Development of a specialist nurse educational program: The NIICE (Nurses Initiative in IBD Care and Education) in Canada Program

Abstract

Although the management of inflammatory bowel disease (IBD) has greatly evolved in the past decade, particularly with the introduction of biologic therapies, nurses have had few opportunities to formally learn about the evolution of care and even less of a chance to discuss how these changes affect their provision of care. In 2007, a national mixed-method (qualitative and quantitative) needs assessment conducted with 46 gastroenterologists, 40 gastroenterology nurses, and 9 patients with Crohn's disease queried participants on Crohn's disease management. Nurses working with patients with Crohn's disease reported a lack of clarity around their roles and responsibilities across the continuum of care, and communication gaps within the health care team that undermined their ability to effectively provide care for patients with Crohn's disease.1 In 2010, a group of 7 gastroenterology nurses with subspecialties in IBD and a member of the Canadian Society of Gastroenterology Nurses and Associates (CSGNA) developed a 7-module, interactive, educational program for small-group learning sessions, named the NIICE (Nurses Initiative in IBD Care and Education) in Canada program. Each module aims to increase nurses' knowledge of a particular aspect of IBD and its management, refine their clinical skills in this area, and offer insight into the social aspects of caring for patients with IBD. There is always a heavy focus on practical advice: how to answer commonly asked questions, how to monitor patients' progress, and which “red flags” warrant referral. There are also open-ended discussion questions, which encourage participants to share their clinical experience and, hopefully, learn practical solutions from the other nurses present. In this way, the modules are sufficiently flexible to allow for discussion of specific regional issues, such as access to care, reimbursement, or special population needs. The 7 modules cover: epidemiology; diagnosis; standard therapy for IBD; anti-tumour necrosis factor treatment; non-pharmacologic treatment; surgical treatment; and communicating with IBD patients. There is also a summary module that provides a brief overview of all of these topics. Once the modules were finalized, a train-the-trainer session was held with members from across Canada, ensuring geographical representation among all trainers. Educational sessions typically involve one presenter (an experienced, selfidentified gastroenterology nurse), 8 to 10 participants and last one hour, which allows enough time for the presentation of one module and a discussion. However, the program is sufficiently flexible that any schedule can be accommodated. Between September 2010 (the time of the program launch) and December 2010, the program was run 41 times in Canada, with 445 nurses participating. The program may also be made available online, allowing nurses from around the world to make use of this program in their own centres. A follow-up needs assessment will determine whether Canadian gastroenterology nurses feel that their roles and responsibilities have been more clearly defined and whether their comfort level with IBD care has increased. Future plans include the creation of additional modules. Participants have already expressed a desire for information on pregnancy in IBD patients and the role of nutrition in IBD management.