Intervention Review

Specialist nursing interventions for inflammatory bowel disease

  1. Ruth Belling*,
  2. Susan McLaren,
  3. Leslie Woods

Editorial Group: Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 29 SEP 2008

DOI: 10.1002/14651858.CD006597.pub2

How to Cite

Belling R, McLaren S, Woods L. Specialist nursing interventions for inflammatory bowel disease. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006597. DOI: 10.1002/14651858.CD006597.pub2.

Author Information

  1. London South Bank University, Institute of Strategic Leadership & Service Improvement, London, UK

*Ruth Belling, Institute of Strategic Leadership & Service Improvement, London South Bank University, 103 Borough Road, London, SE1 0AA, UK. bellinri@lsbu.ac.uk. r.belling@ntlworld.com.

Publication History

  1. Publication Status: New
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Specialist nurse counselling interventions for patients with inflammatory bowel disease

The number and type of gastroenterology and inflammatory bowel disease specialist nurses is increasing, along with the variety of roles performed in patient care and management. This review included one low quality trial of a specialist nurse counselling intervention compared with routine outpatient clinic follow up. No data were reported on remission outcomes. Counselling by a specialist nurse might improve mental health related quality of life for some IBD patients in the short term. However, the poor quality of the one included study does not allow for any definitive conclusions regarding the impact of the nurse-led counselling program. Better designed studies are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

炎症性腸病的專科護理介入

致力於照護和管理炎症性腸病患者之專科護士的數目、類型和任務與日俱增。儘管數字增加,但迄今仍少有證據證明專科護理介入的效力。此文獻回顧旨在確認及評估專科護理介入對炎症性腸病管理,包括治療、緩解、罹病率及生活品質的影響。

目標

確認及評估專科護理介入對改善炎症性腸病(IBD)患者之照護及管理的影響。

搜尋策略

針對資料庫全面搜尋,包括Cochrane Library、MEDLINE和British Nursing Index等,以找出相關試驗。搜尋出相關研究的參考資料,並翻閱相關出版品,包括腸胃病學會議的會議記錄,以找出更多的試驗(最後搜尋日期為2008年9月30日)。

選擇標準

所選擇的試驗包含隨機對照試驗、研究之前及之後進行對照的試驗,以及腸胃病和炎症性腸病專科護士欲改善潰瘍性結腸炎和克隆氏病患者之診療利用及結果的間斷時間序列研究試驗。

資料收集與分析

二位研究員各自獨立選用數據資料及評估試驗的品質。歧異點以討論取得共識解決。

主要結論

一項有100位炎症性腸病患者接受一位專科護士於研究開始、6個月和12個月時到府諮商服務(n = 50)或固定門診追蹤及評估(n = 50)的隨機對照試驗,納入此回顧研究。此項研究的研究方法品質較差。關於疾病的緩解、患者的遵囑性、臨床症狀的改善、護士到府服務的利用、患者的滿意度、住院人數、門診病人的到診率、手術進展、住院期及成本效率等數據資料皆無報導。在6個月後,接受護士到府服務的患者,其心理健康的平均分數比接受固定追蹤患者的分數高。不過差異並無統計上的意義(WMD 3.67; 95% CI 0.44 −.77; P = 0.08)。而身體上和心理學上的評估也無統計上的明顯差異。

作者結論

雖然專科護理諮商介入可能對炎症性腸病患者有益處,不過因此研究的品質不佳,故應謹慎詮釋其研究結果。需要進行較高品質的腸胃病及炎症性腸病專科護理介入研究,以評估專科護理介入對炎症性腸病患者之照護及管理的影響。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

炎症性腸病患者的專科護士諮商介入。照護和管理炎症性腸病患者之專科護士的數目、類型和任務多樣性與日俱增。此文獻回顧包括了一項品質不佳的試驗,此試驗是有關專科護士諮商介入與固定門診追蹤的比較。但此試驗對患者病症緩解的結果並無報告。專科護士的諮商可能可以短期地為一些炎症性腸病患者改善與心理健康有關的生活品質。然而,此項研究因品質不佳,故對於護士所引導的諮商服務所造成的影響並無法得到可靠的結論。因此需要設計較好品質的研究,以評估專科護理介入對炎症性腸病患者之照護及管理的影響。