Nursing at Inflammatory Bowel Diseases
Introduction
Crohn's disease (CD) and ulcerative colitis (UC)
encompass a multisystem group of disorders with specific clinical and
pathological features characterized by focal, asymmetric, transmural,
and occasionally, granulomatous inflammation primarily affecting the
gastrointestinal tract [1]. These two diseases are called as Inflammatory Bowel Diseases (IBD).
IBD affect more than five million people worldwide, with 1.4 million in the US alone, and three million in Europe [2].
The incidence of IBD is increasing worldwide in adult and pediatric
population, especially in traditionally low-incident regions such as
Asia, South America and southern and eastern Europe [3-6]. In Turkey the incidence of UC is 2.6/100.000 and the incidence of CD is 1.4/100.000 [7].
Another study in Bolu/Duzce Region in Turkey, while the mean annual
incidences were 0.99/105 for UC, 0.45/105 for CD between 2004-2005
years, they increased to 4.87/105 and 2.09/105 for ulcerative colitis
and CD respectively between 2011-2013 years. While the prevalence was
higher in urban areas in CD (12.60/105), it was higher in rural areas in
UC (36.17/105) [8,9].
It is important to closely monitore clinically. In
the developed countries such as England, United States, United Kingdom,
Australia, various activities are planned in order to train IBD
specialized nurses and to increase the number of them. But developing
countries do not even have IBD nurses.
IBD nurse is required who has an active role in the
multidisciplinary team for IBD management, has the "expertise" authority
and sufficient knowledge and skills in this regard. Therefore, we aim
at explanation IBD nursing, IBD nurse's tasks and responsibilities in
this review. In all IBD patients, effective symptom management, control
of multiple drug use, continuous monitoring and close clinical follow-up
are required.
Once the symptoms have been checked with effective
symptom management and the remission has been reached, it is aimed to
maintain the long-term remission and increase the quality of life [10,11].
European Crohn’s and Colitis Organisation (ECCO) has
some sub-working groups. One of them is called Nurse-ECCO (N-ECCO).
N-ECCO group has prepared a consensus report describing the nursing
roles in 2012. This report consists of three parts such as Fundamental
IBD Nursing, Advanced IBD Nursing and The Perspectives of IBD Nursing [12].
The aims of this consensus are to identify the
positioning of nurses in the care of patients with IBD and to provide a
consensus on the ideal standard of minimum care that patients with IBD
might expect, irrespective of the level of nurse training, title or
country. The 'ideal' standard of nursing care was deemed an accurate
measure and appropriate by the group in order to provide a standard for
all nurses working with people with IBD [12].
IBD management is required a multidisciplinary
approach consisting of doctors, nurses, dietitians, social workers and
psychologists. In this team the nurse is also key roles. To play an
active role of IBD nurse will contribute to an increase in effective
disease management process and quality of life [13].
The nurse diagnoses according to the general
condition of the patient, plans the blood-based care and turns the
theoretical knowledge into practice. The nurse supports the patient and
his/her family in the diagnosis and treatment process and plans the
necessary trainings with the patient and his/her family. In addition,
nurses should develop a constructive and empathic approach to special
situations such as fistula, incontinence, sexuality, pregnancy and
fertility, pain, fatigue. In order for nurses to fulfill these tasks
successfully, they must be seen as part of a multidisciplinary team [14-17].
There are also some important topics in the job description of the
nursing staff: providing nutritional support, performing training and
counseling roles, defining and developing IBD services.?
Nursing knowledge is underlined in the report of
N-ECCO. Nurses need to have basic knowledge of the diseases, know the
difference between Crohn's disease and ulcerative colitis and appreciate
the importance of establishing timely therapeutic interventions. Timely
therapeutic intervention is essential for disease control.
Nurses caring for patients with IBD need an awareness
of the extra-physical impact of the illness, of patients' key concerns,
and the effect of IBD on health related quality of life [12].
Nursing involves advocacy and effective communication
for all patients. These are of the utmost importance to patients with
IBD due to the complex, uncertain and chronic nature of the condition.
Communication is a two way process. Nurses need to develop an empathetic
and active listening role, and be able to provide essential IBD-related
information and holistic support [12].
An IBD nurse has been found to have an effective role in cost- effective management of IBD. For example [12,18,19]:
- Providing multidisciplinary team communication between primary and other institutions,
- Supporting all aspects of patient and caregiver care in the hospital and community,
- Rapid delivery of services to the nursing leadership, including clinical, telephone support and follow,
- Managing and monitoring of immunosuppression, anti- TNF therapy and nutritional support,
- Developing research projects, ensuring supervision of projects and participating in projects to support the care of patients with IBD,
- Making a teaching plan for the development and education of patients and health personnel for the management of IBD.
Specialist nurses working with patients with
inflammatory bowel disease can perform these roles while working in
polyclinics, medical and surgical clinics, primary care clinics and
endoscopy units.Important roles such as clinical care, education,
research, counseling, improving disease management, compliance and
increasing patient satisfaction are also included in the IBD nursing [17].
Nurses have also important roles in patient education. Training is
needed to activate and strengthen the patients and their family to live
with IBD. The training program should include the basic information
about the disease, nutrition and medical management, the importance of
coming to regular checkups and disease coping skills, etc.
As in other chronicdiseases, nurse is responsible for
the identification of the IBD. At the first meeting with a patient, an
IBD nurse should get IBD history, because it is helpfull and necessary
for patient. The N-ECCO Consensus statements aim to provide practical
value at a local, national and international level in the development of
nursingcare for patients with IBD. These statements are intended to be
used as a means of in forming nurses, improving their knowledge and
understanding and so raise the standard of care for patients with [19,20].
Conclusion
Due to the many influences and uncertainties of the
patients’ lives, the nurse in the IBD management process should be
counseled with holistic support and cARGHy out a careful care process.
In addition, the expert nurse should have adequate knowledge and skills
in relation to the disease.
The other conclusion is about nursing training.
Development of IBD nursing and post-graduate training programs should be
supported. The dissemination of this area of expertise in nursing
science and the support of the branching of the nurses will increase the
quality of the care provided. Thus, the patients and their family will
adapt to the disease, their self-efficacy levels and quality of life
will be increased.
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