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Introduction
Bowel elimination is a basic human need. It is a normal physiological process and supports the daily function of the human body. It is broadly defined as the passage and excretion of waste products that were previously ingested and assimilated by the body. The control of the bowel function is of great concern to people because of the physiologic comfort it creates and the impact on socio-psychological well-being.
Patterns of elimination vary according to the experiences a person encounters throughout his lifespan. Different factors contribute to the ease or difficulty of elimination, some examples point to aging, hormonal changes, stress, change in diet, lack of activities, disease processes, medications, trauma including surgery, and treatment modalities such as chemotherapy and radiation. The adverse reaction to good bowel control results in constipation or diarrhea. For the purpose of this study, constipation will be the main topic to be examined.
Main body
Constipation pertains to the difficulty in the passage of the bowel during the physiological process of elimination. Individuals experiencing constipation generally eliminate their bowel for only a couple of times in a week. In addition, these individuals have to strain in order to succeed in elimination, and they also feel nauseated due to the containment of waste materials within their bodies.
It is not an exaggeration of fact that the normal adult population in America is affected by this perennial problem as previous studies seem to have documented that in non-oncology populations, constipation has remained one of the most common digestive problems in the United States. Martin and colleagues (2006) argued that constipation problems were the primary reason for approximately 2.7 million ambulatory care visits annually and about 55% of costs incurred from inpatient hospitalizations.
Constipation has remained a common problem and major source of both psychological and emotional distress for the post-operative oncology patient population. Statistically, although the exact incidence of constipation in this population is not known, It has been estimated that majority population is troubled with constipation, especially those individuals who are receiving or using opioids (Smith, 2001).
The purpose of this study is to provide data on the actual effectiveness of prune juice in combination therapy with Senna-S for post operative craniotomy patients against those only using Senna-S alone. The specific aim of this investigation is to enhance comfort through appropriate anticipatory guidance and symptom management of patients with bowel elimination problems. There is significant information available in the literature for the prevention and management of constipation in patients with cancer using Senna-S or other combination of laxative-stimulant preparations. However, prune juice is not recognized as an important constituent for bowel management. Therefore, this study aims to provide a means for demonstrating a change in the patient’s outcome and application of nursing intervention through the use of prune juice as a recombinant bowel management to post operative craniotomy patients. The assumption of this research is that the addition of prune juice to a well-documented laxative-stimulant bowel program is a better and more effective regimen in preventing and resolving constipation.
Abdellah (1994) presented a Practice Model, which identifies nurses as problem-solvers and major evaluators of patients’ conditions. The model is based on nursing concepts that covered the major needs, social relationships and basic care of a patient. The model thus is an instrument that assesses experiences, as well as reviews the capabilities of a nurse with regards to providing care to a patient (Tomey and Alligood, 2004). This problem-solving model is thus based on assumptions that reflect both nursing and behavioral science in a perspective manner. The theoretical statements derived from the model provide a basis for investigation on specific patient needs. From the 21 typology of nursing problems, 7 areas were identified which directly relate to the study and are associated to the topic of constipation and the use of a specific bowel regimen.
Nurses play a major role in the assessment and management of constipation. Nurses clinically experienced that post operative craniotomy patients respond to bowel program after drinking prune juice and hot liquids. However, a review of current literature shows that there is no published scientific evidence to support these claims. Since this has not been investigated in the research setting, this nursing research study attempts to proceed towards that particular direction of conducting an evidence-based investigation. It is important to prove in the research that the standards of practice need to be corrected so that prune juice can be recognized as an important component in bowel management.
The most common bowel regimen used to prevent and treat constipation among post operative patients is the intake of a laxative stimulant such as Senna-S. For the purpose of this study, Senna-S will be identified and used to represent laxative-stimulants in general.
Senna is an herb that has been used in several cultures, from Africa, Middle East and India and its use dates back to centuries of history. The active purgative action of Senna was first documented in 1866. Senna contains anthraquinone, which causes intestinal contractions by interacting with the bacteria in the digestive tract making soft, easily-passable stool possible.
The literature and documents on the benefits of Senna can be widely read and has been used in several researches proving its strength as the major bowel regimen for non-hospitalized and hospital-related constipation issues. The science on the use of Senna is extensive compared to that of prune juice.
Prune juice is made from the extracts of plums which were dried and distilled and present as a deep dark purple elixir. It is a natural anti-oxidant, wherein the phenols and beta carotene in prune juice help block oxygen-based free radicals from damaging cells in the body. It is also known to be rich in potassium and iron and low in sodium content. A fact that is often overlooked is that prune juice also contributes in normalizing blood sugar levels by helping in insulin production. Although prune juice has number of beneficial vitamins and minerals, it is most famous for its high fiber-based laxative properties.
Conclusion
Currently, it is widely encouraged to add warm prune juice before a big meal in combination with the use of Senna to facilitate ease in elimination and prevent constipation, but there is scarcity if not absence of literature to support this action. There is no real data that presents the effectiveness of the combined use of Senna-S and prune juice against that of Senna alone. This leads to the identification of the research problem, to present a initial measure or quantitative results on the effectiveness of prune juice with Senna-S in re-facilitating defecation to post operative craniotomy patients against those who will take Senna-S alone.
At the end of this study, it is assumed that the use of prune juice in combination with Senna-S will result in having a larger margin of patients having a bowel movement post craniotomy procedure against the group of patients who received Senna-S only as a post-operative bowel regimen.
References
Abdellah FG, Beland II, Martin A and Matheney RV (1960): Patient-centered approaches in nursing. New York: Macmillan.
Abdellah FG and Levine E (1994): Preparing nursing research in the 21st century: Evolution, methodologies, challenges. New York: Springer.
Halterman TD, Dycus, DK, McClure EA, Schmeiser DN, Taggart FM and Yancey R (1998): Faye Glenn Abdellah: Twenty-one nursing problems. In: Tomey AM and Alligood MR (eds.). Nursing theorists and their work (4th ed.). St. Louis: Mosby.
Smith MR (2001): Causes of Constipation on Patients with Cancer. Clin. J. Oncol. Nurs. 12(2):317-323.
Murdaugh CL and Parsons MA (2002): Health Promotion in Nursing Practice. New Jersey: Prentice Hall.
Polit DF and Beck CT (2004): Nursing research: Principles and Methods (7th ed.). New York: Lippincott.
Pender NJ (1975): A conceptual model for preventive health behavior. Nursing Outlook, 23:385-390
Tomey AM and Alligood MR (2006): Nursing Theorists and Their Work (6th ed). Philadelphia: Mosby.
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