Authors (including presenting author) :
Wong HC(1), Tang LM(1), Mak KN(1), Ng NHY(2)
Affiliation :
(1)Dept. of Palliative Care, Haven of Hope Hospital, Hong Kong, (2)Nursing Services Division, United Christian Hospital, Hong Kong
Introduction :
Constipation can cause significant physical and psychological distress in palliative care (PC) patients. Nursing assessment of constipation by digital rectal examination (DRE) is important in the nursing management of constipation to relieve discomfort of PC patients. Yet, there are insufficient training and limited guidelines of DRE for PC nurses.
Objectives :
(i) To enhance nurses’ knowledge on DRE (ii) To strengthen the DRE skills of nurses (iii) To reduce nurses’ anxiety level in performing DRE (iv) To establish and adopt evidence-based practice (EBP) guideline of providing proper DRE to patients in the PC unit of Haven of Hope Hospital (HHH)
Methodology :
This is a quasi-experimental study with pre- and post-tests study design on PC nurses of HHH(n=20) from January to April, 2024. Three identical 1-hour training sessions supported with a rectal manikin, DRE guideline and procedure checklist, were delivered to the participants. A clinical examination station approach, including educational session, simulation and technique demonstration was adopted. Participants were invited to complete knowledge and self-competency tests before and after the training. The knowledge and self-competency questionnaires were developed and validated by a panel of experts in PC.
Result & Outcome :
Twenty PC nurses were recruited in Haven of Hope Hospital. The outcomes of the study were fourfold:
(i) DRE knowledge of PC nurses has significantly improved after the standardised DRE training(Z=-3.749, p=<0.001, r=0.838).
(ii) DRE skills of PC nurses have significantly enhanced (z=-3.886, p=<0.001, r=0.87).
(iii) 75% PC nurses reduced anxiety level in performing DRE after training with a large effect (z=-3.703, p=0.001, r=0.71).
(iv) Evidence-based practice (EBP) guideline of DRE has been established and implemented in PC ward of HHH.
Conclusions:Promoting standardised training of DRE in clinical examination station approach could be effective in improving nursing competency of assessing constipation conditions in PC patients, by enhancing the knowledge, skills and reducing anxiety of nurses to perform DRE. The present results should be consolidated by recruiting more subjects for analysis in future study.
