scholarly journals N29 Application of the AREA model to a standard care plan for patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S670-S671
Author(s):  
M I Mateos Hernandez

Abstract Background The clinical characteristics of the inflammatory bowel disease (IBD), its psychosocial/occupational impact and the increase in its incidence and prevalence, justify the proliferation of Multidisciplinary Care Units (with reference nurses for patients). The standardisation of care and the recording of the performance of the professionals that integrate them are necessary to give continuity to the care, to value the role of each of them in these, to reduce the variability in clinical practice and the collection of data that allow decision-making at the management and research assistance level. All of the above plus the existence in our country of legal regulations that define and regulate the records of mandatory existence and completion in the medical records, of our patients has made us set ourselves as a general objective: Develop a standard nursing care plan for the care of patients with IBD. Methods A literature review of the literature published in the last 10 years in the Medline, Cocharane, Cinahl and Cuiden databases is carried out. The search criteria establish the existence of the words ‘Care plan’ ‘nursing care’ and ‘nursing diagnoses’, all of them combined with IBD. Natural words bounded by the limits determined in the inclusion criteria. The needs model of Virginia Henderson (Institutional model) is used for the assessment and for the diagnosis, objectives and planning of nursing interventions the taxonomies NANDA, NOC, and NIC (NNN). Finally, in order to achieve a realistic and applicable plan of care taking into account, criteria of average hospital stay per process, and average time of outpatient care, we apply the AREA model (Analysis of Current State Outcomes) of Pesut1. Results The assessment highlights the altered needs: food, disposal, safety mobility, self-realisation, values and communication beliefs. In relation to the diagnoses, we classify them into clinical, psychosocial and secondary to the treatment, discriminating those written as diagnosed by nurses and therefore resolved or minimised autonomously by the nurses from whom they should be considered as collaborative problems. Normality characteristics are defined by protocol. Conclusion The model favours a broad and comprehensive view of the situation, leading to the selection of the diagnosis (or more than three) that allows the holistic approach to be effective and efficient. It would allow us to know the prevalence and incidence of diagnoses and agree on objectives and activities to establish comparison patterns.

2013 ◽  
Vol 105 (5) ◽  
pp. 262-271 ◽  
Author(s):  
Antonio Torrejón ◽  
Lorena Oltra ◽  
Paloma Hernández-Sampelayo ◽  
Laura Marín ◽  
Valle García-Sánchez ◽  
...  

2021 ◽  
pp. 1753495X2110097
Author(s):  
Mandeep K Kaler ◽  
Madeleine Malina ◽  
Klaartje Kok ◽  
Rehan Khan

Objectives Evaluate the management of pregnant women with inflammatory bowel disease. Method We collected data from maternity records for women with IBD who gave birth at The Royal London Hospital between January 2018 and February 2019. Results Twenty-three pregnancies were identified where 8/23 (35%) women had a peri-conception flare and 7/23 (30%) had a flare during pregnancy. Two women received pre-conception counselling. The obstetric medicine team reviewed a patient on average three times and the gastroenterologists twice, during pregnancy. Nine women (39%) gave birth pre-term. Mean birthweight was lower in the group with active disease at conception compared with those in remission (2173 g vs. 2807 g, p = 0.03). Conclusions Women with IBD should all receive pre-conception counselling to reduce the risk of pregnancy complications. By developing a multidisciplinary care pathway for pregnant women with IBD (which includes a joint obstetric/gastroenterology clinic), this will ensure care is standardised throughout the pregnancy and puerperium.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S616-S616
Author(s):  
C Conmy

Abstract Background Inflammatory bowel disease is a chronic condition of the bowel which is known to be very challenging for patients especially during times of active disease or flare ups of their symptoms. Those affected have to adapt their lives to the chronic nature of their condition. The aim of this review was to synthesise qualitative evidence on the perceptions and experiences of those living with inflammatory bowel disease on nursing care received in all health care settings and identify barriers and facilitators for optimal nursing care. Qualitative evidence synthesis guided by Thomas & Harden’s (2008) method of thematic synthesis was used. Methods A systematic search was carried out in CINAHL, Embase, Medline, Cochrane and Google Scholar using combinations of key words. Searches were imported into Covidence which is an online software product used for systematic reviews. Title and abstract screening and full text screening were carried out to screen for eligible papers. Included studies were critically appraised using Critical Appraisal Support Programme (CASP) and thematic synthesis of the data was conducted. Eleven studies were included in the synthesis. Results From the thematic synthesis of the included studies three analytical themes were developed; 1) Meaningful care for patients, 2) Accessible support and information 3) “A constant” for people with IBD. Conclusion This review demonstrated the positive and negative experiences of patients with inflammatory bowel disease on the nursing care they received. It raises key issues for patients which can be addressed by nursing when caring for patients. The results will inform nursing on what is important to patients and how their healthcare needs can be met in all settings. This review will also support evidence for nurses to obtain resources and improve patient care.


1988 ◽  
Vol 2 (2) ◽  
pp. 53-56 ◽  
Author(s):  
B.R. Pinchbeck ◽  
J. Kirdeikis ◽  
A.B.R. Thomson

This paper attempts to estimate the cost of inflammatory bowel disease (IBO) to the health care system of Alberta. In the 1015 patients responding to a questionnaire, two types of direct costs were compared to provincial averages; physicians' fees and hospital costs. Costs were calculated using the Alberta Health Care Insurance Plan prescribed billing races. The 15-to 24-year-old age group exhibited the highest annual physician fees. This was probably due to the high incidence rate of IBD in this group. The mean cost per patient-year for Crohn's disease was estimated to be $4400 and the mean cost for ulcerative colitis was estimated to be $3020; this did not include outpatient laboratory or radiological investigations, and as such represents an underestimation of the total costs to the health care system. However, only a small minority of the patients were using a large majority of the resources: for example, for both Crohn's and ulcerative colitis, 7% of the patients accounted for 69% of hospital days. The average hospital and physician associated costs declined markedly with duration of the disease. It is estimated that the future cost of IBO to the provincial health care system (the percentage of the provincial health care budget used to diagnose and treat IBO) will double from 1985 to 2000. This underscores the need for continued and expanded research into the cause and treatment of IBO, and the importance of maintaining a health care system which can respond to the needs of these patients.


2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S669-S670
Author(s):  
S Fourie ◽  
W Czuber-Dochan ◽  
C Norton

Abstract Background Inflammatory bowel disease (IBD) affects every aspect of one’s life, yet no routine assessment for the impact on sexuality is made. Our aim was to explore patients’ perspective on healthcare professionals (HCPs) addressing sexuality/sexual well-being concerns. Methods This was a qualitative narrative study. Inclusion criteria were any sexual orientation and with known IBD for longer than 18 months. Data were collected via semi structured interviews and anonymous narrative accounts submitted via Google Forms. Thematic analysis was used to analyse the data. Results Fourteen adults, 4 male and 10 female, took part. Eleven participants were from the UK, one from the USA of America and one for South Africa. The following main themes and subthemes were identified: I cannot imagine talking about my sex life (a difficult topic; there is not enough time), Those who talked about sex, talked badly (nobody volunteered information; badly handled conversations), Still living whilst unwell (sex is an important part of my life; sex issues break down relationships, medicalised body), IBD ruined my sex life (feeling unattractive; feelings of shame and embarrassment), I feel unheard (HCPs don’t open the discussion; sex not taken seriously), I’m a person, not my IBD (holistic approach to care; time, space and ways to talk about sex). The findings reflect the importance of sexual well-being to those living with IBD, the experiences of such conversations, barriers to conversations with HCPs on sexual well-being, and suggestions on how HCPs should address their unmet needs. The importance of discussing intimacy and sexuality was emphasised, as participants felt their sexual well-being was considerably affected by IBD. The majority reported that HCPs did not initiate discussions on sexual well-being, nor did they understand the impact of IBD on sexual well-being, with a distinct accent on the perceived lack of a holistic approach to their care. Therefore, participants made suggestions for practice, such as provision of information related to sexual well-being in the form of leaflets, additionally to HCPs raising the issue. Conclusion Our findings indicate that communicating on sexuality/sexual well-being is a problematic area of IBD care. HCPs must be cognisant of the sexual well-being concerns and needs of those living with IBD, who want this topic discussed routinely, as part of a holistic approach to their clinical care.


Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 286
Author(s):  
Jennifer Verrill Schurman ◽  
Craig A. Friesen

While the biopsychosocial nature of inflammatory bowel disease (IBD) is now well accepted by clinicians, the need for integrated multidisciplinary care is not always clear to institutional administrators who serve as decision makers regarding resources provided to clinical programs. In this commentary, we draw on our own experience in building successful integrated care models within a division of pediatric gastroenterology (GI) to highlight key considerations in garnering initial approval, as well as methods to maintain institutional support over time. Specifically, we discuss the importance of making a strong case for the inclusion of a psychologist in pediatric IBD care, justifying an integrated model for delivering care, and addressing finances at the program level. Further, we review the benefit of collecting and reporting program data to support the existing literature and/or theoretical projections, demonstrate outcomes, and build alternative value streams recognized by the institution (e.g., academic, reputation) alongside the value to patients. Ultimately, success in garnering and maintaining institutional support necessitates moving from the theoretical to the practical, while continually framing discussion for a nonclinical/administrative audience. While the process can be time-consuming, ultimately it is worth the effort, enhancing the care experience for both patients and clinicians.


2019 ◽  
Vol 1 (3) ◽  
Author(s):  
Benjamin Click

With rising interest in multidisciplinary care models for inflammatory bowel disease, the optimal team arrangements, roles, and dynamics are unknown. This editorial comments on the importance of work addressing this issue in an inflammatory bowel disease patient-centered medical home model.


2017 ◽  
Vol 9 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Pritesh S Morar ◽  
Nick Sevdalis ◽  
Janindra Warusavitarne ◽  
Ailsa Hart ◽  
James Green ◽  
...  

ObjectiveTo obtain a specialist-based consensus on the aims, format and function for MDT-driven care within an inflammatory bowel disease (IBD) service.DesignThis was a prospective, multicentre study using a Delphi formal consensus-building methodology.SettingParticipants were recruited nationally across 13 centres from July to August 2014.Participants24 participants were included into the Delphi Specialist Consensus Panel. They included six consultant colorectal surgeons, six gastroenterologists, five consultant radiologists, three consultant histopathologists and 4 IBD nurse specialists.InterventionsPanellists ranked items on a Likert scale (1=not important to 5=very important). Items with a median score >3 were considered eligible for inclusion.Main outcome measuresConsensus was defined with an IQR ≤1. Consensus on categorical responses was defined by an agreement of >60%.ResultsA consensus on items (median; IQR) that described the aims of the MDT-driven care that were considered very important included: advance patient care (5;5-5), provide multidisciplinary input for the patient’s care plan (5;5-5), provide shared experience and expertise (5;5-5), improve patient outcome (5;5-5), deliver the best possible care for the patient (5;5-5) and to obtain consensus on management for a patient with IBD (5;4-5). A consensus for being a core MDT member was demonstrated for colorectal surgeons (24/24), radiologists (24/24), gastroenterologists (24/24), nurse specialists (24/24), dieticians (14/23), histopathologists (21/23) and coordinators (21/24).ConclusionsThis study has provided a consensus for proposed aims, overall design, format and function MDT-driven care within an IBD service. This can provide a focus for core members, and aid a contractual recognition to ensure attendance and proactive contribution.


2019 ◽  
Vol 114 (1) ◽  
pp. S3-S3
Author(s):  
Jaqueline Barros ◽  
Madhoor Ramdeen ◽  
Julio Baima ◽  
Rubia Alencar ◽  
Rogerio Saad-Hossne ◽  
...  

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