Even before GI nursing, there was the dreaded "fecal impaction" on the med-surg floor. Perhaps one of my most memorable nursing functions had to do with removing an impaction. Since that time, however, I have given little thought to this less than desirable task, as the GI nurse in an endoscopy unit seldom encounters this. But the nurse on the GI floor, or the nurse on a general floor with a patient who has a severe problem with "constipation" or "obstipation," is far too familiar with this diagnosis. Even though removing an impaction is not an independent nursing function due to the potential dangers involved, a physician's order to remove the impaction (generally these could be felt within reach of the finger tips) is usually not difficult to obtain.
As we consider researched-based nursing care, this research article presents some interesting information regarding constipation/impaction. It adds insight to the concept of fecal impaction versus constipation as a nursing diagnosis. It also gives us an opportunity to learn more about another form of research, the literature review.
Creason, N., & Sparks, D. (2000). Fecal impaction: A review. Nursing Diagnosis, 11(1), 15-22.
Background
The purpose of this study was to review the definition, diagnosis, causes, signs and symptoms, and treatment of fecal impaction. The authors have done an extensive literature review of constipation versus impaction. Not only are the definitions unclear, the signs and symptoms and treatments are also unclear. The authors point out the fact that research-based treatment of fecal impaction is very limited and nonresearched treatment varies. The focus of the article was to review the literature related to this concept.
Methods and Results
An extensive literature review was done to find out what research was available on the topic. The Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was accessed on line and databases from 1982 through 1992 were reviewed in several steps. Use of the terms 'feces,' 'fecal impaction,' and 'impacted' yielded limited articles. The Medical Literature Analysis and Retrieval (MEDLINE) database was assessed using Ovid search software for databases from 1966 through 1998. Again, through a series of steps, the researchers noted that only three research articles and 20 case studies were found. The original intent was to only review research on fecal impaction, but due to the lack of such research, a more general study had to be done. Many of the articles were reviews and case studies. These findings indicated that a lack of clear definition and lack of a system of reporting findings made the true incidence of impaction more difficult to diagnose.
There is a definite need for additional research related to fecal impaction. Definitions, signs and symptoms, and treatments all need to be researched to validate diagnosis and treatment outcomes. A careful review of the literature and research on this topic improves understanding of the diagnosis and our ability to provide appropriate care to our clients.
Discussion
Literature review as a form of research inquiry provides an initial opportunity for those who want to conduct research, but feel the entire process is too complicated. A simple review of the literature lends itself to a great opportunity to research the literature, potentially validating the need for further research. Often, a review of the literature yields interesting and surprising information. While not being an actual research experiment, an extensive review of the current research and the available literature on a given subject adds to the body of knowledge for evidence based nursing care delivery. I recommend this article for information on fecal impaction as well as a useful example of how to do a literature review.