Specijalne sestrinske intervencije za upalne bolesti crijeva
Abstract
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.
PICO
Plain language summary
Savjetovanje specijalizirane medicinske sestre za pacijente s upalnom bolesti crijeva
Broj i vrsta sestara specijaliziranih za probavne bolesti i upalne bolesti crijeva se povećava, zajedno sa različitim ulogama koje obavlja u srbi za bolesnikova i liječenju. Ovaj Cochrane sustavni pregled uključuje jedno ispitivanje loše kvaliteteu kojem je istražena intervencija specijalizirane medicinske sestre savjetnika u odnosu na rutinsku ambulantnu kliničku praksu. Nisu prikazani podatci o rezultatima remisije. Savjetovanje medicinske sestre može poboljšati kvalitetu života povezanu s duševnim zdravljem kod nekih pacijenata s upalnom bolesti crijeva u kratkom roku. No, loša kvaliteta jednog uključenog ispitivanja ne dozvoljava nikakve definitivne zaključke u pogledu utjecaja programa medicinske sestre savjetnika. Potrebne su bolje provedene studije za procjenu utjecaja specijalnih sestrinskih intervencija na njegu i liječenje pacijenata s upalnim crijevnim bolestima.
