Cuidados de enfermagem ao usuário diagnosticado com doença de Crohn: uma revisão integrativa / Nursing care for users diagnosed with Crohn's disease: an integrative review / Cuidados de enfermería a usuarios diagnosticados de enfermedad de Crohn: una revisión integradora

Objetivo: identificar os cuidados de enfermagem direcionados a usuários diagnosticados com a doença de Crohn. Método: trata-se de uma revisão integrativa da literatura, realizada na Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados em Enfermagem, Medical Literature Analysis and Retrievel System Online, Scientific Electronic Library Online e Google Acadêmico. A amostra foi composta por sete estudos. Resultados: a análise dos estudos revela uma série de resultados significativos no contexto dos cuidados de enfermagem, podendo citar.: a necessidade de planejar a assistência de enfermagem adaptada às particularidades da doença; a crescente relevância da telessaúde; monitoramento de sintomas, orientação nutricional, administração de medicamentos e apoio emocional, enfatizando a individualização desses cuidados. Considerações finais: os principais resultados do estudo destacam a importância dos cuidados de enfermagem centrados no bem-estar do usuário, controle da doença, apoio emocional e estímulo ao autocuidado.

Objective: to identify the nursing care provided to patients diagnosed with Crohn's disease. Method: this is an integrative literature review carried out in the Latin American and Caribbean Health Sciences Literature, Nursing Database, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Google Scholar. The sample consisted of seven studies. Results: the analysis of the studies reveals a series of significant results in the context of nursing care, including: the need to plan nursing care adapted to the particularities of the disease; the growing relevance of telehealth; symptom monitoring, nutritional guidance, medication administration and emotional support, emphasizing the individualization of this care. Final considerations: the main results of the study highlight the importance of nursing care centered on the user's well-being, disease control, emotional support and encouraging self-care.

Objetivos:identificar los cuidados de enfermería prestados a pacientes con diagnóstico de enfermedad de Crohn. Método: se trata de una revisión bibliográfica integradora realizada en la Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Base de Datos de Enfermería, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online y Google Scholar. La muestra estuvo constituida por siete estudios. Resultados: el análisis de los estudios revela una serie de resultados significativos en el contexto de los cuidados de enfermería, entre ellos: la necesidad de planificar cuidados de enfermería adaptados a las particularidades de la enfermedad; la creciente relevancia de la telesalud; la monitorización de síntomas, la orientación nutricional, la administración de medicamentos y el apoyo emocional, destacando la individualización de estos cuidados. Consideraciones finales: los principales resultados del estudio destacan la importancia de los cuidados de enfermería centrados en el bienestar del usuario, el control de la enfermedad, el apoyo emocional y el fomento del autocuidado.

Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease.

OBJECTIVE: To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. BACKGROUND: The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. DESIGN - METHODS: A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. RESULTS: A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. CONCLUSION: The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.

Anti-TNF biosimilars in Crohn's Disease: a patient-centric interdisciplinary approach.

Introduction: The purpose of this review is to highlight the role of biosimilars in early treatment in IBD and introduce ways to facilitate a patient-centric switching process through multidisciplinary approach. Areas covered: We summarize existing scientific literature related to the role of biosimilars in inflammatory bowel disease in terms of early treatment and cost-saving and implementing switching process. Expert opinion: Use of anti-TNF biosimilars in patients has the potential for large drug-acquisition cost-saving, which can be reinvested into early treatment. Managed switched programs for adalimumab can add further benefits in the future.

Immunosuppressive/Autoimmune Disorders.

Autoimmune disorders are a category of diseases in which the immune system attacks healthy cells as a result of a dysfunction of the acquired immune system. Clinical presentation and diagnosis are disease specific and often correspond with the degree of inflammation, as well as the systems involved. Treatment varies based on the specific disease, its stage of presentation, and patient symptoms. The primary goal of treatment is to decrease inflammation, minimize symptoms, and lessen the potential for relapse. Graves disease, Hashimoto thyroiditis, rheumatoid arthritis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, and multiple sclerosis are discussed in this article.

Management of long-term conditions and dementia: The role of the Admiral Nurse.

As life expectancy increases so people often develop a range of conditions and disabilities in the years before death. Multimorbidity represents the most common 'disease pattern' found among the elderly and is characterised by complex interactions of co-existing diseases where a medical approach focused on a single disease does not suffice. People with dementia who also have other comorbidities do not always have their comorbid conditions managed as those without dementia which often lead to a high number of hospital admissions with longer lengths of stay and greater treatment costs. This case study presents the case management approach taken by Admiral Nursing in managing the complexities where there is comorbidity of a long-term condition and a diagnosis of dementia. By empowering the person and their carer with information and choices and through good case management and communication, people can be supported to live well and avoid inappropriate hospital admissions.

Effects of introduction of an inflammatory bowel disease nurse position on the quality of delivered care.

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice, and support. We investigated the effect of the introduction of an IBD nurse on the quality of care delivered. METHODS: In September 2014, an IBD nurse position was instituted in our tertiary referral center. All contacts and outcomes were prospectively recorded over a 12-month period using a logbook kept by the nurse. RESULTS: Between September 2014 and August 2015, 1313 patient contacts were recorded (42% men, median age: 38 years, 72% Crohn's disease, 83% on immunosuppressive therapy). The contacts increased with time: Q1 (September-November 2014): 144, Q2: 322, Q3: 477, and Q4: 370. Most of the contacts were assigned to scheduling of follow-up (316/1420), start of new therapy (173/1420), therapy follow-up (313/1420), and providing disease information (227/1420). In addition, 134 patients contacted the IBD nurse for flare management and a smaller number for administrative support, psychosocial support, and questions about side effects. During the study period, 30 emergency room and 133 unscheduled outpatient visits could be avoided through the intervention of the IBD nurse. A faster access to procedures and other departments could be provided for 136 patients. CONCLUSION: The role of IBD nurses as the first point of contact and counseling is evident from a high volume of nurse-patient interactions. Avoidance of emergency room and unscheduled clinic visits are associated with these contacts.

Inflammatory bowel disease.

THE INCIDENCE of inflammatory bowel disease (IBD) is in- creasing worldwide. The underlying causes of IBD, which encom- passes Crohn's disease and ulcerative coLitis, are unknown but are thought to be a com- bination of genetics, environmental factors, abnormal immune re- sponses and disruption to the microbiota in the gut. IBD can be a devas- tating disease, affect- ing quality of Life and increasing risks for bowel cancer. Effec- tive management has been an elusive goal, but with better under- standing of the inflam- matory and immune pathways involved in IBD, more successful therapies are entering clinical practice. To deliver quality care and help people with IBD manage this dis- ease, nurses must be familiar with the cur- rent understanding of its causes.

Identification of Research Priorities for Inflammatory Bowel Disease Nursing in Europe: a Nurses-European Crohn's and Colitis Organisation Delphi Survey.

BACKGROUND: Robust research evidence should inform clinical practice of inflammatory bowel disease [IBD] specialist nurses, but such research is currently very limited. With no current agreement on research priorities for IBD nursing, this survey aimed to establish topics to guide future IBD nursing research across Europe. METHODS: An online modified Delphi survey with nurse and allied health professional members of the Nurses European Crohn's and Colitis Organisation [n = 303] was conducted. In Round One, participants proposed topics for research. In Round Two, research topics were rated on a 1-9 scale and subsequently synthesised to create composite research questions. In Round Three, participants selected their top five research questions, rating these on a 1-5 scale. RESULTS: Representing 13 European countries, 88, 90 and 58 non-medical professionals, predominantly nurses, responded to Rounds One, Two and Three, respectively. In Round One, 173 potential research topics were suggested. In Rounds Two And Three, responders voted for and prioritised 125 and 44 questions, respectively. Round Three votes were weighted [rank of 1 = score of 5], reflecting rank order. The top five research priorities were: interventions to improve self-management of IBD; interventions for symptoms of frequency, urgency and incontinence; the role of the IBD nurse in improving patient outcomes and quality of life; interventions to improve IBD fatigue; and care pathways to optimise clinical outcomes and patient satisfaction. CONCLUSIONS: The prioritised list of topics gives clear direction for future IBD nursing research. Conducting this research has potential to improve clinical practice and patient-reported outcomes.

Reshaping policy to deliver holistic care for adolescents with Crohn's disease.

The number of adolescents with Crohn's disease (CD) is rising, with one third of cases diagnosed before turning 21 years old. Evidence shows that long-term medical intervention, school absence and the physical toll of CD on the growing adolescent also have a psychological effect on patients. In addition, poorly defined transition pathways are extending these problems into adulthood. The National Institute for Health and Care Excellence (NICE) guidelines are important in shaping service delivery and distribution. However, analysis of the full 2012 NICE CD management guidelines indicates they fall short of providing adequate recommendations for holistic management of the disease in young populations. An update in 2016 added a new clinical recommendation to the guidelines, but no further exploration of the psychosocial aspects of the impact of the disease. The authors of this article used a critical review of literature and concluded that service provision for adolescents with CD could be made better by improving CD support networks, involving young people in the development of policy centred on their care, as well as incorporating other (non-NICE) well-researched CD guidelines in national policy. These changes would improve quality of life for this vulnerable population.

Inflammatory Bowel Disease: Caring for a Patient with Crohn's Disease.

The Medical-Surgical Nursing Certification Board (MSNCB) encourages certification for all registered nurses who provide care in a medical-surgical setting. Initial certification is achieved through successful testing by written examination. The certification examination is based on Benner's Nursing Model. Questions on the examination fall within the seven domains of nursing practice: Helping Role, Teaching-Coaching Function, Diagnostic and Patient Monitoring, Effective Management of Rapidly Changing Situations, Administering and Monitoring Therapeutic Interventions and Regimens, Monitoring and Ensuring the Quality of Health Care Practices, and Organizational and Work Role Competencies. The examination is designed to assess comprehensive knowledge of medical-surgical nursing. The medical-surgical practitioner must understand diseases, diagnoses, and treatment modalities to function as a caregiver and educator. The topic of this article is a part of the comprehensive examination given by MSNCB. The following scenario and questions offer an example that potential certificants may use to test their knowledge. For more information about MSNCB, visit www.amsn.org/certification.

The reflection of the quality of life of people with Crohn's disease in nursing.

OBJECTIVES: To determine the quality of life of patients with Crohn's disease and to determine if this is reflected by the quality of nursing care. METHODS: For the purpose of this research, we used a generic standardized questionnaire of the quality of life, published by the World Health Organization (WHOQOL-100). The questionnaire was distributed among 100 patients with Crohn's disease and among 1456 and members of healthy population. To analyze the results, we used the SPSS program and appropriate statistical methods. RESULTS: The comparison of the domain scores of population standards in the Czech Republic and the respondents with Crohn's disease revealed a difference in the domain "physical condition", where the mean value was at the limit of the lower interval of the standard, and in the domain of "independence". CONCLUSION: The results given in this study define the possibilities of nurses and their functioning associated with altered quality of life. An evaluation of the most affected areas allows nurses to determine an appropriate intervention. Providing nursing care, in accordance with the latest knowledge, must be based on the quality of life. This newly incorporated area offers healthcare professionals a new dimension for assessing and determining subsequent interventions.

A high-fiber diet may improve bowel function and health-related quality of life in patients with Crohn disease.

Crohn disease is a chronic disorder characterized by episodes of epithelial inflammation in the gastrointestinal tract for which there is no cure. The prevalence of Crohn disease increased in civilized nations during the time period in which food sources were industrialized in those nations. A characteristic of industrialized diets is the conspicuous absence of cereal fiber. The purpose of this 2-group, randomized, controlled study was to investigate the effects of fiber-related dietary instructions specifying wheat bran consumption on health-related quality of life and gastrointestinal function in individuals diagnosed with Crohn disease, as measured by the Inflammatory Bowel Disease Questionnaire and the partial Harvey Bradshaw Index, respectively. Results demonstrated that consuming a wheat bran-inclusive diet was feasible and caused no adverse effects, and participants consuming whole wheat bran in the diet reported improved health-related quality of life (p = .028) and gastrointestinal function (p = .008) compared to the attention control group. The results of a secondary aim, to investigate differences in measures of systemic inflammation, found no group differences in C-reactive protein or erythrocyte sedimentation rates. This study suggests that diet modification may be a welcomed complementary therapy for individuals suffering gastrointestinal disruption associated with Crohn disease.

[Therapeutic education, a factor of compliance and autonomy]. / L' education thérapeutique, facteur d'observance et d'autonomie.

Improving the daily life of patients suffering from inflammatory bowel disease is one of the objectives of the gastroenterological team of Nice general hospital. Therapeutic patient education has been developed in the hospital, through the Edu MICI programme. The practice of this multi-disciplinary team gives nurses the opportunity to fully express their unique role.

N-ECCO survey results of nursing practice in caring for patients with Crohn's disease or ulcerative colitis in Europe.

BACKGROUND AND AIMS: The difference in nursing roles when caring for patients with inflammatory bowel disease varies across Europe with different levels of responsibility. This might vary widely from country to country and even hospital to hospital depending on the local requirements of the patients and the gastroenterology team. This survey was developed to assess the current nursing practice across Europe. METHODS: A total of 220 nursing delegates who attended the N-ECCO Meeting and School in 2012 were invited to complete a survey. The survey consisted of 11 questions about the role and responsibility of nurses in the care of patients with inflammatory bowel disease. RESULTS: Of the 220 European nurses, 192 responded (87%). A majority (61%) came from 5 European countries, most were between 30 and 50 years old, 73% worked in public hospitals and 68% were involved in adult care. The level of education varied equally between certificate level, degree level, diploma level and masters' level. The nurses' level of experience, above that of the level of education, was the main factor in determining whether to offer advice or not to the patient, independent of a doctor (p<0.01). CONCLUSION: This survey has provided an understanding of the nursing role in the care of patients with IBD across Europe as well as Australia, Canada and Israel. It demonstrates that the role of nurses in IBD exists in various settings within hospital care, providing complex management and autonomous nursing care in a range of services to a significant number of patients with IBD.

Understanding Crohn's Disease.

The following excerpt is from the Understanding Crohn's Disease course available on the ANMF's Body Systems Training Room. The complete course is approximately 70 minutes in duration and will introduce you to the disease state and clinical management of Crohn's disease. This excerpt gives you 30 minutes of CPD toward your annual requirements.

Dietary fiber information for individuals with Crohn disease: reports of gastrointestinal effects.

The experiences of individuals with Crohn disease before and after receiving dietary fiber information have not been described in the literature. This article offers findings from a study that used four semistructured audiorecorded interviews during a 4-week time period for the purpose of exploring the experiences of 11 individuals before and after receiving dietary fiber information from a healthcare professional. The first and second interviews occurred immediately before and after the presentation of information. Follow-up interviews occurred at 2-week intervals. Thematic analysis of the baseline interviews revealed 2 themes: (a) accepting a redefined (lower expectations) definition of normal quality of life and (b) continuing to look for answers. Three themes emerged from the follow-up interviews at Week 4: (a) reevaluating old diet-related concepts, (b) enjoying a healthier lifestyle at a self-set pace, and (c) enjoying positive physical effects of wheat bran consumption. This article examines the 3rd postintervention theme, "enjoying physical effects of wheat bran consumption." The relevance of this research is that nurses equipped with dietary fiber information may be better able to help some individuals with Crohn disease to explore the potential benefits of a well-rounded nutritious pattern of eating that includes wheat bran cereal.

Specialist support.

People with ulcerative colitis of Crohn's disease often develop the conditions in their teens or early twenties. Specialist nurses help people cope and get on with their lives. Access is improving, but one in five young patients still miss out on specialist nursing care.