[Impact of the incorporation of a nurse in an inflammatory bowel disease unit]

Obstacles to Medication Adherence for Patients with Inflammatory Bowel Disease: A Qualitative Study in East China

Purpose

To identify the factors impacting medication non-adherence in patients with inflammatory bowel disease (IBD) in China, and to provide a reference for effective interventions.

Patients and Methods

Individual semi-structured interviews were conducted between December 2020 and July 2021 in four tertiary hospitals in East China. A conventional content analysis method was used in data analysis to extract themes and sub-themes in IBD Patients with poor medication adherence.

Results

The 10 participants included were those who were diagnosed with IBD at least 1 year and could provide rich information and express strong desire. Seven themes emerged after data analysis: (a) non-acceptance of disease; (b) Lack of cognition of disease; (c) medication beliefs; (d) perceived efficacy; (e) Forgetting and delays; (f) costs of medication; (g) personality and psychological factors.

Conclusion

Our data confirmed that in addition to comprehensive disease education and effective communication, medical staff should also pay attention to individualized factors, and develop effective response strategies for medication management support to reduce recurrence and control the disease.

Proposals for the incorporation of the nursing role in the certification of axial spondyloarthritis units. Literature review and expert consensus

OBJECTIVE

To analyse the role of nursing in the approach to axial spondyloarthritis (axSpA) and to make proposals to include the role of rheumatology nursing consultations (RECs) in the quality certification of these specialized units.

METHODS

A systematic review of the nursing role in quality certification systems in the management of axSpA was conducted. Subsequently a consensus conference was held with the participation of three rheumatology nurses to determine elements that should be considered in future revisions of certification standards.

RESULTS

The systematic review yielded five papers as relevant. None of the publications reviewed explicitly proposed standards applicable to nursing care in the management of patients with axSpA, although they contemplated the activities of this professional group. The proposals agreed upon to incorporate the role of RECs in the certification standards for axSpA monographic units included the following: basic equipment and resources, organization, administration of pharmacological treatments and promotion of adherence, standardized programmes for axSpA, telematic consultation for monitoring the stable patient, registry of patient-reported outcome measures and e-consultation.

CONCLUSIONS

The literature on quality standards and certification standards for axSpA monographic units is scarce and hardly reflects the role of RECs in providing quality care. The consensus proposals in this study would incorporate RECs into quality certification standards. In the future, the increased presence of RECs in Spain should be accompanied by a review of the indicators regarding their role.

Patient Understanding of "Flare" and "Remission" of Inflammatory Bowel Disease

Patients with inflammatory bowel disease have adopted medical jargon terms of "flare" and "remission," but what they mean by these terms is ill-defined and may have implications for nurse-patient communication and treatment expectancy. The aim of this study was to elicit patients' understanding of "flare" and "remission." Individuals with self-reported inflammatory bowel disease were recruited through social media. A web-based survey, with closed and open-ended questions, was administered. Conventional content analysis was used to evaluate respondents' perceptions of jargon terms. A word cloud was generated to augment analysis by visualization of word use frequency. A majority of the 34 respondents had a symptom-focused understanding and described these terms as alternating states. Various symptoms were understood to signify "flare," which was largely attributed to lifestyle factors. Corroborated by the word cloud, there was rare mention of inflammation or tissue damage. This study demonstrates that an understanding of "flare" and "remission" by patients with inflammatory bowel disease is largely symptom-based. The role of inflammation, medication failure, and targets of inflammatory bowel disease treatment beyond symptom control are not currently well known to patients with inflammatory bowel disease. To create a shared understanding of symptoms and treatment goals between the patient and the nurse, patient education on emerging expectations of inflammatory bowel disease care should be prioritized.