Second N-ECCO Consensus Statements on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis

This is the second Nurses European Crohn’s and Colitis Organisation [N-ECCO] Consensus Statements document addressing inflammatory bowel disease [IBD] nursing across Europe. N-ECCO continues to be an active member of the European Crohn’s and Colitis Organisation [ECCO], providing education and networking opportunities for nurses across Europe within three designated nursing sessions, N-ECCO Network Meeting, N-ECCO School and the N-ECCO Research Forum, in addition to e-learning and podcasts. The overarching aim of ECCO is to improve the care of patients with IBD through the development of guidelines, education and research. Current evidence is fundamental in enabling N-ECCO to meet this progressive aim. This document updates the first N-ECCO Consensus Statements based on the ‘ideal’ standard of care,1 and provides additional statements and evidence supporting contemporary IBD nursing practice, while acknowledging the extensive variety in IBD nursing practice across Europe.2 The N-ECCO Consensus Statements required revision due to the emergence of new evidence supporting the role of the IBD Nurse. In line with Standard Operating Procedures set out by ECCO, the proposal to update the Statements was approved by ECCO’s Governing Board. The ECCO Office sent an international call for N-ECCO members in January 2017; 10 nurses and the current N-ECCO committee of 2017 were selected and divided into four working groups [WGs] in March 2017, each responsible for a different section of the consensus document. Each WG performed literature searches so as to enable review of the original Statements and to add new Statements. The electronic literature-search databases included AGRIS, Embase, Global health, HMIC, Journals @ Ovid full-text, OVID Medline [R] In-process Non-indexed citations, Medline, PsychArticles Full text, PsychInfo, Your Journals @ OVID EMBASE, CINAHL and the British Nursing Index via the OVID platform from 2010 onwards. The consensus process was based on a modified Delphi method, a recommended method for determining consensus for a defined clinical concern.3,4 The iterative method uses rounds of voting to determine consensus of opinion,4 with participants debating the agreed Statements at the final voting round.5 The updated Statements document was submitted to an online platform for discussion and for online voting by all national representatives of N-ECCO in May 2017, and 63% of national representatives and the Consensus Working Group voted. The voting indicated that 83% of the Statements had gained over 90% consensus, indicating that further online consensus rounds were unnecessary. Statements receiving <80% consensus were reviewed; for the second and final voting round, which took place in June 2017, the Consensus Working Group met and achieved 100% consensus agreement for all 31 Statements. The Consensus Statements are divided into four sections. ‘Fundamental IBD Nursing’ details the basic nursing care required in order to meet the needs of patients with IBD, delivered by nurses working across many settings. The section ‘Advanced IBD Nursing’ pertains to nurses who have developed their knowledge, skills, research and expertise in IBD. ‘Advanced IBD nursing care for particular situations’ provides guidance on supporting patients with IBD who are facing special situations, and ‘Benefit of an IBD Nurse’, addresses the value and benefits of the specialist nurse within the IBD multidisciplinary team [MDT]. Nurses in contact with patients with IBD working in any setting need basic knowledge of the diseases, to know the difference between Crohn’s disease and ulcerative colitis, and to appreciate the importance of establishing timely therapeutic interventions. Understanding of key diagnostic strategies and the main medical and surgical options available in the management of IBD is recommended [EL2]. IBD is an umbrella term for the life-long bowel diseases of ulcerative colitis [UC] and Crohn’s disease [CD]. IBD is a global disease with a rising prevalence,6,7 and it follows an unpredictable relapsing and remitting course. Common symptoms of active disease in both conditions include diarrhoea, abdominal pain, anaemia and fatigue. Although the causes of IBD are unknown, it is recognized as an immune-mediated disease, possibly precipitated by various genetic and environmental factors, and it is advisable to read the ECCO Topical review on environmental factors in IBD.8 Although IBD often presents in adolescence or young adulthood, 10–30% of patients are over 60 years old, either having aged with IBD or developed it in middle adulthood. Illness in older adults is often complicated by the physical changes of ageing, associated co-morbidities, and atypical presentations.9 Paediatric forms of IBD are characterized by a more complicated disease course, with marked inflammatory activity and frequent need for corticosteroids and immunosuppressive therapy compared with adult-onset IBD.10 UC affects only the rectum and colon. Originating in the rectum, it can extend proximally to the sigmoid, descending or entire colon.11 The inflammation is continuous and limited to the mucosa. Symptoms include rectal bleeding, passing mucus, abdominal pain, diarrhoea and faecal urgency, sometimes with incontinence. Location and severity of disease activity determines therapy options.12 CD occurs anywhere between mouth and anus. The inflammation is intermittent, with patches of disease activity [skip lesions] between areas of healthy mucosa. Symptoms vary according to disease location and include abdominal pain, diarrhoea, weight loss, anorexia and fever. 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