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    Essentials of Evidence-Based Practice


    Course Project Overview


    Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, nurses can connect the results of relevant research studies to their nursing practice.


    For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the course project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice.


    Before you begin, review this document, which contains information about all three parts of the Course Project.


    Note: This Course Project will serve as the Portfolio Assignment for the course. In addition to submitting portions of this Project in Weeks 2 and 5, you will turn in all three deliverables in Week 10.



    The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question that you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources. 


    To prepare:


    • Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
    • Using the question that you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
    • Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
    • Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

    To complete:

    Develop a 2- to 3-page literature review that includes the following:

    • A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
      • Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
    • Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
    • Your literature review summary table with all references formatted in correct APA style

    Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

    Part 2 of the Course Project is due by Day 7 of Week 5. It will also be a component in your portfolio assignment in this course, which is due by Day 7 of Week 10.


Subject Nursing Pages 6 Style APA


Literature Review

                There is a dramatic increase in constipation with age. Gandell, Straus, Bundookwala, Tsui, and Alibhai (2013) note that the estimated prevalence of the condition among geriatrics is approaching 50% which is a public health concern. Some of the key elements associated with the condition are medication use, low socioeconomic status, the non-white race, gender where the prevalence is higher among women, and related mental disorders such as depression and anxiety. Constipation management is described by the effective alleviation of the adverse symptoms including straining during defecation, hard and lumpy stools, incomplete evacuation, anorectal obstruction, manual manoeuvres, and reduced defecations per week (Lamas, Karlsson, Nolen, Lovheim, and Sandman, 2017). Various approaches have been developed which aid in constipation management. These include osmotic agents, bulk agents, stool softeners, prokinetic agents, and lifestyle modification. This paper, therefore, entails a literature review of examining the variation between medication therapy and diet and fluid intake.

The understanding of constipation’s etiology and its management has evolved. For the elderly, however, there is more than a single etiologic mechanism which prompts the use of a multifactorial management strategy. De Giorgio et al. (2015) in this regard points out that among most aged patients, the response to lifestyle modification and diet combined with bowel training approaches is effective in managing the comorbid conditions. With more than 30% of the total elderly population experiencing constipation at a point in their lifetime, there is a need to develop alternative approaches especially with the rise in the herbalists and pharmacies. Nebhinani and Suthar (2017) on the other hand notes that the most effective management approach is one that takes a combination of various factors. In a literature review, Nebhinani and Suthar (2017) noted that healthcare providers must demonstrate competence in developing a combination of approaches that will profoundly relieve the patient’s symptoms. Among the combined approaches of managing the condition include medication therapy, lifestyle and behavioural modification, and the use of laxatives.

                The type of management strategy depends on the patient and environmental factors. In a qualitative exploratory study by Munch, Tvistholm, Trosborg, and Konradsen (2016), it was established that the management approach for a patient is dependent on a number of individual factors including other conditions, social activities, and hospitalization. The consideration of these issues is critical in preventing further complications and patient issues especially in using multiple medications. The study illuminated the need for medical practitioners to pay attention to the patient factors which aid in developing a profound intervention plan. This aspect was further supported by Nebhinani and Suthar (2017) who added that a number of steps have to be followed to manage the condition among the elderly. These phases have to include identifying the constipation diagnosis which considers the existence of one or more symptoms, a physical examination which considers a thorough inspection of the anal-rectal, and establishing the different treatment approaches, especially on the reversible issues. Based on these steps, the management strategy can be developed which is a consideration of different issues including laxative therapy and lifestyle modification which is a combination of taking fibres and plenty of water.

                The use of medication therapy is associated with other challenges including adverse side effects and high costs. In a descriptive study by Yilmaz and Asiret (2017), it was established that the use of laxatives among other pharmacological approaches is discouraged based on the high costs and side effects which prompt the consideration of the non-pharmacological strategies. According to these authors, the implementation of the behavioural and lifestyle modification such as taking a diet that is rich in fibre and increasing the intake of fluids is associated with better patient outcomes. This contradicted the systematic review performed by Martinez-Martinez, Calabuig-Tolsa, and Cauli (2017) who espouse that the use of medication therapy is effective although the duration of use should be carefully selected. However, the key issue is that the use of drugs should be combined with diet and lifestyle modification to enhance the quality of patient outcome and profoundly relieve the symptoms.

Research Gap Problem

                Drawing from the literature analysis above, it is apparent that both pharmacotherapy and non-pharmacological approaches are effective in managing constipation. However, it is not clear which strategy between diet and fluid intake and the use of drugs is effective in managing the condition especially among the hospitalized patients for one month. The study by Martinez-Martinez et al. (2017) for instance considers the use of pharmacotherapy as more effective. However, these authors point a concern when the drugs are used in the long term which therefore demonstrates the importance of diet and fluid intake. Yilmaz and Asiret (2017) counters the use of drug therapy based on the cost and side effects grounds and point out on the importance of considering the lifestyle modification such as fluid intake and consuming foods rich in fibre and vegetables. However, there is still no study that specifies the duration of stay at the hospital for these patients and which strategies are therefore essential in addressing the patient’s symptoms especially between diet and fluid intake and the use of drugs.

Summary Table


Aim and Objective 



Level of Evidence

De Giorgio et al. (2015)

To develop and update on the etiology, diagnosis, epidemiology, and limitations on constipation management among the aged.

Literature Review

Effective diagnosis approaches are required to develop a management plan that is in line with patient factors. Laxatives are effective but have a safety concern.

Level II

Lamas et al. (2017)

Investigating constipation prevalence among geriatric patients and related characteristics

Cross-sectional study.

Poor nutrition and use of a high number of drugs increases the condition prevalence which should be considered in the management plan

Level I

Martinez-Martinez et al. (2017)

Examining the efficiency of using probiotics to manage constipation among the elderly.

Systematic review. 

Medication therapy including laxatives is effective although they should be used in the short term only.

Level II

Munch et al. (2016)

Explore the experiences of aged patients with constipation and effective handling approaches.

Qualitative exploratory research design


Level I

Nebhinani and Suthar (2017)

Assessment, management, and prevention of constipation among the aged and with mental conditions

Literature review

Effective steps are required to diagnose the condition among the aged and management should include a holistic approach.

Level II

Yilmaz and Asiret (2017)

Identifying the constipation levels among the aged and the recovery approaches

Descriptive study

Most aged individuals with constipation use laxatives and fluids in the condition management.

Level I


                In summary, the above literature analysis demonstrates the research gap in constipation management among the elderly. With the condition prevalence being high among the aged, it is imperative to identify the specific patient and environmental conditions that may affect the intervention strategy. Although the use of drugs is considered effective, their long-term application remains a challenge based on the side effects and costs. Therefore, diet and fluids intake are critical in the management plan. The research gap identified is that among hospitalized patients, it is not clear which strategy between drugs and diet and fluid intake is essential in managing the condition especially in the short-term which is the foundation of the change project and research.






    De Giorgio, R., Ruggeri, E., Stanghellini, V., Eusebi, L. H., Bazzoli, F., & Chiarioni, G. (2015). Chronic constipation in the elderly: a primer for the gastroenterologist. BMC gastroenterology15(1), 130.

    Gandell, D., Straus, S. E., Bundookwala, M., Tsui, V., & Alibhai, S. M. (2013). Treatment of constipation in older people. Cmaj185(8), 663-670.

    Lämås, K., Karlsson, S., Nolén, A., Lövheim, H., & Sandman, P. O. (2017). Prevalence of constipation among persons living in institutional geriatric‐care settings–a cross‐sectional study. Scandinavian journal of caring sciences31(1), 157-163.

    Martínez-Martínez, M. I., Calabuig-Tolsa, R., & Cauli, O. (2017). The effect of probiotics as a treatment for constipation in elderly people: A systematic review. Archives of gerontology and geriatrics71, 142-149. doi: 10.1016/j.archger.2017.04.004

    Munch, L., Tvistholm, N., Trosborg, I., & Konradsen, H. (2016). Living with constipation—older people’s experiences and strategies with constipation before and during hospitalization. International journal of qualitative studies on health and well-being11(1), 30732.

    Nebhinani, N., & Suthar, N. (2017). Constipation in elderly patients with psychiatric disorders. Journal of Geriatric Mental Health4(1), 11.

    Yilmaz, C. K., & Asiret, G. D. (2017). Identifying the Constipation Levels of Older People and their Interventions for Recovery. International Journal of Caring Sciences10(3), 1605-1614.














    Appendix A:

    Communication Plan for an Inpatient Unit to Evaluate the Impact of Transformational Leadership Style Compared to Other Leader Styles such as Bureaucratic and Laissez-Faire Leadership in Nurse Engagement, Retention, and Team Member Satisfaction Over the Course of One Year

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