Care and Management of Ulcerative Colitis as a Long-Term Condition

Introduction

The long-term condition is chronic health issue that leads the individuals to suffer for more than six months extending to a lifetime. In this study, an overview regarding care and management for Ulcerative Colitis as a long-term condition is to be explained.

1. Prevalence, multi-morbidity and severity of Ulcerative Colitis

Ulcerative Colitis is inflammatory bowel disease (IBD) that leads to cause ulceration and inflammation of the inner lining of the large intestine and rectum that are parts of the end of the oesophagus (NICE, 2019). The NICE mentions that Ulcerative Colitis is the most common inflammatory bowel disease (IBD) with the prevalence of 243 individuals per 100,000 population (NICE, 2021). This indicates that the disease is quite commonly present in many individuals in the UK population. The people affected by Ulcerative Colitis often experience co-morbidities like fibromyalgia, depression, chronic migraine and wide nature of extraintestinal manifestation along with chronic diseases (Chen et al., 2018). The severity of Ulcerative Colitis ranges from mild to very severe condition in which people with mild condition expresses symptoms like normal erythrocyte rate, no bleeding in stools and fewer than 4 bowel movement (NICE, 2019). However, people with very severe condition express symptoms like more than 10 times bowel movements, rapid heartbeat, blood in stool, expanded colon and others (NICE, 2019).

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Rationale for Ulcerative Colitis

In the UK, Ulcerative Colitis is estimated to occur around 1 in each 420 people in the country. This is equal to 146,000 individuals suffering from the condition at any age in the UK (NHS, 2021). This indicates that the condition is quite common among individuals in the UK. The NHS mentions that the condition is mostly diagnosed in the UK in people aged 15-25 years even though it can occur at any age (NHS, 2021). This indicates that the long-term condition affects individuals at early stage which leads to disrupt the well-being and health of the people. Thus, to determine the way to manage the health condition to promote better health of people of all ages and reduce its prevalence, the current discussion regarding management of Ulcerative Colitis is important.

Psychological issues impact the health and well-being of Ulcerative Colitis

The psychological issues like stress and anxiety are seen to impact exacerbation of the condition regarding people affected with Ulcerative Colitis but are not related to the cause of the disease. This is because during stress or anxiety, the body develop fight-or-flight mode which triggers the production of increased cytokines and other chemicals. It impacts the immune system to be turned on which raises the risk of inflammation in the body (Reed-Knight et al., 2017).

Assessment, planning and management of Ulcerative Colitis

The assessment of Ulcerative Colitis is executed by use of endoscopic procedure with biopsy of tissues from the affected area so that other inflammatory bowel diseases like Crohn’s disease can be ruled out and confirmation of the disease can be assured (Lichtenstein et al., 2020). The care of Ulcerative Colitis is planned on the basis of the severity of the condition in individual. The common management used for mild to moderate condition of the disease includes administration of medication like aminosalicylates, perdinsolone, tacrolimus and azathioprine are provided (Tun et al., 2017). The surgery is used in severe conditions of Ulcerative Colitis patients where the individuals reject responding to all other available treatment (NICE, 2019).

Opportunities and challenges for nurses in managing Ulcerative Colitis

In Ulcerative Colitis, the nurses to assess and plan care regarding the management of the condition has opportunity of enhanced medical support to effective diagnose the disease and its severity, availability of pharmacotherapy, evidence-based information and others to improve well-being of the patients (Fiorino et al., 2017). However, the challenges faced by the nurses is that patients report side-effects of medication leading them to avoid taking proper diose which causes remission of the disease among the individuals (Sharara et al., 2018).

Biopsychosocial elements impact Ulcerative Colitis

The biopsychosocial elements like race, family history, lifestyle and social condition impact the rise of Ulcerative Colitis. It is evident as people of the white origin or individuals belonging to Ashkenazi Jewish descent are seen to show increased risk of developing the disease. This is because of the presence of increased genetic mutation associated with IBD in the race (Murphy et al., 2020). The lifestyle that included stress and increased intake of alcohol affect the worsening of Ulcerative Colitis as they support inflammation of the body tissues (Jonefjäll et al., 2018).

Self-monitoring and self-management of Ulcerative Colitis

The self-monitoring way for patient with Ulcerative Colitis is tracking their bowel movement and nature after the treatment for the disease and report the condition to the physicians. This is because based on the bowel movement the primary symptoms regarding the diseases can be determined if managed (Östlund et al., 2021). The self-management strategies to be for patients with Ulcerative Colitis are intake of proper meals, performing exercise, thinking positively and others to avoid the body negatively react and worsen the condition (Vernon-Roberts et al., 2021).

Attitudes, values and beliefs related to Ulcerative Colitis

The belief related to Ulcerative Colitis is that the condition may lead individuals to develop colon cancer and the risk of development of the cancer increases with prolonged presence of the disease (Lopez et al., 2018). The presence of Ulcerative Colitis creates negative impact on the mood out of long-term suffering leading individuals to show anxious and depressed behaviour (de Campos Silva et al., 2020)

4. Nurses role in managing Ulcerative Colitis

The nurse’s role in managing Ulcerative Colitis is that they are work with the multi-disciplinary team for supporting well-being of patients through treatment. This indicates that the nurses are to work with paediatrician in case of child or with obstetrics and gynaecology team in case of pregnant women affected with the disease (NICE, 2019). The role of the nurses is to interact with the dietician and physical trainer to determine the food and exercise to be suggested and used for patients with Ulcerative Colitis for the betterment of their health (NICE, 2019). The nurses also have the role to work with gastroenterologist to support managing and treatment of the condition in patients in effective and specific manner (NICE, 2019).

Developing resource that promotes health and well-being on the basis of collaborative principles in Ulcerative Colitis

The WISE model of self-management support is to be implemented in promoting health and well-being of patients with Ulcerative Colitis. This is because it assists to create, find and implement effective self-care support for patients with long-term condition (Thompson et al., 2018). The Ulcerative Colitis is a long-term condition and the use of the model is effective as it would help the patient understand the way they can find self-care and implement them to control their well-being. The WISE model is to be applied for self-management of Ulcerative Colitis by providing training to patients regarding its use and way to evaluate it to more effective use it for care (Kennedy et al., 2014).

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Conclusion

The above discussion informs that Ulcerative Colitis is a long-term condition that can be managed with use of effective pharmacotherapy and surgery. It is highly prevalent in the UK and the use of WISE model can be done for self-management of the disease by the patients.

References

Chen, J.H., Chen, H.J., Kao, C.H., Tseng, C.H. and Tsai, C.H., 2018. Is fibromyalgia risk higher among male and young inflammatory bowel disease patients? Evidence from a Taiwan cohort of one million. Pain physician, 21(3), pp.E257-264.

Fiorino, G., Bonovas, S., Cicerone, C., Allocca, M., Furfaro, F., Correale, C. and Danese, S., 2017. The safety of biological pharmacotherapy for the treatment of ulcerative colitis. Expert opinion on drug safety, 16(4), pp.437-443.

Jonefjäll, B., Simrén, M., Lasson, A., Öhman, L. and Strid, H., 2018. Psychological distress, iron deficiency, active disease and female gender are independent risk factors for fatigue in patients with ulcerative colitis. United European gastroenterology journal, 6(1), pp.148-158.

Kennedy, A., Rogers, A., Chew-Graham, C., Blakeman, T., Bowen, R., Gardner, C., Lee, V., Morris, R. and Protheroe, J., 2014. Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients. Implementation Science, 9(1), pp.1-16.

Lichtenstein, G.R., Shahabi, A., Seabury, S.A., Lakdawalla, D.N., Espinosa, O.D., Green, S., Brauer, M. and Baldassano, R.N., 2020. Lifetime economic burden of Crohn’s disease and ulcerative colitis by age at diagnosis. Clinical Gastroenterology and Hepatology, 18(4), pp.889-897.

Lopez, A., Pouillon, L., Beaugerie, L., Danese, S. and Peyrin-Biroulet, L., 2018. Colorectal cancer prevention in patients with ulcerative colitis. Best Practice & Research Clinical Gastroenterology, 32, pp.103-109./p>

Murphy, L.K., Rights, J.D., Ricciuto, A., Church, P.C. and Ahola Kohut, S., 2020. Biopsychosocial correlates of presence and intensity of pain in adolescents with inflammatory bowel disease. Frontiers in pediatrics, 8, p.559.

NHS 2021, Ulcerative colitis: Overview, Available at: https://www.nhs.uk/conditions/ulcerative-colitis/ [Accessed on: 16 July 2021]

NICE 2019, Ulcerative Colitis, Available at: https://www.nice.org.uk/guidance/ng130/chapter/Recommendations#treating-acute-severe-ulcerative-colitis-all-extents-of-disease [Accessed on: 16 July 2021]

Östlund, I., Werner, M. and Karling, P., 2021. Self-monitoring with home based fecal calprotectin is associated with increased medical treatment. A randomized controlled trial on patients with inflammatory bowel disease. Scandinavian Journal of Gastroenterology, 56(1), pp.38-45.

Reed-Knight, B., Maddux, M.H., Deacy, A.D., Lamparyk, K., Stone, A.L. and Mackner, L., 2017. Brain–gut interactions and maintenance factors in pediatric gastroenterological disorders: Recommendations for clinical care. Clinical Practice in Pediatric Psychology, 5(1), p.93.

Sharara, A.I., Al Awadhi, S., Alharbi, O., Al Dhahab, H., Mounir, M., Salese, L., Singh, E., Sunna, N., Tarcha, N. and Mosli, M., 2018. Epidemiology, disease burden, and treatment challenges of ulcerative colitis in Africa and the Middle East. Expert review of gastroenterology & hepatology, 12(9), pp.883-897.

Thompson, D.G., O’Brien, S., Kennedy, A., Rogers, A., Whorwell, P., Lovell, K., Richardson, G., Reeves, D., Bower, P., Chew-Graham, C. and Harkness, E., 2018. The WISE model of self-management support. In A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment. NIHR Journals Library.

Tun, G.S., Harris, A. and Lobo, A.J., 2017. Ulcerative colitis: management in adults, children and young people–concise guidance. Clinical Medicine, 17(5), p.429.

Vernon-Roberts, A., Gearry, R.B. and Day, A.S., 2021. Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. Gastrointestinal Disorders, 3(2), pp.61-77.

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