting wellbeing of patients and symptoms control to maintain quality of life. There is a practice gap and room for quality improvement from a nursing perspective. Standardized training should be provided for staff and proactive symptom management by patients could be promoted.
This program could help paediatric oncology nurse to handle patient with complex health conditions by providing case management, plan and implement diagnostic strategies and providing proper individualized nursing interventions; assess and adjust plans for continuous management of patient’s health status; and monitors patients for follow-up. Besides, it also advocates and empowers paediatric oncologic patients to participate in symptoms management actively. A therapeutic relationship could be established through communication and education talk, quality of life of patients could be enhanced and nursing quality could be upheld by evaluating the effectiveness of the nursing management.
Objectives :
(1) Encourage standardized assessment of patients’ conditions.
(2) To improve quality of life of paediatric oncology patients.
(3) Provide systematic training to nursing colleagues.
(4) Promote evidence-based practice to patients.
(5) Perform standardized patient education.
Methodology :
A comprehensive literature review was conducted, and five international guidelines have been reviewed to gather the latest evidence-based practice for identifying different directions of management by current oncologist experts. Donabedian model was used as the project framework and separated into two parts: nurse training workshop and patient education. This model includes three phrases which could recognize factors that may affect provision of care and for evaluation of quality of care.
Phrase one is 'structure’, which refers to the requirement of the organization to provide quality care such as resources and qualification of the providers. Staff training workshops include a training PowerPoint and interactive demonstration session. Training will include cause and risk factors of treatment-induced constipation, patient assessment content and screening tool, pharmacological and non-pharmacological interventions. Pretest and posttest are the same questions and will be arranged for evaluation of the knowledge perceived. Besides, the ward physical environment and the equipment such as number of bedpans will be counted.
Phase two is ‘Process’. which refers to the activity or care delivered to patients. There will be an admission screening for participant recruitment by convenience sampling with inclusion and exclusion criteria. The age of participants needs to be seven to eighteen years of age. The setting of age range is based on Piaget’s theory of cognitive development. Afterwards, pre-education knowledge assessment, Constipation Severity Instrument (CSI) and Patient Assessment of Constipation Quality of Life (PAC QOL) questionnaires were provided for initial assessment. An educational talk with a booklet will be provided. Content of the booklet will include causes of constipation, introduction of laxative, non-pharmacological interventions, suggestions on developing healthy bowel habits. The education talk will include some interactive activities including demonstration and return demonstration of abdominal massage and toilet positions for raising participants’ interest. A three dimensions print model of standardized assessment tool Bristol Stool Scale was used as training material to intensify audience memory and make the training become more interesting. Midterm follow up will be provided to check the compliance of participants.
Phase three is ‘Outcome’, which refers to the result of quality care like satisfaction and health status. After the education talk, post assessment will be adopted to examine participants' knowledge. Besides, CSI and PAC QOL will be repeated four weeks later for reassessment. Two program evaluation forms are designed for nursing colleagues and participants, respectively.
Result & Outcome :
The project was carried out from May-August 2022, a total of sixteen nursing staff and eight patients had joined the program, excluding pilot study for verifying the understanding of the material.
Ward physical environment and equipment were satisfactory. There was enough room and curtains to provide privacy for bowel open. The equipment includes bedpan and number of toilets were enough to fulfill the needs of patients.
Pre- and post-training knowledge assessment tests have been done for both nursing staff and patients. The average correct marks of knowledge assessment for nursing staff increased from 6.13±0.96 (pre-training workshop) out of 10 to all correct in the post-training assessment with 63% improvement. The average correct marks of patient knowledge assessment increase from 6.5±0.93 (pre-education talk) out of 10 to 9.75±0.46 (post-education talk) correct with 50% improvement.
Constipation Severity Instrument (CSI) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires have been used for assessing patients condition before and after education. The constipation severity of participants is less severe (Pre-score: 38.8/73; Post score: 20/73) and expresses a better quality of life (Pre-score: 51.8/112; Post score: 26.8/112) after 4 weeks of lifestyle modification and engaged in health care activities.
The program with positive feedback from both nursing colleagues and patients. All nursing colleagues were satisfied with the systematic training program and material. They showed understanding of the nursing role and have confidence in providing nursing care associated with constipation afterwards.
It was noticed that as the knowledge of patient participants was enriched, they were able to undergo self-care and self-management. Their constipation severity could be alleviated and thus result in a better quality of life. Patients are empowered for proactive symptom management, their knowledge, attitude, and practice have changed positively.
