The nursing roles in caring for patients with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by recurring inflammation and severe mucosal damage in the intestine. In Taiwan, there has been a rapid increase in the incidence and prevalence of IBD, posing significant challenges for patient care.¹ A newly diagnosed patient with IBD may face uncertainty about the future and worry about their prognosis. Unfortunately, IBD is a chronic condition that can vary significantly in terms of its extent, severity, and activity. Some patients may develop disease that is refractory to available treatments, leading to a significant decline in quality of life.^{1, 2}

Refractory IBD patients are at increased risk of malnutrition and psychological complications.³ When assessing the reasons for treatment failure, it is essential to rule out any concomitant clinical conditions, evaluate potential disease complications, assess patient adherence to therapy, and explore opportunities for treatment optimization.² There are numerous factors that can influence medication adherence, including infections, pregnancy, drug delivery methods, and patient concerns about potential complications.^{1, 4} Among patients with IBD, medication nonadherence rates range from 7% to 72%. This is a significant contributing factor to treatment refractoriness or loss of response.⁵ According to the study, regarding concerns about adverse reactions, 38.8% of patients reported never or rarely feeling worried, while 40.3% felt sometimes worried, 12.8% often worried, and 6.1% always worried.⁵ A study revealed that the COVID-19 pandemic led to changes in the medical behavior of IBD patients. However, educational interventions by clinicians and IBD nurses successfully reduced anxiety levels and enhanced medication adherence.⁴ During pregnancy, clinicians or patients may also change the drug regimen due to concerns about side effects.¹

A multidisciplinary team (MDT) in IBD care consists of healthcare professionals from various disciplines who collaborate to provide comprehensive patient care. However, nursing roles within MDTs for IBD patients can vary significantly across different regions of the world.³ According to the second N-ECCO consensus statements on European IBD care, nurses working in any setting that involves contact with IBD patients need a fundamental understanding of the diseases, including the distinction between Crohn's disease and ulcerative colitis. They must also recognize the importance of timely therapeutic interventions. Nurses should cultivate empathy and active listening skills, and be able to provide essential IBD-related information and holistic support.⁶ In Taiwan, the institutionalization of IBD nurse specialists occurred in the late 2010s. According to the study, regarding the usefulness of IBD nursing services for disease education, medication education, and outpatient clinic scheduling, ~10.9%–12.5% of patients rated them as useful, while 78.1% rated them as very useful.⁵

Effective IBD management requires strict control of disease progression, utilizing an interdisciplinary, holistic approach. This is especially crucial for hospitalized IBD patients, where close collaboration between gastroenterologists and colorectal surgeons is essential.³ Furthermore, IBD nurses play a crucial role in the IBD MDT, acting as a bridge between gastroenterologists and colorectal surgeons. They address a wide range of patient care needs, from communication and therapeutic education to the management of more complex issues such as fistulas care.

The psychological morbidity of refractory IBD should be also recognized; this is driven by the impact of multiple treatment failures, the realization that disease outcome may be undesirable, frequent exposure to opioids, and the significant distress caused by fluctuation or unremitting symptom.³ The IBD clinician was unable to allocate sufficient time to discuss the entire disease course with patients. IBD nurses play a pivotal role in patient care, often encompassing patient education, disease management, nutrition counseling, and wound care. In addition, they assist patients with daily life aspects that can impact the course of the disease, such as diet and sexuality. They also address the psychological challenges that IBD patients may face.⁷

In conclusion, the role of IBD nursing is increasingly recognized globally, including in Taiwan, as a fundamental component of effective IBD healthcare services and is firmly established within the MDT.

The authors declare no conflicts of interest.