[Nursing in the approach to inflammatory bowel disease]

Introduction

Effects of introduction of an inflammatory bowel disease nurse position on healthcare use

OBJECTIVE

Inflammatory bowel diseases (IBDs) are chronic relapsing remitting diseases which potentially result in hospitalisation, 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.The aim of this study was to assess the impact of introduction of an IBD nurse position on healthcare use and costs in a tertiary IBD centre.

METHODS

An IBD nurse was instituted in September 2017 in our multidisciplinary IBD team. We compared differences in healthcare use 1 year before and 1 year after the introduction of an IBD nurse position for all the patients with a confirmed diagnosis of IBD attending the Robert Debre Hospital via two information sources: Programme de Médicalisation des Systèmes d'Information and Centre des Maladies Rares.

RESULTS

252 patients (78.5% of patients with IBD followed up in our centre) were included in the patient education programme. After the introduction of an IBD nurse position, fewer patients were hospitalised for a flare, with less hospital stays: 56 before vs 28 after (p=0.002). An estimated saving of €35 070 was achieved through the decrease of hospitalisations for flare.More patients were also hospitalised for diagnosis: 32 hospitalisations before vs 54 hospitalisations after (p=0.001). All other hospitalisation categories were comparable, and the same reasons for hospitalisation were found before and after.

CONCLUSION

This study demonstrates that the IBD nurse position reduces hospital admissions. Instead of the traditional model, the IBD nurse provides accessible advice and allows patients to be outpatients.

Gastrointestinal Symptoms of and Psychosocial Changes in Inflammatory Bowel Disease: A Nursing-Led Cross-Sectional Study of Patients in Clinical Remission

Background and Objectives: Nursing management in Inflammatory Bowel Disease (IBD) is focused on global patient care. Starting from basic knowledge of diagnostic and therapeutic management, nurses can assess the impact of IBD on patients’ quality of life not only at the physical level, but also at the psychological, social, and emotional levels. The aim of this study was to evaluate the impact of gastrointestinal symptoms on psychosocial changes in IBD patients in remission through nursing-led Patient-Reported Outcomes. Materials and Methods: We performed a cross-sectional study of 109 IBD patients in clinical and endoscopic remission. Specialist nurses invited patients to complete questionnaires on gastrointestinal symptoms and quality of life through the Patient-Reported Outcomes Measurement Information System (PROMIS). Results: We found that the gastrointestinal symptoms that the patients reported had a significant impact on the analyzed aspects of health. More specifically, belly pain, diarrhea, and bloating were associated with depressive symptoms (p < 0.001), anxiety (p < 0.001), fatigue (p < 0.001), and sleep disturbances (p < 0.001). Moreover, these symptoms also significantly affected patients’ social dimension in terms of satisfaction with participation in social roles (p < 0.001, p < 0.05, and p < 0.001 for belly pain, diarrhea, and bloating, respectively) and physical functions (p < 0.001). The results were virtually the same in a multivariable analysis adjusted by age, gender, body mass index (BMI), and disease duration. Conclusions: Even during remission, gastrointestinal symptoms are the main factors that influence quality of life in IBD patients. This exploratory study highlights the need to adopt validated questionnaires in clinical practice, and demonstrates that PROMIS is a valid, objective, and standardized instrument that can help nursing staff to better define the consequences of the disease in a patient’s daily life.

Nurses are Critical in Aiding Patients Transitioning to Biosimilars in Inflammatory Bowel Disease: Education and Communication Strategies

The increasing prevalence of inflammatory bowel disease and the high costs associated with biologic therapies suggest that biologics with lower costs, but no compromise on efficacy and safety, should be considered when developing a treatment plan for inflammatory bowel disease. Biosimilars offer a more cost-effective alternative, and although the European Medicines Agency has approved the use of biosimilars for many indications, including inflammatory bowel disease, patients may be concerned about the safety and efficacy of these agents. The updated Nurses-European Crohn's and Colitis Organisation statements, published in March 2018, recommend that inflammatory bowel disease nurses facilitate patient choice of biologic or biosimilar therapy. Nurses are pivotal in managing the challenges associated with patients transitioning to biosimilars. However, there is limited information available on how inflammatory bowel disease nurses can communicate the concept of biosimilars to patients and also on how best to support them before and during the switch from originators. This review article will focus on patients' concerns regarding biosimilars and describe considerations for nurses when supporting patients transitioning from originators to biosimilars. Through nurse-led patient education and the use of structured communication strategies, as well as investment in managed switching programmes, patients will become more confident and adherent to their biosimilar therapy, and this may lead to overall reductions in health-care expenditure for inflammatory bowel disease.

Creating a synergy effect: A cluster randomized controlled trial testing the effect of a tailored multimedia intervention on patient outcomes

OBJECTIVE

Improving adherence is a challenge and multiple barriers are likely to explain non-adherence. These barriers differ per patient and over course of the regimen. Hence, personalized interventions tailored to the specific barriers are needed. In a theoretical and evidence-based Tailored Multimedia Intervention, technology (online preparatory assessment, text messaging) was used as an add-on to a tailored counseling session (learned during a communication skills training), with the expectation of synergistic effects.

METHODS

A cluster randomized controlled trial was conducted in six hospitals, eight nurses and 160 chronic patients. Patient satisfaction with communication, beliefs about medication, self-efficacy and medication adherence were assessed at initiation of the treatment and after six months.

RESULTS

Intervention effects were found for patient satisfaction with nurses' affective communication and self-efficacy at the initiation of treatment. The effect on self-efficacy remained after six months.

CONCLUSION

By combining tailored counseling with technology, this intervention resulted in positive changes in important prerequisites of medication adherence.

PRACTICAL IMPLICATIONS

Technology can contribute significantly to health care providers' ability to tailor information to the patients' needs.

Establishing a nurse-led pelvic floor and functional bowel service

Jane Turner, Colorectal Nurse Specialist, Cardiff and Vale University Health Board, was awarded a travel scholarship by the Florence Nightingale Foundation. She used it to find out about the running of nurse-led pelvic floor and functional bowel services around the UK.

An important specialism

Inflammatory bowel disease (IBD) nurse specialists provide invaluable support and expertise to patients to help improve their quality of life and give them more control over their treatment.

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.

The Nurses who Specialise in Savings

Specialist nurses are far from just the 'icing on the cake' - in inflammatory bowel disease alone they are consistently preventing emergency attendances and ensuring the most appropriate use of services.

Support to Self Manage

The support of a specialist nurse can equip IBD patients to better manage their condition, thereby reducing dependency on hospital services. Claire Read reports.

Supporting Cost Effective Innovations in Treatment

Specialist IBD nurses at key to ensuring cutting edge biological therapies are used in a way which benefits both trust and patient, as Claire Read explains.

Bringing it All Back Home

Shrewd service redesign by specialist nurses can lead to greater efficiency for providers and better care for patients.

'Kate always treated me as a person, as well as a patient'

I was diagnosed with ulcerative colitis in 2008 and since then my inflammatory bowel disease (IBD) nurse specialist Kate Blight has been a vital member of the team overseeing my treatment. During a 3-year period when my health deteriorated and my hospital visits increased, she went beyond the call of duty many times to provide the best patient care.

Faecal incontinence intervention study (FINS): self-management booklet information with or without nurse support to improve continence in people with inflammatory bowel disease: study protocol for a randomized controlled trial

BACKGROUND

Inflammatory bowel disease, comprising Crohn's disease and ulcerative colitis, is a life-long currently incurable illness. It causes bouts of acute intestinal inflammation, in an unpredictable relapsing-remitting course, with bloody diarrhoea and extreme urgency to access a toilet. Faecal incontinence is a devastating social and hygiene problem, impacting heavily on quality of life and ability to work and socialise. Faecal incontinence affects 2-10 % of adults in the general population. People with inflammatory bowel disease have a high risk of incontinence with up to 74 % affected. No previous study has explored conservative interventions for these patients.

METHODS

This randomised controlled trial will recruit 186 participants to answer the research question: does implementation of the UK nationally recommended guidance approach to stepwise management of faecal incontinence improve bowel control and quality of life in people with inflammatory bowel disease? We have worked with people with inflammatory bowel disease to translate this guidance into a condition-specific information booklet on managing incontinence. We will randomise participants to receive the booklet, or the booklet plus up to four 30-minute sessions with an inflammatory bowel disease specialist nurse. To be eligible, patients must be in disease remission and report incontinence. The primary outcome measure at 6 months after randomisation is the St Mark's incontinence score. Other outcomes include quality of life, MY-MOP (generic tool: participants set two goals for intervention, grading goals at baseline and then re-scoring after intervention) and EQ-5D-5 L to enable calculation of quality-adjusted life years. Analysis will be on an intention-to-treat basis. Qualitative interviews will explore participant and health professionals' views on the interventions.

DISCUSSION

Few high-quality studies of conservative interventions in inflammatory bowel disease, and none for faecal incontinence, have been conducted. We have collaborated with patients to design this study. Blinding to this behavioural intervention is not possible, but our self-report outcome measures with a degree of objectivity. There is genuine equipoise between the booklet only and booklet plus nurse arms, and the study will determine if additional support from a nurse is a crucial element in implementing advice.

TRIAL REGISTRATION

clinitrials.gov.uk: NCT02355834 (Date of registration: 12 December 2014). Protocol version: 4.0. 08.04.15.

Work Foundation study calls for more IBD nurses

Boosting the number of specialist nurses caring for people with inflammatory bowel disease (IBD) will help people affected by the condition manage it at work, research published last week reveals.

[Therapeutic education, a factor of compliance and autonomy]

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.

Algorithm-based management of patients with gastrointestinal symptoms in patients after pelvic radiation treatment (ORBIT): a randomised controlled trial

BACKGROUND

Chronic gastrointestinal symptoms after pelvic radiotherapy are common, multifactorial in cause, and affect patients' quality of life. We assessed whether such patients could be helped if a practitioner followed an investigative and management algorithm, and whether outcomes differed by whether a nurse or a gastroenterologist led this algorithm-based care.

METHODS

For this three-arm randomised controlled trial we recruited patients (aged ≥18 years) from clinics in London, UK, with new-onset gastrointestinal symptoms persisting 6 months after pelvic radiotherapy. Using a computer-generated randomisation sequence, we randomly allocated patients to one of three groups (1:1:1; stratified by tumour site [urological, gynaecological, or gastrointestinal], and degree of bowel dysfunction [IBDQ-B score <60 vs 60-70]): usual care (a detailed self-help booklet), gastroenterologist-led algorithm-based treatment, or nurse-led algorithm-based treatment. The primary endpoint was change in Inflammatory Bowel Disease Questionnaire-Bowel subset score (IBDQ-B) at 6 months, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00737230.

FINDINGS

Between Nov 26, 2007, and Dec 12, 2011, we enrolled and randomly allocated 218 patients to treatment: 80 to the nurse group, 70 to the gastroenterologist group, and 68 to the booklet group (figure). Most had a baseline IBDQ-B score indicating moderate-to-severe symptoms. We recorded the following pair-wise mean difference in change in IBDQ-B score between groups: nurse versus booklet 4·12 (95% CI 0·04-8·19; p=0·04), gastroenterologist versus booklet 5·47 (1·14-9·81; p=0·01). Outcomes in the nurse group were not inferior to outcomes in the gastroenterologist group (mean difference 1·36, one sided 95% CI -1·48).

INTERPRETATION

Patients given targeted intervention following a detailed clinical algorithm had better improvements in radiotherapy-induced gastrointestinal symptoms than did patients given usual care. Our findings suggest that, for most patients, this algorithm-based care can be given by a trained nurse.

FUNDING

The National Institute for Health Research.

The role of psychological factors in inflammatory bowel disease

Evidence-based practice is one of the cornerstones of contemporary community nursing, and conflicting research evidence can therefore have serious implications for nurses' decision-making. A debate about the role of psychological factors in inflammatory bowel disease (IBD) has been going for over 80 years without reaching consensus and is cause for concern among clinicians. This article discusses the barriers to reaching consensus in the debate about the role of psychological factors in IBD, and why reaching a consensus to this debate is important for practitioners supporting IBD patients in the community. The aim is to raise awareness among community nurses when making sense of the contradictory evidence. The absence of clear and consistent research or guidelines can make it difficult to carry out evidence-based practice, and patient-centred care based on individual assessment of every person presenting with symptoms of IBD becomes even more important.

Patients assessing students' assignments; making the patient experience real

The care of patients with inflammatory bowel disease (IBD) frequently falls short of the highest standards. This is noted in several publications, including national standards, despite nursing students being taught the importance of listening to and understanding patients. Teaching staff at the University of Glasgow primarily responsible for teaching third year undergraduate nursing students undertook a radical rethink of the planning, delivery and assessment of lectures on IBD. The subject had previously been delivered in a modified lecture format. Although the topic could be included in the end-of-year exams, there was little evidence to show whether this traditional teaching method had any effect on students' clinical practice. In a novel approach to learning and assessment, students were invited to research and produce an information leaflet for newly diagnosed patients with IBD. The leaflets were then assessed and grades awarded by an expert panel of patients and carers. Such enquiry based learning (EBL) intended to demonstrate in practice, the key role patients can play in both undergraduate nurse education and in service planning and delivery in the National Health Service (NHS). The panel found the exercise both interesting and insightful, while the students reported being invigorated and felt the expert assessment meant they were forced to achieve a higher level of work.

[National survey on stoma appliances]

A stoma constitutes a surgical solution for diseases, most commonly cancerous, of the digestive or urinary systems or for inflammatory bowel diseases. In order to gain a better understanding of how people choose and use their stoma appliances, the French federation of stoma patients (FSF) carried out a survey of its members in 2004.

Specialist nursing interventions for inflammatory bowel disease

BACKGROUND

The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life.

OBJECTIVES

To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD).

SEARCH STRATEGY

A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008).

SELECTION CRITERIA

Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion.

DATA COLLECTION AND ANALYSIS

Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus.

MAIN RESULTS

One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences.

AUTHORS' CONCLUSIONS

Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.

Continence care for patients with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic illness that causes inflammation of the gastrointestinal tract. Symptoms commonly include frequency, urgency and faecal leaking or incontinence. This article discusses the causes of incontinence in IBD, medical and practical aspects of management and the role of the nurse in supporting patients living with often embarrassing symptoms.

Inflammatory bowel disease--nursing care during the surgery treatment period

Inflammatory bowel disease is highly associated with an option of potential surgical treatment. Variety of surgical methods require detailed and appropriate patient preparation for the operation. In our study we tried to present some problems in dealing with patients with inflammatory bowel disease in aspect of perioperative period. We discussed methods of solving these problems and expected effects of nursing procedures.

Irritable bowel syndrome and inflammatory bowel disease in pregnancy

Irritable bowel syndrome and inflammatory bowel disease are gastrointestinal disorders affecting young adults. The peak incidence of irritable bowel syndrome and inflammatory bowel disease is in the late adolescence and early adult years, the time during which many women are planning and beginning their families. Since the potential for life-altering changes and pregnancy complications exist with these diseases, affected pregnant women present a challenge for the gastroenterologist, pregnancy provider, and nurses caring for them. This article outlines what is known about these diseases and their effect on fertility and pregnancy as well as their clinical management during pregnancy.

Inflammatory bowel disease: symptoms in the bowel and beyond

Inflammatory bowel disease (IBD) is a chronic illness that patients may develop at any age. Clinicians often face puzzling symptoms before and after a patient's IBD diagnosis. This article details both typical and atypical presentations of this disease.

Telephone clinic improves quality of follow-up care for chronic bowel disease

The unpredictable course of inflammatory bowel disease means that many patients are in remission when they are scheduled to attend a follow-up appointment. They often face long, unnecessary waits in congested outpatient departments when they require only verbal intervention. This article describes a year-long pilot study by a team of nurses and a consultant which involved offering telephone support to IBD patients. The service reduced unnecessary follow-up, provided rapid help during periods of relapse and promoted individualised care.

Prevention of psychological distress in persons with inflammatory bowel disease

This paper presents an overview of IBD with a critical analysis of the causes and effects of psychological distress in persons with this illness. Based on this literature, risk factors for the development of psychological distress are delineated. It is recognition of these risk factors for the development and the early signs of psychological distress in this population that can enable nurses to prevent this unfortunate psychosocial consequence of this disease. Preventive interventions discussed include the following: treating comorbid psychiatric illness, enhancing problem-solving coping, facilitating mourning and grieving, reducing stress, enhancing the positive appraisal of uncertainty, increasing personal control, increasing social support, and educating patients, families, and others.

Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease

AIM

Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated.

METHODS

Physical and psychological well-being were assessed using questionnaires administered to 100 out-patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months.

RESULTS

Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF-36) scores for mental health were low in inflammatory bowel disease patients; 62.9 +/- 9.1 (SD) in ulcerative colitis, 60 +/- 9.8 (SD) in Crohn's disease, compared with 72.4 +/- 7.2 (SD) in healthy controls (P < 0.05). Mean SF-36 scores for social function were also reduced in Crohn's disease patients; 68.4 +/- 10.1 (SD) in Crohn's disease, compared with 87 +/- 10.1 (SD) in healthy controls (P < 0.05). As expected, the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 +/- 1.5 (SD) compared with 82.4 +/- 14 (SD) in healthy controls (P < 0.05). Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 +/- 3.7 (SD) in Crohn's disease patients and 6.86 +/- 3.5 (SD) in healthy volunteers (P < 0.05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index.

CONCLUSION

Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.

Evaluation of the effectiveness of a specialist nurse in the management of inflammatory bowel disease (IBD)

OBJECTIVE

To determine the effect of a specialist nurse on the management outcome of patients with inflammatory bowel disease (IBD).

DESIGN

Audit of the management of a cohort of patients in the year prior to the employment of the specialist nurse and the year immediately after.

SUBJECTS

339 patients, both male and female, with either Crohn's disease or ulcerative colitis, resident in the Cambridge health district.

SETTING

Addenbrooke's Hospital NHS Trust Outpatient Centre.

MAIN OUTCOME MEASURE

Health status was measured by blood tests (C-reactive protein, albumin and haemoglobin) throughout the year, symptom indices, number of clinic attendances, admissions to hospital and length of stay. Quality of life was measured via a postal questionnaire.

RESULTS

Hospital visits were reduced from 1377 to 853 (38% reduction) and in-patient length of stay measured in bed-days from 516 to 417 (19% reduction). The number of patients in remission increased from 63 to 69%. Patient satisfaction improved in key areas, in particular, access to information on IBD and advice on avoidance of illness and maintaining health. Of a total of 251 calls to the telephone helpline, only 19 patients were referred for a medical opinion and five patients required hospital admission.

CONCLUSION

The IBD nurse specialist is a valuable and cost-effective member of the gastroenterology team.

Doctor or nurse? The patients' choice

This project's aim was to assess patients perceived need for a specialist nurse in inflammatory bowel disease. A letter was sent to 64 patients with a summary of the potential role of a specialist nurse. Patients were asked to complete a questionnaire of 10 scenarios on who would be their preferred provider on the range of issues. There were 35 (55%) replies. When comparing the results between the consultant and the specialist nurse patients preferred to see a specialist nurse significantly in four scenarios, and patients preferred to see the consultant significantly in two scenarios. The results indicate that patients feel specialist nurses would have more time to discuss issues and they do not want to bother the busy doctors with them. But they do want doctors to carry out the medical aspects of their care.

The effects of inflammatory bowel disease on adolescents

Adolescence is a time of profound change for individuals. It is a period that witnesses biologic, social, and psychological change in the individual as well as role changes within the family and peer groups. Compounding these difficult transitions with the onset of inflammatory bowel disease leads to additional problems with adolescence adjustment. In the limited studies that have addressed the adolescent and inflammatory bowel disease, several key concepts emerge that point to ways for successfully dealing with these adolescent adjustment problems. Roy's Adaptation Model provides a foundation for identifying and selecting interventions in working with adolescents and chronic illness. A review of the literature finds the need for further study of the difficulties encountered by the changes of adolescence coupled with the onset of inflammatory bowel disease.

The birth and dissolution of an inflammatory bowel disease support group: lessons in providing support

In response to requests from the members of the local Crohn's and Colitis Foundation chapter, a nurse-facilitated support group was formed. Its goals were to provide support and information for people coping with inflammatory bowel disease (IBD). Despite the interest expressed by the membership, attendance at the monthly meetings was sporadic and sparse. Eventually the group ceased to exist. To understand why the group dissolved, each member was interviewed and asked the following open-ended questions: (1) What did you want from a support group? (2) Why did you not attend meetings regularly? (3) What, if anything, would have kept you coming to the group? Despite coping with IBD, most people described a normal life in which support from the family and established relationships was sufficient to meet their needs. Extra support, such as group support, was only perceived to be needed at certain key times. Innovative methods for providing support, when needed, are discussed.

Primary care for women. Management and treatment of gastrointestinal disorders

This article outlines the clinical management of common gastrointestinal disorders encountered in the primary care setting. The general assessment of a woman presenting with a gastrointestinal concern is reviewed. Diagnosis and management of acute and chronic diarrhea, constipation, irritable bowel syndrome, and anorectal disorders are covered with emphasis on client education. Gastroesophageal reflux disease and peptic ulcer disease is discussed with the latest treatment recommendations for Helicobacter pylori infection outlined. Diagnosis of gallbladder disease and gallstones with alternative treatment options is reviewed. Finally, the diagnosis and management of viral hepatitis is outlined. A case study is given to illustrate the basic principles needed by the nurse-midwife in the assessment, diagnosis, and management of a woman with a gastrointestinal concern.

Sexual health issues in inflammatory bowel disease

Alterations in sexual health caused by inflammatory bowel disease (IBD) may affect quality of life and disease status. IBD usually strikes adolescents or young adults, who are also facing developmental milestones important to sexual health. Issues include growth and development, body image, intimacy and sexual functioning, fertility, and pregnancy. A review of published research regarding these issues, in addition to suggestions for nursing assessment and interventions, is included in this article. Nurses must offer sensitive support and suggestions for coping. Nurses must be aware of the issues influencing sexual health when providing total care to clients with IBD.

Supporting the patient with inflammatory bowel disease

Inflammatory bowel disease is a term that describes Crohn's disease, colitis and proctitis. This paper considers the nurse's role in patient education, information and support for people with these conditions.