Abstract
Abstract Background There is evidence that a higher number of nurses is associated with better patient outcomes in acute care settings, but little is known in outpatient settings. Patients with inflammatory bowel disease (IBD) are largely treated in outpatient settings and sometimes face difficulties due to their disease or treatment. Through the experience of living with their disease and managing it well, their self-efficacy related to IBD management would improve. Health professionals play important roles in empowering patients and supporting them to be able to manage their disease conditions well. The aim of this study is to explore the impact of adequate support with abundant nurse staffing on self-efficacy and difficulties of life among patients with IBD in clinical remission. Methods This is a cross-sectional questionnaire survey, using secondary analysis of a previously reported larger study. Data of a total of 499 patients with IBD in clinical remission, 318 from a specialized IBD clinic (UC: 83, CD: 235) and 181 online (UC: 109, CD: 72), was used for this study. The clinic has 10 full-time staffs (2 physicians, 7 nurses, 1 pharmacist) and 3 part-time staffs (2 doctors, 1 counselor) for approximately 30 outpatients visiting the clinic per day. This number shows the clinic is considerably abundant in nurse staffing compared to the Japanese standard of 1 nurse per 30 outpatients set by the Medical Care Law. The IBD-Self-Efficacy Scale (IBD-SES) and difficulty of life scale (DLS) were used as disease specific patient reported outcome measures. Multiple regression analysis was conducted in order to assess the extent of influence by the difference of facility after adjusting potential effects of confounders. Results All multi regression models included following confounders; age, sex, disease, job status, use of biologic, and disease duration. In IBD-SES, the subscales except for the subscale “managing medical care” showed significantly higher self-efficacy scores in patients who were recruited from the specialized clinic than those from online. As for DLS, all subscales and the total score showed significantly lower difficulty scores in patients who were recruited from the clinic. Conclusion Our results suggest that abundant nurse staffing influences favorably on self-efficacy and difficulties of life among patients with IBD in clinical remission.
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