The Effects of a Motivation-Enhanced Self-Management Program for Female College Students with Irritable Bowel Syndrome

Purpose@#The purpose of this study was to develop a motivation-enhanced self-management (MESM) intervention for irritable bowel syndrome (IBS) and to evaluate its effects on female college students with IBS. @*Methods@#The program was constructed to reflect the conceptual framework of the self-determination theory including autonomous motivation enhancement strategy through the satisfaction of psychological needs. The experimental group (n=24) participated in the all eight weekly MESM sessions, and the control group (n=25) received one hour education of IBS. Primary outcome measures were the IBS symptom severity scale (IBS-SSS) and the IBS specific quality of life (IBS-QOL), and assessed at the baseline and at eight and 16 weeks after the allocation. Others were autonomous motivation, self-determined behavior, and psychological distress assessed at the baseline and at eight weeks. @*Results@#The experimental group showed improvement in the IBS-SSS (p<.001) at 16 weeks compared to the control group. They showed markedly more improvement in the IBS QOL (p=.008), but the magnitude of this difference decreased at 16 weeks. The experimental group showed improvements in autonomous motivation (p=.035), self-determined behavior (p=.023), and psychological distress (p=.044) compared to the control group. @*Conclusion@#Study results suggest that the MESM intervention for female college students may effectively improve the IBS-SSS and the QOL.

Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis / 정신간호학회지

PURPOSE: The aims of this study was to evaluate the effects of acceptance and commitment therapy (ACT) for chronic pain patients. METHODS: Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched the Cochrane Library, CINAHL, EMBASE, OVID, PubMed and Korean databases to identify randomized controlled trials published through May 2019. To estimate the effect size, a meta-analysis of the studies was performed using the R program, and the risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies. RESULTS: A total of 11 studies were included in this study. Studies were heterogeneous, and random effects models were used in the analyses. ACT was effective for improving pain (g=−0.40, 95%CI:−0.69~−1.12, p<.001, I2=80%), pain acceptance (g=1.24, 95% CI:0.41~2.05, p<.001, I²=95%), anxiety (g=−0.47, 95% CI:−0.81~−0.13, p<.001, I²=84%), depression (g=−0.52, 95% CI:−0.85~−0.19, p<.001, I²=85%), and quality of life (g=1.14, 95% CI:0.11~2.17, p<.001, I²=95%). CONCLUSION: Our study findings of the ACT seems to be effective for improving pain, pain acceptance, anxiety, depression, and quality of life in patients with chronic pain. Additionally, ACT may be useful for reducing barriers to therapy, and various studies should be attempted.

Factors Affecting Sleep Quality in Women with Cancer Undergoing Radiotherapy

PURPOSE: The purpose of this study was to investigate the severity of subjective sleep quality and factors related to sleep disturbances in breast and gynecologic cancer patients undergoing radiotherapy. METHODS: Ninety four women (68 breast cancer and 26 gynecologic cancer) undergoing radiotherapy were recruited and asked to complete the Pittsburg Sleep Quality Index (PSQI), Piper Fatigue Scale, and Hospital Anxiety Depression Scale. The data were analyzed using χ2-test, t-test, ANOVA and logistic regression. RESULTS: The average global PSQI score was 8.34±4.41 and 70.2% of the patients reported poor sleep quality (PSQI>5). There were significant differences between the poor sleepers and the good sleepers in concurrent chemo-radiotherapy (p=.022), number of radiation treatments (p=.013), total amount of radiation dosage (p=.048), sleeping pills (p=.030), fatigue (p<.001), anxiety (p<.001), and depression (p=.024). Logistic regression showed that significant predictors for poor sleep quality were fatigue and concurrent chemo-radiotherapy. CONCLUSION: These findings suggest that sleep disturbance was a significant health problem in patients with breast and gynecologic cancer who were receiving radiotherapy. Also that fatigue and concurrent chemo-radiotherapy were highly associated with sleep disturbance. However, limited evidence was found for the role of radiotherapy in the sleep disturbance of these patients.

The Effects of Case-Based Learning (CBL) on Learning Motivation and Learning Satisfaction of Nursing Students in a Human Physiology Course

PURPOSE: The purpose of this study was to investigate the effects of case-based learning (CBL) on learning motivation and learning satisfaction of nursing students in a human physiology course. METHODS: The development and application of CBL scenarios was conducted from February to June, 2013. Nursing students (n=142) who registered for a human physiology course were assigned into either a control or CLB group. The control group received traditional lectures for 14 weeks. The CBL group received the same 14-week lectures and an additional 5 CBL sessions. The learning motivation and satisfaction were measured by questionnaires at the beginning and the end of the semester. Seven students in the CBL group were randomly selected for a focus-group interview. Quantitative data were analyzed by chi2-test and t-test, and qualitative data were analyzed by content analysis. RESULTS: The learning motivation and learning satisfaction were not significantly different between the two groups. However, 59% of the CBL group answered with a positive impression on the CBL approach as it helped them to feel a sense of achievement, excitement, to form their identity as nursing students, and so on. CONCLUSION: These findings suggest that the CBL could be a challenging but useful learning method in a physiology course for nursing students. Further studies with guidance, such as instructors' questions and feedback design are needed to utilize CBL more effectively.

The Relationship of Eating Habits and Trigger Foods to Symptom Severity of Irritable Bowel Syndrome

PURPOSE: The purpose of this study was to investigate eating habits and the frequency of trigger-food consumption in patients with irritable bowel syndrome (IBS) and to examine the associations of these variables with IBS symptom severity. METHODS: We included 145 ROME III-positive IBS patients (mean age 31.2 years, 73.8% of female). Subjects completed an eating-habits and food- consumption questionnaire, IBS-Symptom Severity Scale (IBS-SSS) and Brief Symptom Inventory-18 (BSI-18) for psychological distress. RESULTS: Subjects with unhealthy eating-habits such as irregular meal times, frequently eating out and overeating tended to show higher IBS symptom severity. The severity of IBS symptoms related to the frequency of the consumption of trigger foods. Subjects who ate trigger-foods (i.e., tofu, beans, almonds, and peanuts) less frequently showed higher IBS symptom severity (p=.045, .042, .016, and .019, respectively). However, subjects who ate spicy foods, instant foods, and noodles more frequently experienced more severe IBS symptoms (p=.018, .011, and .023 respectively). CONCLUSION: This study showed that IBS symptom severity was related to meal intake patterns and frequency of trigger food consumption. These findings could provide a basis for developing an intervention program for IBS patients.

Update on Irritable Bowel Syndrome Program of Research

PURPOSE: This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS). METHODS: This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model. RESULTS: IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep. CONCLUSION: The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.