Gastroenterology nurse prescribing in China: A Delphi method

AIM

This study aims to identify and reach a consensus among experts on the specific gastroenterology drugs that a gastroenterology nurse may be able to prescribe.

DESIGN

This study employs a modified Delphi design to reach a consensus among medical and nursing experts about the gastroenterology system drugs that nurses may prescribe medication.

METHOD

From August 2019-November 2019, a two-round study, consisting of 26 medical and nursing experts, was conducted using the Delphi method. IBM SPSS Ver. 22 and descriptive statistical software were used to analyse the results of the consultations.

RESULTS

A total of 37 drugs across nine categories are identified as relevant to Chinese nurses working in gastroenterology departments. Among them, four drugs are generally prescribed independently, 24 tend to be prescribed collaboratively and nine are prescribed either independently, or in collaboration with others.

CONCLUSIONS

This list is a fundamental and dependable instrument for identifying the gastroenterology drugs that could possibly be prescribed by gastroenterology nurses in China. The research results have important guiding significance for the formulation and implementation of relevant policies for nurses to prescribe medicines.

IMPACT

Nurse prescribing has become a global trend and is slowly gaining attention in China under the development strategy of 'Healthy China'. As such, this list will give some reference for policy formulation and implementation of future nurse prescribing in mainland China.

Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care: a multi-site retrospective case note review of clinical practice

BACKGROUND

Constipation is a common symptom for patients receiving palliative care. Whilst international clinical guidelines are available on the clinical management of constipation for people with advanced cancer receiving specialist palliative care (SPC), the extent to which the guidelines are implemented in practice is unclear. This study aimed to examine clinical practices for the assessment and management of constipation for patients with advanced cancer within inpatient SPC settings.

METHODS

A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three inpatient SPC units across the United Kingdom between August 2016 and May 2017. The variables selected for review were determined by the recommendations within the clinical guidelines. Descriptive statistics, cross tabulation, chi square, and bivariate correlations were used to examine clinical practices compared to policy guidelines for the assessment and management of constipation. Reporting was structured by the STROBE checklist for observational research (Additional File 2).

RESULTS

A comprehensive assessment, including a full history and performing a physical exam, was recorded for 109 patients (73%), however, no standardised documentation was utilised. Assessment was nurse led, with variable involvement across sites of other members of the multidisciplinary team (MDT). Education on prevention was documented in 30 (20%) case-notes, and 53% recorded evidence of non-pharmacological intervention. Age, gender, and reason for admission did not impact on the likelihood of receiving a comprehensive assessment, education, or non-pharmacological intervention, however, significant differences were evident between sites. Pharmacological management was well developed and aligned to the guidelines however, 33% of patient case-notes recorded no information on the titration of laxatives. Twelve percent of patients experienced partial or complete bowel obstruction, and management strategies were variable.

CONCLUSIONS

Constipation management is driven by a pharmacological approach, with little evidence of the implementation of preventative and non-pharmacological strategies. The nurse plays a key coordinating role in assessment; however, involvement and roles of the wider MDT varies. Accurate recording of care is essential when examining clinical practice and identifying areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to ensure consistency in assessment and implementation of appropriate non-pharmacological/ preventative strategies.

Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature

BACKGROUND

Constipation is an important issue for patients receiving palliative care within specialist palliative care settings. Questions and ambiguity, however, persist about international best practice and management.

AIM

To synthesise the current evidence base on the assessment and management of constipation for palliative care patients within a specialist palliative care setting.

DESIGN

This is a systematic review.

DATA SOURCES

MEDLINE, Embase, CINAHL, Scopus and Cochrane databases were systematically searched in April 2017 for empirical studies, written in English, on the assessment and management of constipation in specialist palliative care settings, published between 2007 and 2017. Two researchers independently reviewed and critically appraised all studies, conducted data extraction, and undertook a thematic analysis.

RESULTS

In total, 13 studies were included in the review comprising randomised trials ( n = 3), observational ( n = 4) and descriptive studies ( n = 6). Most research was conducted in specialist palliative care units, targeting either healthcare professionals or patients. The analysis highlighted a lack of standard definition of constipation, raising questions on the existence and comparability of baseline prevalence figures, the physical and psychological impact on patients, resource impact on staff and service, the subjective and objective methods of assessing constipation, and key aspects of constipation management, including a lack of focus on non-pharmacological management in this setting.

CONCLUSION

The results of this review are being used to inform the development of an educational intervention targeting healthcare professionals. Gaps in the evidence base include lack of consistent definition of constipation, constipation prevention, non-pharmacological management, and the consideration of the management of constipation for the dying patient.

Bowel movement: the sixth vital sign

Bowel movements provide vital information on how the body is functioning, and constipation among older adults is especially problematic. Although we do not like hearing the details of someone else's bowel movement, it is a function that nurses need to assess, support, and treat with the same attitude as when caring for patients with pain.

Constipation in palliative care: treatment options and considerations for individual patient management

Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a very distressing stage of life not only for the patient but also for their caregivers. It is during this time that, too often, the complexity of managing the condition moves the locus of control away from the patient toward the health professionals. This article considers a number of different treatment options and facets of individual management that may enable patients to move the locus of control back to a position of joint management by patients, caregivers, and health professionals.