Supporting patients in reducing postoperative constipation: fundamental nursing care - a quasi-experimental study.

Background: The prevalence of constipation in the general population is 2-28%. Patients with constipation report symptoms of abdominal pain, bloating, nausea, straining to defecate and general discomfort. Strategies for preventing constipation include laxatives, exercise and increased fluid and fibre intake, but life style adjustments, such as exercise, eating more fibres and drinking more fluids, were not considered a solution by older patients. Previous studies have shown that actively involving patients through individualised care and support increases patients' outcome.

Aim: To test the efficacy of a nursing intervention based on active patient involvement including individualised nursing care plans and daily dialogues for patients with hip fractures in preventing constipation after surgery.

Methods: A quasi-experimental design was applied. Inclusion criteria hip fracture needing surgery, understand Danish. Exclusion criteria dementia, gastrointestinal disease. A total of 186 patients were included and 155 completed. An admission interview including Constipation Risk Assessment Scale was undertaken. On that basis an individualised nursing care plan was made. At admission, discharge and 30 days after surgery constipation, intake of fibres and fluid were measured. The Bristol Stool Scale and Rasmussen's scale were used to measure constipation. Patients in the control group received standard care of the ward.

Results: After 30 days constipation rates for patients in the intervention group were significantly lower than for patients in the control group (p = 0.042). The fibre intakes and fluid intakes were significantly higher in the intervention group (p ≤ 0.001). The effect of liquid intake was statistically significant (OR = 1.1, 95% CI: 1.0-1.2). Likewise, the effect of fibre intake was statistically significant; the odds of constipation decreased with increasing fibre intake (OR = 0.4, 95% CI: 0.2-0.8).

Conclusion: Patients with hip fractures that were actively involved in their own care in preventing constipation were significantly less constipated 30 days after surgery than control patients. Increases in fluid and fibre intakes had significant effects on reducing the risk of developing constipation.