| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 101 === Abstract
Difficulty in defecation is a common problem among patients hospitalized. The purpose of this study was to explore the effects of using a “Bowel Movement Protocol” to alleviate the defecation difficulty of patients with lumbar intervertebral disc herniation after surgery. A quasi-experimental design was adopted and purposive sampling was used to select patients undergoing a discectomy for lumbar intervertebral disc herniation or cage interbody fusion from the neurosurgical ward at a medical center in northern Taiwan. The patients were then divided into a control group and an experimental group according to their time of admission. Patients from the control group (n=34) received routine nursing care, while patients from the experimental group (n=20) received the “Bowel Movement Protocol” intervention every day. The intervention consisted of: 1) 30 cc/kg of water intake per day according to the patient’s weight; 2) minimum dietary fiber intake of 35 g/day; and 3) an abdominal massage 15 minutes after breakfast provided by nurse. The massage consisted of drawing clockwise circles with three fingers closed together from the ascending colon to the transverse colon and then to the descending colon for 15 minutes at a depth of 4.5 cm. A self-developed bowel movement assessment questionnaire was used in this study with the following effectiveness evaluation indicators: 1) frequency of bowel movements; 2) symptoms of difficulty in defecation (including pain during/after bowel movements, extreme use of energy required during bowel movements, hard stools, still feeling the urge to defecate after defecation or a feeling of obstruction in the anorectal area, etc.); and 3) frequency of stool softener and enema use. The period of data collection ran from before the surgery through the first day after the surgery to the day of discharge (the sixth day after the surgery). Statistical methods such as percentage, mean, standard variation, independent t-test, Chi-square test, Fisher’s exact test, and GEE (generalized estimating equation) were used to analyze the data. The research results showed the following: 1) frequency of bowel movements: the daily bowel movement frequency of the experimental group was 10.159 times of that of the control group (p<0.05), and the daily bowel movement frequencies on the second and third day were higher than the first day (p<0.001); 2) with regard to symptoms of difficulty in defecation, patients from the experimental group indicated fewer experiences of anal pain during and after bowel movement, extreme use of energy during bowel movement, and hard stools compared to the control group, indicating a statistical significant difference (p<0.001); and 3) the experimental group used stool softeners and enemas 0.012 (p<0.001) and 0.274 (p<0.05) times as often, respectively, as the control group. Overall, the “Bowel Movement Protocol” can effectively alleviate difficulty in defecation in patients with lumber intervertebral disc herniation after surgery. Hope this non-invasive nursing measures this evidence-based data, clinical nurses can provide improvements in patient defecation difficulties as a reference for .
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