Effects of a clinical nursing practice guideline for caring of older people with the spinal cord injury having neurogenic bowel dysfunction

Abstract

This quasi-experimental research with two group pretest-posttest design aimed to examine effects of a clinical nursing practice guideline (CNPG) for caring of older people with spinal cord injury having neurogenic bowel dysfunction. Sample was 38 people, recruited by using consecutive sampling and then divided, according to time period, into either the control group or the experimental group, 19 people for each group.

Research instruments consisted of:1) instruments for screening the study sample, including the neurogenic bowel dysfunction score (NBDS) scale, Thai version; the 2-question Depression Screening Test (Patient Health Questionnaire (PHQ)-2: 2Q); the 9-question Depression Scale (PHQ- 9Q: 9Q); and the 6-Item Cognitive Impairment Test (6CIT), Thai version; 2) Instruments for research conduction: the CNPG for caring of older people with spinal cord injury with neurogenic bowel dysfunction, which was developed by the researchers; 3) Instruments for data collection, comprising of a demographic, health, illness and physical examination data record form; the NBDS Scale;  and the Spinal Cord Injury–Quality of Life (SCI–QOL) Scale (Tulsky et al., 2015), Thai version. Instrument quality was verified by five experts. Improvement of the tools according to the experts' suggestions was done before using them in the study. Verification tests of 1) the CNPG; 2) the demographic, health, illness and physical examination data record form; and 3) the SCI–QOL Scale obtained Content Validity Index (CVI) of 0.86, 0.90, and 0.96, respectively. Reliability test of the SCI–QOL Scale indicated Cronbach's Alpha Coefficient of 0.96.

Comparison of demographic, health, illness and physical examination data between the experimental group and the control group, was analyzed using chi-square and fisher's exact test, and revealed no difference (p>0.05); except the main methods of defecation and defecation care procedures in the past four weeks, regarding normal defecation (p.=038), forceful defecation (p.=046); and fiber intake in the past 3 days (p=.049). Comparing outcomes between the control groups was carried out using independent t-test and the Mann-Whitney U test. Comparison of the outcomes within groups was analyzed using the paired t-test and the Wilcoxon signed rank test.

The results indicated that the developed CNPG did not affect the NBDS score, but had a positive effect on the SCI–QOL scores of spinal cord injury patients with difficulty managing bowel problems. After the experiment, SCI–QOL scores of the experimental group was significantly better than that of the control group (p=.003). The difference in SCI–QOL scores in the experimental group was significantly higher than that of the control group (p=.002). The CNPG should be, therefore, applied in provision of care to promote quality of life for older people with spinal cord injuries suffering bowel problems. Further studies should be carried out with larger sample size to examine its effectiveness.