The Caspian Nursing Process Project: A Structured Nursing Approach to New-onset Constipation After Stroke

Background: The effect of new-onset constipation on outcomes in acute stroke patients is not well defined. Objectives: This study aimed to develop a structured care plan for managing constipation in stroke survivors, emphasizing the evolving role of nursing interventions in addressing this issue. Materials & Methods: This multi-stage evolutionary study was conducted with several phases, including searching for scientific sources, formal content validity, RAND and Delphi methods, results and changes made at the Delphi stage, and a panel of experts to develop a care plan. Each recommendation was rated across four domains—priority, benefit, applicability, and concept—on a scale from 1 to 5. This study adhered to PRISMA (preferred reporting items for systematic reviews and meta-analyses) and AGREE II (appraisal of guidelines for research & evaluation) guidelines. A literature search across ScienceDirect, Cochrane Library, Medline, Scopus, PubMed, and Google Scholar identified 21 studies published from January 2004 to December 2019. Results: After evaluating the included articles, the final care plan was defined according to the nursing process steps. In the implementation stage, nursing-led interventions generally included physical activity and exercise, diet, modified drug regimes, fiber therapy, abdominal massage therapy, patient training, and patient follow-up. New interventions were defined according to nursing diagnoses. Conclusion: This study established a structured nursing approach for new-onset stroke constipation, incorporating validated tools, such as the Rome IV criteria and Bristol scale, along with comprehensive interventions, including diet, exercise, and education. Future research should assess its effectiveness and adapt it for different populations.