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Palliative care is a specialized form of medical attention provided to people with serious illness. It focuses on providing relief from pain and suffering associated with severe cases. The goal of palliative care is to make life more bearable for the patient and less stressful for the family. Palliative care is a joint effort involving nurses, doctors, social workers, and other specialists. The end of life care offered to patients believed to be in their last days is one of the examples of palliative care. [Click Essay Writer to order your essay]

Problem and Relevance to the Healthcare
Patients receiving palliative care face numerous challenges. Erichsen (2015) states that constipation is one of the problems that affect many patients receiving palliative care. However, due to limited knowledge on assessment, diagnosis, and management of constipation palliative care, providers often overlook it and tend to focus more on nausea, vomiting, shortness of breath, and general pain relief. Constipation is a relevant and important topic because if not checked, it puts the lives of palliative care patients at risk. Similarly, constipation reduces the absorption rate of oral drugs and causes bowel obstruction which increases the risk of oral perforation. All these can lead to sudden death. There is a need for extra research and awareness creation on constipation.[Need an essay writing service? Find help here.]

Investigation of the Problem
Constipation is one of the common forms of suffering that palliative care patients go through. The average prevalence of constipation among patients receiving palliative care is between 32%-87 % (Larkin et al., 2008). Specifically, the prevalence rates are between 23%-65% for cancer patients, 38%-42% for heart disease patients, 34%-35% for AIDS patients, 27%-44% for COPD, and 29%-70 % for ENSRD (Renal Disorder) (Larkin et al., 2008).These prevalence rates depict constipation as a nightmare for most palliative care patients. It is one form of discomfort that they experience at least once in their stay in the palliative care institutions.

Palliative care, being an approach to improve the quality of life of individuals grappling with chronic, life-threatening disorders, seeks to provide relief to all forms of pain. This way, the last days become more bearable. As a form of physical suffering constipation causes restlessness and anxiety in patients under palliative care, which is a risk factor for other conditions such as stroke, depression, and heart disease (Clemens, Faust, Jaspers, & Mikus, 2013).When considering the high constipation prevalence rates and the risk that constipation carries for palliative care patients, failure to put constipation into check compromises the overall mission of palliative care (Clemens et al., 2013).

Current Situation of the Problem
Constipation prevalence rate of 32%-87 % among palliative care patients is one of the leading causes of concern. Unfortunately, due to the scarcity of data and limited knowledge by palliative care nurses regarding its assessment, diagnosis, and management, no standardized approach has been adopted for its management. Larkin et al. (2008) note that its management, on many occasions, is based on the opinion of the healthcare provider.

A considerable number of constipation cases are not addressed since palliative care providers often associate the discomfort emanating from constipation to other types of disorders.   Evidence-based practice recommends that if a patient under palliative care has difficulty passing stool, feels stomach and lower abdominal pain, experiences bloating, or experiences bowel movement less than once in two days, they ought to be examined for constipation (Larkin et al., 2008). However, this does not happen in most palliative care centers due to limited knowledge.

According to Erichsen (2015), the main risk factors for constipation for palliative care patients include decreased fruit and fluid intake, immobility, and opioid medications. The fact that limited data makes its management among palliative care patients heavily reliant on the opinion of the clinician makes it a more serious threat to the lives of palliative care patients. Constipation is thus difficult for healthcare providers to manage. Additional research on this area is necessary.

Current Practice
Most of the palliative care patients receiving care through a hospice are given a “comfort kit” prescription. Larkin et al. (2008) reveal that the kit is meant to help them cope with uncomfortable symptoms of the disease. In the kit, there normally opioid medications intended to help patients deal with pain, vomiting, nausea, anxiety, and shortness of breath. A Dulcolax suppository is also included in the kit to be used to counter constipation. It is to be administered rectally.

Numerous challenges face the administration of this Dulcolax medication. One of them is that there are restrictions imposed on a visiting or hired private caregiver. They are not allowed to administer any medications through the rectal route. The other challenge is that family members and most other caregivers without a background in medicine are mostly not comfortable administering medications through the oral route. This implies that a nurse should be dispatched in case a palliative patient needs to have a suppository medication administered. Delays and extra costs arise and the patient at times has to endure the discomfort for hours (Larkin et al., 2008).

Proposed Solution and Implementation
The most viable prospect solution is to have each patient given a bowel focused comfort kit. This will be an addition to the pain reduction comfort kit they already have. The proposed package should have different oral bowel medications accompanied by instructions on how to use them. The medications should range from mild to strong ones with instructions that patients are to begin with the mild ones and proceed to stronger ones with increases in discomfort. This way, both the patients and the caregivers, regardless of their level of training, would have the ability to treat constipation in case it occurred (Clemens et al., 2013). Oral administration of medication is easier and culturally appropriate. There would be no need to dispatch a nurse to a patient if this kit was made available.

Assuming that the patient does not have any contraindications, the kit would have the following medications. First, there would be a bulk forming laxative medication such as Metamucil, which should be given the priority because it is gentler on the body and the safest option for the patient (Clemens et al., 2013). Second, there would be a stool softener such as Colace which would aid in softening the stool, making it less stressful for the patient to pass. Third, there would be an osmotic laxative such as milk of magnesia which acts by drawing water from the surrounding tissue into the colon. It would be used in case the first and second options fail to work. Lastly, the kit would have an oral stimulant, a good example being Senna. It functions to stimulate the movement of intestinal muscles orally (Clemens et al., 2013).

In case all these options fail, the next step would be to try a rectal suppository such as Dulcolax. It also works to stimulate the movement of intestinal muscles. According to Larkin et al. (2008), incase none of these works, the last option would be either an enema or a digital disimpaction


Justification for the Proposed Solution
There are treatment and management options for a majority of other forms of pain. If there are management options for nausea, vomiting, anxiety, and depression, then there is a need for a treatment option focusing on constipation, which has been identified as a primary cause of discomfort for palliative care patients (Goodman, Low, & Wilkinson, 2005).

Since a large number of calls from palliative care patients are expected to be related to constipation, there is a need for the patients to be issued with the bowel comfort focused kits discussed above. Despite the fact that the company or institution will incur additional costs to provide an extra kit for every patient, the need to have a nurse dispatched every time will be eliminated. The general environment around the patient will be more relaxed. The patient will be in less pain, and the family members will be happier knowing that constipation is not one of the worries their relatives has.

Implementation Resources and Cost-Benefit Analysis
A nurse, pharmacist, or a physician’s assistance will be necessary for the implementation of the proposed solution. They will identify the medications needed and the most appropriate timings. The proposed solution is expected to lead to huge cost savings. According to Wee et al. (2010), it costs approximately $18,033 to treat constipation in a palliative care patient for six months. If the proposed solution is implemented, these costs will fall to less than $2,000 for a six months period.

The recommended current practice is to have a nurse contact the pharmacy, and have them assemble all the medications they need in the kit. The consultation is often a mutual exchange with both the nurse and the pharmacist exchanging ideas on the issue. During the consultation the pharmacist fills a form and later assembles all the medications, which are later sent to the patient with all the instructions. The same procedure should be used in the acquisition of the proposed bowel comfort kit.

Key Stakeholders, Engagement, Feedback, and Partnership
Stakeholders to participate in the process are to include physicians/nurses, family members, and pharmacists. The nurse and physician will be required to conduct an assessment of the patient to evaluate bowel patterns, and assess whether there is a likelihood of allergies and contraindications. Nurses will also play a crucial role in evaluating the effectiveness of the medication and determining whether another action is necessary.

A pharmacist will be required to conduct an assessment of the patient and determine whether the ordered medications are appropriate for the patient based on their medical history and assemble the kit. Family and other caregivers are also stakeholders for they assist the nurse in analyzing changes in bowel movements and at times administering the medication under the instructions of the nurse. Since constipation is one of the leading causes of discomfort for palliative care patients, these stakeholders will most probably opt for this kit, which is a proactive way of dealing with constipation.

Implementation and Evaluation
The implementation would be a multi-stakeholder initiative whose success would be established by comparing the number of palliative care patients in need of an enema, a suppository, or another disimpaction medication process before and after the intervention. In case the recorded number is less, this is an indication that the bowel comfort kits are effective in keeping patients from being impacted by constipation. Larger numbers recorded will indicate that the bowel comfort kits are not efficient, and there is a need for an alternative approach.

How I Played the Role of a Scientist, Detective, and Manager
I played the role of a scientist by adopting the scientific process of problem-solving. When identifying the problem and coming up with a list of solutions and choosing the best from the list, I played the role of a scientist. This process involved critical analyses of the problem, its contributing factors and the best way to deal with these contributing factors.

When gathering data on the current state of the problem, I was acting as a detective. I had to consult with numerous people to find out how they go about this issue as well as their general perception of the problem. Finally, when developing the implementation and evaluation procedure, I was a manager. I had to balance the actions of various stakeholders to ensure that the outcome will be favorable.[“Write my essay for me?” Get help here.]

Clemens, K., Faust, M., Jaspers, B., & Mikus, G. (2013). Pharmacological treatment of constipation in palliative care. Current Opinion in Supportive and Palliative Care7(2), 183-191.

Erichsen, E. (2015). Linköping University, Studies in Health Sciences, Thesis No. 130 Constipation in palliative care: Prevalence, definitions, symptom distress and risk-factors. Linko¨ping: Linko¨ping University Electronic Press.

Goodman, M., Low, J., & Wilkinson, S. (2005). Constipation management in palliative care: A survey of practices in the United Kingdom. Journal of Pain and Symptom Management29(3), 238-244.

Larkin, P., Sykes, N., Centeno, C., Ellershaw, J., Elsner, F., & Eugene, B. et al. (2008). The management of constipation in palliative care: clinical practice recommendations. Palliative Medicine22(7), 796-807.

Wee, B., Adams, A., Thompson, K., Percival, F., Burslem, K., & Jobanputra, M. (2010). How much does it cost a specialist palliative care unit to manage constipation in patients receiving opioid therapy? Journal of Pain and Symptom Management39(4), 644-654.

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By Hanna Robinson

Hanna has won numerous writing awards. She specializes in academic writing, copywriting, business plans and resumes. After graduating from the Comosun College's journalism program, she went on to work at community newspapers throughout Atlantic Canada, before embarking on her freelancing journey.

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