The role of the nurse in behavioural therapy (biofeedback).

The clinical nurse specialist plays an essential role in the treatment of patients with functional bowel disorders, a group of patients who are traditionally difficult to manage medically or surgically.

The role of the specialist nurse in pelvic floor dysfunction.

Pelvic floor dysfunction can have a devastating effect on people's lives. The specialist nurse can play a vital role within the multidisciplinary team to help improve the quality of life for these patients by offering conservative management and support through surgical treatment options.

Natural killer cell function and psychological distress in women with and without irritable bowel syndrome.

The primary purpose of this exploratory study was to compare percentages of natural killer (NK) cells and activated NK and T cells, and both cytotoxic and in vitro cytokine production activity in women with and without symptomatic irritable bowel syndrome (IBS). A secondary purpose was to examine the relationships of psychological distress and low sense of coherence with immune function indicators and stress hormones. NK cell percentage and activity have been shown to vary in response to many psychological and physiological stressors. The authors compared 2 groups of women: symptomatic IBS (n = 12) and control (n = 12). Between-subject variability for all immune measures was large. The percentage of activated NK and Tcells was significantly lower in the IBS group compared to control (Mann-Whitney U = 30, P = 0.05). Relationships were significant between activated NK and T cell percentage and depression, anxiety, and overall distress (r = -0.54, -0.49, and -0.47, respectively, P < 0.03) and between interferon-gamma production and anxiety (r = -0.45, P < 0.03). There was a trend toward a positive relationship between sense of coherence and NK cytotoxicity (r = 0.39, P = 0.11). Thesefindings are important because they suggest that nursing interventions targeting ongoing physical and psychological distress might also be helpful in improving immune function.

Irritable bowel syndrome: more than a gut feeling.

Irritable bowel syndrome (IBS) is a common functional bowel disorder that affects approximately 8% to 20% of the populations of industrialized countries. In most countries the majority of patients seeking health care services for IBS are women. During the past 10 years there has been a remarkable growth in both basic and clinical research on IBS. At the same time, new drugs are currently under investigation for their efficacy in the management of IBS. This review is intended to cover the current research related to the etiology and pathophysiology of IBS, as well as the diagnosis and management of this condition. Because nurses are frequently at the forefront of assessing and managing patients with this condition, nursing care issues are addressed.

Women's colonic digestive health.

Digestive problems in women are common and sometimes debilitating. Twenty percent of women suffer from irritable bowel syndrome, 20% have constipation, and all American women will need screening for colon cancer, the number two cause of cancer death in women. This article reviews management of these disorders as well as lower gastrointestinal symptoms associated with menses, hysterectomy, fecal incontinence, and rectal bleeding.

Irritable bowel syndrome. A survey of nurses' knowledge.

Nurses in a variety of clinical settings are often involved in educating and managing patients with irritable bowel syndrome, though their knowledge and perceptions of irritable bowel syndrome are not well known. A national survey was undertaken as a part of a larger study of patients and healthcare providers to determine nurses' knowledge of irritable bowel syndrome, including diagnosis, etiology, disease impact, management, beliefs, and attitudes regarding irritable bowel syndrome. In addition, the nurses' perceptions of the effect of irritable bowel syndrome on the patient's lifestyle and the severity of symptoms were compared to those of irritable bowel syndrome patients. One hundred practicing registered nurses were randomly selected and then interviewed by telephone using a questionnaire. A random-digit dialing method was used to identify and recruit 1,014 women with irritable bowel syndrome. The majority of registered nurses interviewed (75%) felt that nurses played a moderate-to-major role in counseling patients with irritable bowel syndrome. Only 13%, however, were aware of the diagnostic criteria for irritable bowel syndrome. The majority of nurse subjects felt the current therapies for irritable bowel syndrome had limited effectiveness varying from 6-21% depending on the symptom being treated. Almost half of the nurses felt they had an important role in management of irritable bowel syndrome and that both they and their patients needed more education about irritable bowel syndrome. There was close agreement between the nurses and the patients with regard to the impact of irritable bowel syndrome. With increased public attention on irritable bowel syndrome as a common problem affecting women, there is a need for nurses working in a variety of settings to have increased knowledge regarding the syndrome. In this article, recommendations are made regarding how to increase nurses' knowledge about this common health problem.

Learning needs of Taiwanese nurses caring for patients with irritable bowel syndrome.

This study, building on work on irritable bowel syndrome conducted by Letson and Dancey (1996), explores Taiwanese nurses' knowledge, perceptions and beliefs about caring for patients with irritable bowel syndrome (IBS). A 46-item questionnaire was completed voluntarily by 120 registered nurses from a large tertiary acute care facility in Taiwan. The study used a descriptive research design and a questionnaire was developed that used a five-point Likert scale (strongly agree = 5, to strongly disagree = 1). The questionnaire consisted of six categories: demographic information; nurses' sources of IBS information; nurses' knowledge about IBS; nurses' perceptions about patients with IBS; nurses' beliefs about IBS; and learning requirements for nurses. Overall, the results indicted that Taiwanese nurses who participated in this study had little specific knowledge of IBS. The researchers developed a booklet containing information on the condition of IBS that may be used by the participants in this study to fill the knowledge gaps about this condition and provide useful information.

Management of bowel dysfunction: evacuation difficulties.

Bowel dysfunction affects many people and encompasses a variety of problems. This article examines the different forms of bowel dysfunction and considers the nurse's role in caring for patients with this disorder, including manual evacuation.

Nurses' use of patient notes to chart bowel care management for the palliative care patient.

Little is known about nurses' knowledge base and practice in the provision of Bowel Care Management (BCM). Recently, a study designed to investigate both factors was conducted in two hospices, one in New South Wales and the other in South Australia. Twenty-four nurses and 100 palliative care patients participated in the study. The audit of patients' medical records, one of several research methods used in the study, will be discussed here. The research identified that in all but two cases, patients' information about their BCM practices used in the home environment was not documented on their admission to the hospice. Further, the considerable number of charts used in each hospice to record BCM generally asked for information related to bowel function and the use of pharmaceutical preparations, to the exclusion of other methods of management.

Managing irritable bowel syndrome.

IBS is a functional gastrointestinal disorder in which the patient has chronic or recurrent gastrointestinal symptoms (diarrhea, constipation or abdominal pain and bloating) that are unexplained by any structural or biochemical abnormalities. Research has demonstrated no causal relationship between psychosocial factors and the development of IBS. IBS cannot be diagnosed through radiologic, endoscopic or laboratory studies because the symptoms are not explained by structural or chemical abnormalities. One of the most important components of treatment is the development of an effective provider patient relationship. Behavioral treatments may be helpful in select patients. Dietary management can also reduce symptoms if the patient can identify foods that trigger them.

Self-report and polysomnographic measures of sleep in women with irritable bowel syndrome.

BACKGROUND: Women who report chronic gastrointestinal symptoms compatible with a diagnosis of irritable bowel syndrome (IBS) frequently report sleep disturbances. OBJECTIVES: The purposes of this study were to (a) compare self-reported and polysomnographic indicators of sleep quality in women with IBS symptoms (IBS-SX, n= 16) and controls (n= 16); (b) examine the relationship between the indicators of sleep quality; and (c) determine the relationship between sleep indicators and psychological distress. METHOD: The women slept in a laboratory for 2 consecutive nights. Polysomnographic measurements were recorded during sleep, and a sleep questionnaire was completed upon awakening each morning. Psychological distress was measured with the Symptom Checklist-90-R during the initial interview. RESULTS: Women in the IBS-SX group reported significantly greater numbers of awakenings during sleep (p = .008) and had a longer latency to REM sleep (p = .04) than did the controls. Self-reported and polysomnographic indicators were more highly correlated in the control group than in the IBS-SX group. In the IBS-SX group, the greater the psychological distress, the less alert (rs = .419) and rested (rs = .564) the women felt in the morning and the more time the women spent in stages 3 and 4 sleep (rs = .479) and less in stage 2 (rs = -.447) and REM (rs = -.414) sleep. In the control group, psychological distress was not significantly associated with self-reported measures but was significantly associated with the number of awakenings (rs = .506) and time in stages 3 and 4 sleep (rs = -.677). CONCLUSIONS: Although the women in the IBS-SX group reported significantly more awakenings, the weak relationship between self-reported and polysomnographic indicators suggests that clinicians must keep in mind that further assessments may be necessary.

Women with gastrointestinal symptoms: implications for nursing research and practice.

Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GIGl symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments. In humans, symptoms are highest when these hormones are at the lowest levels. Thus, symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies.

Nurses' perceptions of irritable bowel syndrome (IBS) and sufferers of IBS.

The present study set out to discover nurses' attitudes towards, and beliefs about, irritable bowel syndrome (IBS) and IBS sufferers. A 54-item questionnaire was completed by 254 qualified nurses from 18 London hospitals. Nurses rated statements relating to IBS on a scale from disagree (1) to agree (5). Questionnaire items fell into four broad categories. The first related to the way nurses felt about the sufferers of IBS; the vast majority of nurses agreed with items stating that IBS patients are demanding, unable to cope with life, lazy and crave attention, and waste doctors' time. The second category related to nurses' beliefs regarding their knowledge of the syndrome; only half the sample believed that they would recognize the symptoms of IB and that they had a good understanding of the disorder. Ratings on items relating to the nurses' general knowledge of the symptoms showed that between a quarter and a half of the sample felt uncertain about the veracity of the statements. A fourth category was the nurses' beliefs regarding the attitudes held by health professionals, with half of the sample believing that doctors and health professionals generally had a poor understanding of IBS. Surprisingly, results showed that older, more experienced nurses, and those suffering from the syndrome were not more sympathetic and understanding than younger, non-sufferers. The present study shows that the majority of nurses hold negative attitudes towards IBS sufferers, which can only be detrimental to the treatment of those patients with IBS.

Interventions for irritable bowel syndrome: a nursing model.

Irritable Bowel Syndrome (IBS) is a common problem affecting a significant portion of the U.S. population. Nurses are involved directly in the planning and implementing of therapeutic interventions for this patient population. Using a Human Response Model, the authors of this article review intervention studies for IBS. This model provides a context for integration of Person (vulnerability) and Environment (risk) factors that may modify the patient's response to a given therapeutic regimen. Human responses are categorized as Physiological, Pathophysiological, and Behavioral/Experiential. Interdisciplinary therapeutic strategies include motility manipulations via pharmacological agents, dietary modifications, and self-care enhancement. Areas for nursing research are described.

The RN's role in the office treatment of irritable bowel syndrome.

Irritable Bowel Syndrome (IBS) is one of the most common human ailments. The symptoms of IBS can be quite distressing and can lead to considerable economic cost to society. To more effectively treat this disorder in the medical office setting, it is proposed that Registered Nurses assume a comprehensive role. A program is presented in this article that resulted in patient satisfaction, reduced medical cost to patients with IBS, and enhanced patient productivity and general well being.

Psychophysiological factors associated with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with no known pathophysiological etiology. Many individuals with IBS, however, report higher than normal levels of stress and exhibit abnormal personality characteristics. In this article, the author reviews the psychophysiological factors associated with IBS and discusses gastrointestinal neuroendocrinology, the effects of stress on gastrointestinal motility, and the nursing implications related to this syndrome.

Levsin (hyoscyamine sulfate USP).

Levsin is an anticholinergic drug used in the treatment of irritable bowel syndromes, functional intestinal disorders, and as adjunct therapy in peptic ulcer disease. Levsin is also used parenterally to reduce duodenal motility to facilitate diagnostic studies. Levsin is readily absorbed through the gastrointestinal tract, reaches peak effects in 2-2.5 hr, and is excreted in the urine within 24 hr.