SAMMANFATTNING Bakgrund: Förstoppning är ett vanligt återkommande problem hos barn och kan uppträda som  diffusa symtom som magont, irritabilitet, uppblåst buk och minskad aptit. Tillståndet kan skapa  stress i familjen vilket resulterar i en ond cirkel som blir allt svårare att ta sig ur. I dagens samhälle samt för många föräldrar är “att bajsa på sig” förknippat med skuld och skam. Symtom som avföringsläckage, förstoppningsdiarré samt sängvätning gör anamnesen svårtolkad och symtombilden omfattande. Att se sitt barn lida av både fysiska och psykiska besvär på grund av förstoppningen är påfrestande för föräldern.   Syfte: Syftet är att beskriva vilka egenvårdsråd samt vilket stöd som sjuksköterskan kan ge till föräldrar vid förstoppningsproblematik hos barn i åldrarna 2-17 år. Metod: En deskriptiv design med kvantitativ ansats och litteraturstudie som metod användes för att besvara syftet. Resultatet baseras på 11 kvantitativa originalartiklar. Resultat: Resultatet delades in i tre delar, vilket var information, rekommendationer och uppföljning. Information behövs för tidig identifiering samt för att barnet och föräldrar kan känna igen symtom men även veta varför de uppkommer. Då riskfaktorer som stillasittande, ohälsosamma livsstilsvanor, lågt intag av grönsaker, frukt, fibrer och vätska ökar prevalensen av förstoppning behövs rekommendationer då dessa riskfaktorer kan påverkas hemifrån av barnets föräldrar genom egenvårdsråd och stöd från sjuksköterska. För att undvika återkommande förstoppning är uppföljning en viktig del av behandlingen. I samtliga delar har sjuksköterskan en nyckelroll för ett lyckat resultat.  Slutsats: Det visade sig att egenvårdsråd, stöd och information i ett tidigt skede leder till ökad förståelse, stärkt självförtroende samt hur kostvanor och fysisk aktivitet påverkar tillståndet. / ABSTRACT Background: Constipation is a common recurring problem in children and can occur as diffuse  symptoms such as stomach pain, irritability, bloated abdomen and decreased appetite.  The condition can create stress in the family, which results in a vicious circle that becomes increasingly difficult to get out of. In today's society and for many parents, "accidentally pooped in their trousers” is associated with guilt and shame. Symptoms such as soiling, stool diarrhea and bedwetting make the anamnesis difficult to interpret and the symptom picture extensive. To see your child suffering from physical and mental disorders due to constipation are stressful for the parent.   Aim: The aim with this study was to describe self care advice and what kind of support a nurse could give the parents of constipated children aged 2-17 years.   Methods: A descriptive design with a quantitative approach and literature study as a method is used to answer the purpose. The result is based on 11 quantitative original articles. Results: The result of this study was divided up in categories such as information, recommendation and follow up. Parents and children need information for early identification of symptoms and why they appear, but also knowledge about risk factors such as sedentary, unhealthy lifestyle habits, low intake of vegetables, fruits, fiber and fluids increase the prevalence of constipation. These risk factors can be influenced by the parents of the children at home through self-care advice and support from a nurse. To avoid recurrent constipation, follow-up is an important part of the treatment. In all parts, the nurse has a key role to play in a successful outcome.   Conclusion: It turned out that self-care advice, support and information in an early stage leads to an increased understanding of the condition, strengthened self-confidence and the effects of diet and physical activity as well.

Bakgrund Förstoppning är ett problem för många barn och prevalensen tros ligga mellan 1–31 procent världen över. Problematiken skapar obehagliga konsekvenser för barnet och enbart läkemedelsbehandling visar sig har otillräcklig effekt då studier visat att cirka 25 procent av barn som diagnostiserats med förstoppning lider även av detta i vuxen ålder. Syfte Syftet med denna litteraturöversikt är att beskriva sjuksköterskans omvårdnadsåtgärder till barn med förstoppning. Metod Examensarbetet genomfördes som en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter. Resultatet baseras på elva vetenskapliga artiklar. Artiklarna har inhämtats från databaserna Pubmed och CINAHL. Resultat I resultatet presenteras de två huvudkategorierna utbildning och bemötande. De omvårdnadsåtgärder som identifierades och gav resultat innehöll att kompetensutveckla sjuksköterskor så att rätt information ges till föräldrar om förstoppning men också att skapa förtroende och använda ett patientanpassat förhållningsätt. Kunskap, information och förhållningssätt var grundläggande faktorer till ett optimalt omhändertagande. Slutsats Litteraturöversikten visar att sjuksköterskans kunskap, erfarenhet och bemötande har en betydande roll i barnens återhämtning. Sjuksköterskan behöver kunna förmedla egenvårdsundervisning på ett patientanpassat sätt för att förbättra barns möjlighet att tillfriskna och öka föräldrars kunskap. Dessa åtgärder visade sig vara betydelsefulla inslag i omvårdnaden kring barn med förstoppning / Background Constipation is a problem for many children and the prevalence is believed to be between 1-31 percent worldwide. The problem creates unpleasant consequences for the child and medical treatment alone proves to have insufficient effect as studies have shown that around 25 percent of children diagnosed with constipation also suffer from this in adulthood. Aim The purpose of this literature review is to describe the nursing measures for children with constipation. Method The literature review was carried out as a structured literature review with elements of the methodology used in systematic reviews. The result is based on eleven scientific articles.The articles have been obtained from the databases Pubmed and CINAHL. Results The results present the two main categories: education and treatment. The nursing measures that were identified and yielded results included developing the skills of nurses so that the right information is given to parents about constipation but also building trust and using a patient-friendly approach. Knowledge, information and attitude were fundamental factors for optimal care Conclusions The literature review shows that the nurse's knowledge, experience and attitude have a significant role in the children's recovery. The nurse needs to be able to convey self-care education in a patient-adapted way to improve children's opportunity to recover and increase parents' knowledge. These measures proved to be important elements in the careof children with constipation

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants. Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution. Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake. Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment. Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state. Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.