Ask an answerable question (PICO)：
Our department is the Colorectal Surgery Outpatient Clinic at a medical center. With the increase in positive cases of colorectal cancer screening provided by the National Health Agency, we frequently encounter patients who require colonoscopies. The cleanliness of the bowel directly affects the results of the colonoscopy. Currently, the preparation of the bowel before a colonoscopy and the factors influencing the effectiveness of the examination are numerous. For most patients, their main concern is the complicated bowel preparation process before the procedure. The European Society of Gastrointestinal Endoscopy recommends enhancing patient education on bowel preparation. In addition to traditional oral education, there are also enhanced educational methods, including visual aids (videos or educational pamphlets), social media, phone or text services, and smartphone applications. This has inspired the author to explore through evidence-based literature and clinical research whether the use of smartphones can improve the effectiveness of bowel preparation for colonoscopy, with the aim of developing future educational measures and strategies to promote care quality.
The Method and Analysis of Literature Review：
Using MeSH terms to search with different spellings and synonyms for P, I, C, O keywords, and applying the limit search function, we conducted searches across various evidence-based databases, including PubMed, Embase, ClinicalKey Nursing, Cochrane Library, and the Airiti Library (CEPS-Chinese Electronic Periodical Services). Boolean logic was employed during the search process. Filters and the limit search function were used to select RCTs, SRs, and Meta-Analysis articles, with no restrictions on the year or language. Initially, 122 articles were identified. After removing duplicates, non-PICO studies, and applying exclusion criteria, one randomized controlled trial (RCT) and one systematic review article were finally selected.
Critical Appraisal：
Based on the literature evaluation tools, the latest Critical Appraisal Skill Programme (CASP) checklists for systematic reviews (2018) and randomized controlled trials (2020) were used to assess the effectiveness, significance, and applicability of the studies. The percentage of studies rated "Yes" for these aspects was 90% for randomized controlled trials (RCTs) and 90% for systematic reviews (SRs). The evidence levels of both studies were evaluated according to the Oxford Centre for Evidence-Based Medicine (CEBM) 2011 guidelines and were rated as Level I.
Clinical Application of Evidence：
Based on the recommendations from the literature, an evidence-based plan was developed. Convenient sampling was used to include colonoscopy patients aged 50 to 70 years, divided into an experimental group and a control group. Three days prior to the examination, messages were sent to the experimental group via an official LINE community. The study will be conducted from May 6 to May 30, 2024, with a total of 60 patients participating. The Aronchick scale will be used to assess the patients' bowel cleanliness.
Evaluation of Effectiveness：
Results after the intervention showed that the experimental group had better bowel cleanliness compared to the control group, with a significant difference (p=0.042), indicating that the intervention was effective in improving bowel preparation for colonoscopy.
Conclusions and Recommendations：
This study explores through evidence-based literature whether the use of smartphones can improve the effectiveness of bowel preparation for colonoscopy. Based on the integration of evidence and the results of our clinical application, it shows that using smartphones for enhanced health education is feasible. It is convenient, quick, not limited by time or location, and can be viewed at any time, making it a cost-effective health education strategy. We plan to revise relevant procedures into outpatient workflow guidelines to achieve the goal of translating evidence-based knowledge into practice and implementing scientific evidence in nursing clinical practice and its promotion.
