Mechanical Bowel Preparation - Essay Example

CHAPTER ONE: INTRODUCTION Background of the Study The traditional technique of mechanical bowel preparation has been found to have been used for so many years (Gordon and Nivatvongs, 1999). According to several scholars who have written regarding the topic - Gordon and Nivatvongs (1999); Colwell, Goldberg and Carmel (2004), Delaini and Nicholls (2005), Kumar and Bellamy (2006), Guenaga, Matos and Willie-Jorgensen (2009) - its method usually involves a three day regimen that consists of a low-residue or clear liquid diet that are combined with purgation through the use of laxatives and enemas. It was then through the use of this conventional method of mechanical bowel preparation that the said authors found its capacity to provide satisfactory cleansing in about seventy percent of patients. Aside from this, researchers has also noted that the importance of mechanical bowel preparation can be seen in terms of its ability to reduce the amount of bacteria, thus helping patients in avoiding infection during surgery (Colwell, Goldberg and Carmel, 2004; Guenaga, Matos and Willie-Jorgensen, 2009). Furthermore, they also believe that this method could also allow the performance of other surgical methods when necessary (Colwell, Goldberg and Carmel, 2004). Kumar and Bellamy (2006) also noted of the different benefits that patients may gain through their cooperation in processes relating to mechanical bowel preparation. These authors believe that it is through this that postoperative morbidity related to septic bowel content can be efficiently reduced (Kumar and Bellamy, 2006). In fact, they note that this process has always been associated with decreased morbidity and mortality of patients who have undergone operations of the colon, Kumar and Bellamy (2006) discussed. However, this method tends to face several challenges to its proper implementation such as the inability of the patients to comply (Gordon and Nivatvongs, 1999). The failure of patients to comply are brought about by four causes: first, the tendency of this method to exhaust them due to the fact that it diminishes their nutritional state before the operation due to restricted intake of calories; second, the method's association with high rates of abdominal pain and fatigue; third, it causes electrolyte disturbance which may in turn, cause the dehydration of the patients; and lastly, the regimen associated with mechanical bowel preparation tends to be time-consuming and expensive (Gordon and Nivatvongs, 1999; Platell and Hall, 2007; Pena-Soria). It is then because of the abovementioned that Colwell, Goldberg and Carmel (2004) noted that the use of mechanical bowel preparation has always been faced with controversies. In fact, many debates have arisen in relation to the topic on whether or not mechanical bowel preparation must still be performed for patients undergoing surgeries (Kumar and Bellemy, 2006). Hence, a number of health care institutions have stopped requiring patients to undergo the said method due to the publication of several researches that have reiterated the safety of surgeries even without the said method. Nonetheless, Colwell, Goldberg and Carmel (2004) noted that it has remained the standard of care in the Northern American region. The continuous use of the mechanical bowel preparation method, despite the challenges it poses to the patients receiving it has then raised issues with regard to the capacity of nurses and other members of healthcare institutions to carry the said procedures. This research then seeks to contribute to the existing body of research by looking into the roles played by health care professionals in order to ensure the proper observance of methods related to mechanical bowel preparation. Objectives of the Study The main objective of this study is to explore and account for the nurses' experiences in caring for patients who are undergoing procedures related to mechanical bowel preparation. This objective can be achieved through a careful examination of their views, knowledge and perspectives on their practice concerning the care of the patients. Aside from this, the research also aims to establish an understanding among trained nurses on the practice of mechanical bowel preparation in elective colorectal surgical patients. Furthermore, the researcher also aims to attain the following objectives: 1. To address the topic or issue concerning the perspective of the nurses in performing procedures concerning mechanical bowel preparation for the researcher has not been able to find any research relating to this; and 2. To contribute to the field of medicine by proposing on how it could come up with standardised policies that are related to the application of mechanical bowel preparation procedures. Problem Statement Mechanical bowel preparation, as earlier established, has been considered to be of vital importance in terms of reducing the patients' chances in acquiring infections caused by bacteria after surgery because of the fact that they are cleansed through procedure that basically makes use of a cleansing diet. Aside from this, previous researches have also shown that mechanical bowel preparation have also reduced the number of morbidity and mortality rates amongst patients who have undergone surgeries, especially those that are colorectal in nature. However, due to the process involved in the said procedures of mechanical bowel preparation, it has been perceived to bring about negative effects to patients who more or less affect their nutritional state and lessen their electrolytes. Because of this then, many health institutions have ceased in applying the procedures of mechanical bowel preparation in order to lessen these effects. In the same manner, these institutions have also argued that colorectal surgery can be performed safely even without the patient undergoing mechanical bowel preparation. Nonetheless, the practice of mechanical bowel preparation is still continued. As a result, the researcher then looks into the practices of nurses and other members of the health staff with regard to ensuring the proper care of patients who are undergoing the method. Furthermore, the researcher, as previously stated also aimed to measure the knowledge of the nurses and other health care professionals regarding the negative effect of the process to the patients and what they do in order to minimize such effects. It is then in relation with this that the following research questions shall also be answered by this research: Research Questions 1. Do nurses have the knowledge necessary to provide patients with the best care when receiving mechanical bowel preparation (MBP)' 2. Do nurses know what effect mechanical bowel preparation have on patients who undergo elective colorectal surgery' Hypotheses It in line with the research questions previously mentioned that the researcher also aims to either prove or disprove the following hypotheses: Hypothesis 1. Null Hypothesis (H0): Nurses do not have the knowledge necessary to provide patients with the best care when receiving mechanical bowel preparation (MBP). Alternative Hypothesis (H1): Nurses have the knowledge necessary to provide patients with the best care when receiving mechanical bowel preparation (MBP). Hypothesis 2. Null Hypothesis (H0): Nurses do not know what effect mechanical bowel preparation has on patients who undergo elective colorectal surgery. Alternative Hypothesis (H1): Nurses know what effect mechanical bowel preparation has on patients who undergo elective colorectal surgery. Significance of the Study Previously mentioned was the tendency of institutions of health to continue their practice of mechanical bowel preparation despite the negative effects it has on the patients. Apparently, the continuance of such practice is brought about by the fact that this procedure can lessen the chances of patients from acquiring infection from bacteria. In the same manner, this continuance is also brought about by capacity of the process to reduce the rates of morbidity and mortality after surgery related to the said bacterial causes. Because of this then, this research has deemed it imperative to look into the role of the nurses in making sure that they undertake significant steps in order to ensure the safety of their patients. It is also the goal of this research to come up with suggestions in order to facilitate the development of a standardised policy relating to the performance of procedures concerning mechanical bowel preparation in order to reduce its negative effects on the patients. Hence, without a doubt, the significance of this research lies on its ability to come up with safety measures necessary to reduce the risks that patients may receive from mechanical bowel preparation. Furthermore, its significance also lies on its ability to determine whether or not the process of mechanical bowel preparation is really necessary for patients undergoing colorectal surgery. Scope and Limitations This study shall cover the organisation where the researcher is a member. Generally, the study will only focus on the processes related to mechanical bowel preparation and the methods observed by the health care professionals in order to ensure that the risks that patients may receive from such is reduced, if not eliminated. This study then is limited only to the practices within the United Kingdom, more specifically, those that belong to the said organization. Moreover, the questionnaire shall also be carried out only amongst one hundred nurses (100). Furthermore, the study would also be confined only to mechanical bowel preparation amongst patients of elective colorectal surgery. Methodology Overview This section of the introductory chapter, as its title implies provides an overview of the methodology that the researcher shall use in gathering pertinent information needed for this research. Note that this is only an overview and all the details pertaining to the said topic shall be thoroughly discussed in the third chapter (Methodology). This research is quantitative in nature. It would specifically be conducted within the positive paradigm. In doing so, the researcher shall make use of statistics in order to determine the relationships amongst variables in order to produce valid and reliable conclusions regarding the issue at hand. The main tool for data collection will be the questionnaire method. It is in line with this then that a descriptive survey will be developed for distribution to one hundred nurses within the organization of the researcher. The questionnaire will be basically divided into three parts; these are the following: (1) Part A that seeks to examine the theoretical knowledge behind mechanical bowel preparation; (2) Part B that aims to asks the nurses their professional opinion about the value of using mechanical bowel preparation in elective colorectal surgical patients; and lastly, (3) Part C which asks the nurses to report the impact and feedback they receive from their patients who have or are receiving mechanical bowel preparation. The sampling shall be carried out using the purposive technique which means that the selection of respondents shall carefully abide to the inclusion criteria which the researcher shall develop. Despite being quantitative in nature, the researcher shall make use of the review of existing literature in the discussion of the participants' responses to items included within the survey questionnaire. Hence, the analysis of data entails the comparison between the results obtained with the findings of previous studies reviewed by the researcher. Aside from this, the researcher shall also make use of the Statistical Package for the Social Sciences or SPSS in order to effectively summarize and analyze those responses coming from the survey questionnaires, as provided by the respondents of the study. Operational Definition of Terms This section is then devoted to the discussion of terms that shall often be used throughout the entire study. Mechanical Bowel Preparation- Mechanical Bowel Preparation or MBP refers to a three day regimen that consists of a low- residue or clear liquid diet that are combined with purgation through the use of laxatives and enemas (Gordon and Nivatvongs, 1999; Colwell, Goldberg and Carmel, 2004; Delaini and Nicholls, 2005; Kumar and Bellamy, 2006; Guenaga, Matos and Willie-Jorgensen, 2009). Mangiante, Castelli and Feil (2005) noted that this particular concept is founded on three rules, namely: (1) absolute starvation especially of fibre, (2) antibiotic prophylaxis; and (3) enemas or laxative drugs. Colorectal Surgery - Colorectal surgery refers to the medical practice of repairing the damage to the colon, rectum and anus through the use of different procedures that may have a little or great long-term consequence to the patient. At times, it also involves surgery to the pelvic floor in order to repair hernias (Encyclopaedia of Surgery: A Guide for Patients and Caregivers, 2009). Organization of the Study The study is divided into six chapters, namely: (1) Introduction, (2) Literature Review; (3) Methodology; (4) Results; (5) Discussions; and (6) Summary, Conclusions and Recommendations. Chapter One, contains introductory information regarding the study covering its background, the objectives of the research, the problems and questions it aims to answer; the hypotheses it aims to prove and/or disprove; the significance of the research; its scope and limitations; an overview of the methodology; the definition of terms, and the organization of the study. Chapter Two, on the other hand, discusses the review of literature conducted by the researcher to gain a background of the topic. Chapter Three then provides an in depth discussion of this research's design, the methods to be used, sampling techniques and procedures of data analysis. Chapter Four presents the results obtained by the researcher through a descriptive report and the presentation of charts and graphs. Chapter Five discusses the results obtained by comparing it in relation to the literature reviewed by the researcher. Lastly, Chapter Six summarizes the study, provides the answers to the research questions, and finally, recommends steps that may be undertaken by future scholars who wish to undertake a study with regard to the topic at hand. Read More