The role of nursing staff in IBD 

Inflammatory bowel disease (IBD) is chronic in nature. This means that the disease evolves over time in different ways and it is necessary to support the patient on an ongoing basis, since living with it often has a high impact on the quality of life of the patients and their families, affecting them not only physically, but in all areas of their lives: their social lives, families, relationships, work, school and emotional state. This circumstance requires specialised health professionals: medical teams, psychological care and nursing professionals.

Some more frequent symptoms, such as pain, fatigue, tiredness, body image disorders, or inflammation, can affect mood and generate high levels of stress, anxiety and an increased risk of depression. All of this can lead to abandonment of treatments, an increase in outbreaks and, as a result, poor control of the disease, making an interdisciplinary and multidisciplinary approach essential.

The appearance of symptoms, sometimes non-specific, throughout the course of the disease requires fluid communication between the different care centres and easy access to both the medical and nursing teams so that the patient can receive care adapted to their physical, emotional and professional needs.

For this reason, it is common to find a specialised team, trained and up-to-date on inflammatory bowel disease, in referral centres. In addition, in order to meet these needs, the N-ECCO (Nurses-European Crohn’s & Colitis Organisation) was created at european level to standardise criteria and share experiences that enrich the work carried out by these professionals when accompanying patients with IBD, so that this work is as optimal as possible and adapted to their individual and specific needs.

How does a nurse help a patient with IBD?

The bond that is created between the medical team and patients suffering from a chronic disease is very close. They all work hand in hand so that the patient understands and accepts their disease as soon as possible after diagnosis in order to integrate it into their daily life, taking into account each person’s specific needs.

This is why the nursing team performs vital work in order to design a specific care plan for each patient. These include the following:

• Establishing the beginning of a trusting relationship with the patient.
• Providing the patient with quality information so they can understand the disease and its care, resolve any doubts they may have about it and introduce healthy habits into their life that improve their autonomy and control of the disease.
• They provide information on how to access the IBD Unit, explaining how visits to the IBD Unit are organised, when it is necessary to go there, what are the warning signs and symptoms of the disease and how to act in each case.
• Helping and supporting the patient in the acceptance of the disease: understanding the impact it will have on their life in the future, the potential limitations they may face and the changes they will need to introduce in their life at each stage of their disease.
• Detecting the need for emotional support during this period or at certain times throughout the disease so that their quality of life is affected as little as possible.
• Checking the patient’s immunisation status before starting any immunosuppressive treatment and scheduling, updating and administering the necessary vaccinations and recording their effectiveness.
• Involving and educating the patient on the importance of adherence to treatment as the best strategy for successful disease management and flare-up prevention.
• Administering some pharmacological medications or hospital therapies and carrying out and necessary session planning, test requests or coordination with other medical teams, as well as educating and informing the patient regarding pre- and post-treatment precautions, if necessary.
• As it is an immunological disease, it is possible that some extraintestinal manifestations may appear that require treatment or other types of follow-up by the nursing staff, as well as multidisciplinary management.

Situations that may require contact with a nurse

There are a wide variety of situations that may require consultation with nursing staff. We will highlight some of them below:

• Suspicion of worsening of the disease or presence of symptoms associated with the onset of an flare-up.
• Doubts regarding prescribed medical treatments (dosage, regimen, form of administration, side effects, interactions, etc.).
• Requesting scheduled follow-ups of the disease.
• Requesting information on pending diagnostic tests and the necessary preparations for such tests.
• Gathering information on topics related to the disease (symptoms, extraintestinal manifestations, diet, healthy lifestyle habits, exercise, consumption of toxins, sexual relations, pregnancy, breastfeeding, medications, vaccines, contraceptives, travel, etc.).
• Verifying the information about the disease obtained from different sources (internet, family, friends, etc.).
• Communicating the presence of changes and discomfort in the perianal area.
• Checking the appearance of extraintestinal manifestations of IBD (dermatological, ophthalmological, rheumatological and nephrological).
• Reporting a pregnancy or clarifying related doubts.

Role of the nursing team in patients undergoing surgery

When surgery is part of the treatment of IBD, the nurse has a very important role to play in resolving any possible doubts or problems that may arise regarding the management, handling and acceptance of the ostomy, if necessary. A nurse specialised in ostomy care, advice and/or counselling is called a stomal therapist.

The placement of an ostomy pouch can be a challenging experience for some patients, not only on a practical level but also on an emotional level. This procedure is performed through surgery, so for it to work successfully, close communication with the patient should be established both before and after surgery, informing the patient about the preoperative period and also seeking a space where they can express their concerns and doubts, not only physical, but also emotional, both for the acceptance of the ostomy, and so that, in the future, the effectiveness of this measure is not compromised, providing clear guidance on the care and maintenance of the ostomy.

In short, nurses are an essential part of the team of healthcare professionals who will accompany people suffering from IBD throughout the course of their disease. In addition, they will often be the direct and most common point of contact with the patient for the entire medical team, playing a key role in establishing and promoting good communication with the rest of the medical team.

• https://www.ecco-ibd.eu/about-ecco/ecco-operational-board/n-ecco.html