D031: Evidence-Based Innovation Plan for Constipation Management in Hospice Care

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Western Governors University 

D031 Advancing Evidence-Based Innovation in Nursing Practice

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Date

D031: Evidence-Based Innovation Plan for Constipation Management in Hospice Care

Management of Constipation in Hospice and Palliative Care Patients

Nurses play a vital role in shaping patient outcomes, satisfaction, and the overall quality of care in all healthcare settings. Consistent, competent, and responsive nursing care has a direct positive impact on symptom control, patient trust, and quality of life. Therefore, nurses—whether staff, leaders, or advanced practitioners—have an ethical and professional responsibility to engage in evidence-based innovation. Frameworks like the Stetler Model and the Iowa Model help nurses systematically identify clinical issues, evaluate evidence, and implement sustainable changes in practice (Polit & Beck, 2019).

In hospice and palliative care, nursing innovation is especially critical. Hospice nurses prioritize comfort, symptom relief, and dignity for patients at the end of life. Many patients enter hospice with chronic symptoms that have been poorly managed, often due to fragmented care, inadequate education for patients and caregivers, and lack of standardized clinical protocols. Constipation is among the most common and distressing symptoms in this population, worsening pain, nausea, anxiety, and overall discomfort.

The Centers for Medicare & Medicaid Services (CMS) evaluates hospice performance using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. This survey includes family and patient feedback on symptom management, such as bowel care (Parast et al., 2021). Data indicate that constipation management continues to be a quality concern, highlighting opportunities for disruptive innovations focusing on early identification, prevention, and ongoing symptom monitoring to enhance patient comfort and meet regulatory standards.

Constipation as a Clinical Problem in Hospice and Palliative Care

What is the prevalence of constipation among hospice and palliative care patients, and why is it often overlooked?

Constipation affects a large number of hospice and palliative care patients. Studies reveal that about 40% of patients report constipation at their initial palliative care assessment, with prevalence rising to nearly two-thirds in specialized settings (McIlfatrick et al., 2019). Despite its frequency, constipation is often underrecognized due to inconsistent assessment methods, poor documentation, and competing priorities in end-of-life care.

How does inconsistent assessment hinder symptom management?

Irregular bowel assessments impede effective symptom control. McIlfatrick et al. (2019) found significant variability in how nurses evaluate bowel function, record results, and initiate treatments. Pharmacological and nonpharmacological interventions are frequently delayed or skipped, causing extended patient suffering and lowered quality of life. Without standardized assessment tools, early signs of constipation are missed, leading to reactive rather than proactive care.

A consistent bowel assessment tool integrated into electronic health records, supported by digital tracking and evidence-based treatment guidelines, would facilitate early intervention. This aligns with hospice principles of comfort, dignity, and patient-centered care while enabling caregivers to participate in symptom monitoring.

Existing Disruptive Innovations Supporting Symptom Management

Healthcare innovations increasingly rely on technology to enhance safety, efficiency, and quality. For example, electronic medication administration records (eMAR) reduce medication errors, improve documentation accuracy, and facilitate real-time communication across care teams (Covetus Technologies Pvt Ltd., 2020). In hospice, eMAR supports prompt initiation and adjustment of bowel regimens, promoting continuity and accountability.

Telehealth has emerged as a powerful tool in various clinical areas, including mental health, nutrition, dermatology, and chronic disease management (Siwicki, 2021). During the COVID-19 pandemic, telehealth maintained care continuity while minimizing infection risks. In hospice, virtual platforms allow symptom assessment, caregiver education, and care plan updates without in-person visits, thus improving access and responsiveness.

Nurse Innovator Role in Hospice Care

How can nurses drive innovation within hospice settings?

Nursing innovation starts with recognizing gaps in practice and the courage to challenge ineffective procedures. Nurses innovate daily through clinical judgment, problem-solving, and adapting to patient needs. Advanced practice nurses and nurse scientists integrate research, clinical expertise, and organizational goals to lead improvements in care delivery (Johnson & Johnson, n.d.).

In hospice, advanced nurses design and assess standardized bowel assessment tools, embed treatment protocols in eMAR systems, and analyze outcomes. Evidence shows that nursing-led innovations enhance patient results, staff efficiency, and organizational performance (Kirby et al., 2007).

Using Big Data for Innovation

Big data involves analyzing large datasets to identify patterns and guide clinical and administrative decisions. In healthcare, it supports quality improvement, population health management, and policy development. Hospice organizations can use data from electronic health records, medication logs, and patient-reported outcomes to track constipation prevalence, treatment effectiveness, and satisfaction.

Ethical data use requires informed consent, strong governance, and privacy compliance (Leon-Sanz, 2019).

Ethical Use of Big Data

Ethical principles are fundamental in healthcare innovation. The American Nurses Association Code of Ethics mandates nurses to advance practice while safeguarding patient privacy, autonomy, and rights (ANA, 2017). Though big data can illuminate disease trends and disparities, transparency must never compromise confidentiality.

By following ethical frameworks and regulations, nurses can responsibly use data to design patient-focused innovations that improve symptom control and maintain trust (Howe III & Elenberg, 2020).

Using New Technology for Innovation

Health information technologies such as eMAR, patient portals, and telemedicine have significantly enhanced patient safety and care coordination. These tools reduce medication errors, improve documentation, and accelerate communication (Alotaibi & Federico, 2017).

Telemedicine delivers clinical outcomes comparable to in-person visits and is especially useful for hospice patients with mobility challenges or infection risks. These technologies also support data collection necessary for continuous quality improvement and innovation.

Proposed Disruptive Innovation

What innovation can enhance constipation management in hospice care?

The proposal involves implementing a standardized, organization-wide constipation management protocol starting at patient admission. This includes:

• Structured nursing bowel assessments embedded in electronic health records.

• Multimedia educational resources for patients and caregivers.

• A stepwise treatment algorithm combining pharmacologic and nonpharmacologic options.

• A digital bowel-tracking table accessible to patients, caregivers, and providers for real-time monitoring integrated into the patient chart.

Admission nurses would initiate the protocol, while case managers provide ongoing education and follow-up. Data from eMAR would support evaluation and refinement of the protocol.

Proposed Healthcare Organization

The innovation targets Carolina Caring, a nonprofit hospice based in Newton, North Carolina. Since 1979, Carolina Caring has served 12 predominantly rural counties, offering hospice, palliative care, inpatient services, and the Program of All-Inclusive Care for the Elderly. With a patient census frequently exceeding 1,000, Carolina Caring is well-suited to pilot standardized symptom management initiatives.

The organization’s dedication to indigent care and comprehensive services aligns with the goal of equitable, high-quality hospice care.

Goal of the Innovation

Hospice care aims to provide compassionate, patient-centered services emphasizing comfort and dignity. CMS enforces accountability through the CAHPS Hospice Survey, which gauges family perceptions of symptom management, including constipation (CMS, 2020).

How does this innovation support organizational goals?

Standardized bowel assessments and treatment protocols allow nurses to quickly address patient needs, reduce symptoms, and improve documentation. These improvements are anticipated to enhance clinical outcomes and positively affect CAHPS satisfaction scores.

Relevant Sources Summary Table

Synthesis of Literature

Research consistently reveals gaps in constipation assessment, documentation, and caregiver education in hospice care. Delays in intervention and inconsistent practices are common (McIlfatrick et al., 2019). Patient-reported outcomes and satisfaction surveys indicate that effective symptom control is closely linked to perceived quality of care (Parast et al., 2021; Myring et al., 2022).

Collectively, the evidence supports the adoption of standardized assessments, treatment algorithms, and comprehensive education incorporating both medication and alternative therapies.

Evidence for the Innovation

The available evidence endorses a structured, evidence-based constipation management protocol within hospice care. Utilizing existing technologies and nursing frameworks can improve assessment consistency, treatment timeliness, and monitoring. Better bowel management correlates strongly with enhanced patient comfort, dignity, and overall hospice experience.

Reflection on the Advanced Professional Nurse Role

Advanced professional nurses are key leaders in disruptive innovation. Though implementing change can be challenging, success relies on delegation, stakeholder engagement, and ongoing evaluation. Nurse leaders must set clear standards, provide education, and foster a culture that values innovation and quality improvement.

Strategies for Implementation

As a nurse educator and clinical trainer, there are opportunities to implement this innovation through staff training, policy development, and technology integration. Training admission nurses and case managers on standardized bowel assessments and treatment protocols will promote consistency and confidence. Collaborating with technology and marketing teams to develop digital educational materials and tracking tools will further empower patients and caregivers.

By integrating education, technology, and evidence-based practice, this innovation has strong potential to improve constipation management, patient comfort, and satisfaction in hospice care.

References

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180.

American Nurses Association. (2017). Code of ethics for nurses. https://www.nursingworld.org

Centers for Medicare & Medicaid Services. (2020). CAHPS hospice survey. https://www.cms.gov

Covetus Technologies Pvt Ltd. (2020). The features and benefits of eMAR. https://www.covetus.com

Howe III, E. G., & Elenberg, F. (2020). Ethical challenges posed by big data. Innovations in Clinical Neuroscience, 17(10), 24–30.

Johnson & Johnson Nursing. (n.d.). Innovation 101. https://nursing.jnj.com

Kirby, E. G., Keeffe, M. J., & Nicols, K. M. (2007). Innovative practices and hospice performance. Health Care Management Review, 32(4), 352–359.

Leon-Sanz, P. (2019). Ethical evaluation of healthcare big data. Philosophies, 4(3), 49.

Lindley, L., et al. (2022). Management of constipation in pediatric hospice care. Journal of Hospice & Palliative Nursing, 24(1), 70–77.

McIlfatrick, S., et al. (2019). Constipation assessment and management in palliative care. BMC Palliative Care, 18(1), 57.

Myring, G., et al. (2022). ICECAP-SCM in hospice settings. BMC Palliative Care, 21(1), 1–10.

Parast, L., et al. (2021). Hospice care experiences among cancer patients. Journal of General Internal Medicine, 36(4), 961–969.

Polit, D. F., & Beck, C. T. (2019). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

Siwicki, B. (2021). The future of telemedicine. Healthcare IT News.

Wang, P. M., et al. (2019). Effect of acupressure on constipation in advanced cancer. Supportive Care in Cancer, 27(8), 2867–2874.