Assignment

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Crohn’s Disease Pilot Project

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Crohn’s Disease Pilot Project

Nikeesha Gowkaran

Nova Southeastern University

Professor Dr. Janice Linton

February 7, 2022

Introduction

Crohn’ disease is “classified as chronic inflammatory bowel disease…and can lead to digestive disorders and inflammation in the digestive system.” (Seyedian, 2019). Numerous factors might increase the risk of an individual to develop the condition. These factors include development of an autoimmune disease where the bacteria within the digestive track may trigger the body’s immune system to attack the healthy cells. The second factor is genetics such as from an inflammatory bowel disease which have been found to run in families. Apart from that, smoking is another causation factor which can double the risk of getting the disease.

Purpose Statement

In nursing, Crohn’s disease is a major clinical problem because it is a chronic illness that causes irritation and inflammation within the digestive tract by affecting the small intestines along with the beginning of the large intestines. Nevertheless, the disease can affect any part of the digestive tract starting from the mouth to the anus. The purpose of this pilot is to explain the relevant steps that should be taken for evidence-based practice (EBP) to outline all models of implementation and translate the interventions amongst Crohn’s disease patients into the clinical setting.

The Clinical Problem

The main concern for Crohn’s disease patients is the threat of contracting other complications such as fistulas, malnutrition, anal fissures and ulcers. Crohn’s disease also increases the risk of the patient to develop colon cancer and blood clots. Another growing concern about this disorder is the increasing rate at which the disease is spreading across the United States. According to the CDC in 2015, 3 million US adults reported being diagnosed with irritable bowel disease. Crohn’s disease normally develops in younger people, especially in their late teens, twenties or thirties (Centers for Disease Control and Prevention, 2021). Nonetheless, the condition can develop at any age equally among males and female and it can also appear among young children. Crohn’s disease depicts its name depending on the region of the digestive tract it is affecting.

The PICOT Question

The PICOT question in this case is that; In adult patients with the Crohn’s disease, how effective is plant-based diet compared to pharmaceutical treatment in relieving symptoms within six months?

Chosen Intervention

The intervention for this PICOT project is guided by administering a plant-based diet as it has proven to improve the patient health condition within six months. With this intervention, patients should eat more fiber as it plays an integral role in promoting the general gut health. Plant-based diet with high fiber content provides essential nutrients to the healthy bacteria in the gut which offer a protective environment against Crohn’s disease. With the intervention, the patients were advised to consume more grains such as whole grains, fruits, vegetables, yogurt, soya, and fish.

The Pilot Project for the Chosen Intervention

The focus of this pilot project is to implement a plant-based diet as the standard of care for patients with Crohn’s disease. The pilot project will include various parties such as the patients, nurses, hospital administrators, and clinical nurse specialists. The actions that will be undertaken by this pilot include assessing the needs of the patients with Crohn’s disease such as using colonoscopy, abdominal CT scan or blood test to determine the health of the colon. The pilot project will be carried out in the nursing facility where the patients and their families will discuss with the practitioner on the foods that are compatible with their patient for the best outcome. The project will be executed for a period of six months where the nurses will closely follow up with the patient to determine whether the impacts of Crohn’s disease are decreasing. To guarantee success of the pilot project, various actions will be executed such as planning regular meetings with stakeholders, hold educational sessions, collect data and enroll the patients in intervention groups so that they can have a platform to interact and support each other.

Consequently, the framework of change that will be used to facilitate the successful implementation of this intervention is by using EBP model. To implement change, the framework focused on identifying complications of Crohn’s disease among patients which included irritation and inflammation. Analysis of these complications was helpful in identifying strategies that will be used to manage the disease. The EBP will provide advice to the nurses which will play the role of enabling them to understand the strategies they can use to encourage behavior change among patients to accept a plant-based diet for six months. The EBP will also identify key enablers along with the barriers that the nursing practitioners will encounter while addressing the change to minimize the opportunities of relapse (Holcomb et al., 2021).

Framework of change to facilitate implementation of the intervention

Theoretical Domain Framework (TDF) will be used as the specific framework in implementing the EBP interventions. Using TDF, a qualitative focus group discussion with 35 nurses directed by a highly trained instructor investigated why nurses implemented or failed to manage plant based or pharmaceutical treatment on the Crohn’s patient. Domain-specific questionnaires with descriptions of enablers and barriers theoretically enabled the instructors to conclude that nurses' training, awareness, preparedness, and ethical responsibilities (Croke et al., 2018). Some barriers may include cultural barriers, lack of cooperation when initiating the intervention brought by inadequate information on the issue, and resistance from the patient to change lifestyles.

The next step was ascertaining the tools necessary for the intervention delivery in terms of modes and techniques of change that could help overcome barriers and enhance the enablers to attaining change. The nurses will oversee that the identified barriers will be responded in a timely manner before the intervention commences. This will include educating the patients on the diet they should adopt and the foods they should eliminate. Also, the nurses will conduct a thorough background on the patient culture to avoid administering foods that are against their culture.

Using the theoretical framework selected for this pilot study and empirical evidence on the effectiveness of various behavior change techniques, facilitated workshops were chosen as the best approach to identify the contents of the intervention which was found to be highly effective (Atkins et al., 2017). The nurse's responsibility is to check the content to ensure that the promoter feasible and cohesive delivery model and method are recognized. The last step was to acknowledge the measuring techniques of behavior change to evaluate the effectiveness of the change pathways.

Roles of stakeholders in the pilot project

The project will involve various stakeholders including nurses, patients, hospital administrators and professional organizations and ethical review boards, professional organizations and ethical review board. The project will also include funders and government agencies as key stakeholders to play a role in ensuring that the intervention will be implemented safely among the patients. Nurses are the first stakeholders in this EBP pilot project. Their role is to come up with questionnaires that would be used to explore the domains related to Crohn’s disease complications among the patients. The second group of stakeholders are the hospital administrator of the nursing facility. Their responsibility is to review the interactive education contents to ensure that it is feasible and suitable for nurses. They also play an integral role in the overall implementation of the intervention by ensuring that the nurses will employ due diligence when administering the intervention to the patients by providing them with the best care they need for successful outcomes. The stakeholders will also include professional organizations and ethical review boards whose role is to ensure that the pilot project is implemented in compliance with the general ethical consideration in research and clinical practice.

Apart from that, professional development centers and training institutions are stakeholders will be assigned the responsibility of ensuring that the intervention model deployed will participate in the knowledge advancement for nurses' professional development. Crohn’s disease patients and their relatives are important stakeholders in this pilot project and their role is to act as subjective and concerned parties in the EBP clinical trial. This is important in providing feedback on the effectiveness of the framework. The last group of stakeholders in this pilot study will be the funders, government agencies, research institutions, and regulatory authorities are stakeholders. Their primary role is to oversee the pilot project and ensure that it is implemented objectively to attain its target.

Strategies that would promote engagement of the stakeholders in the project.

Formal invitations such as e-mails or letters, inviting stakeholder to a luncheon or inviting them to participate in continuing education courses are the main strategies used to promote stakeholders’ engagement. The other strategy was obtaining permission from the hospital, professional bodies and honest review to conduct a pilot project. This strategy involved organizing meeting forums with healthcare providers and administrators to brief them on the pilot project's significance. The other system presented the EBP pilot project for protocol approval to obtain an ethical green light to go ahead with the project. There is room for explaining the research objectives provided by intervention nurses to the stakeholders so that important feedback that can shape the final pilot project protocols is achieved.

Specific Practice Guideline that Support the Intervention

Specific guidelines that support the intervention include overseeing plant-based intervention that can reduce Crohn’s complications effectively within six months compared to pharmaceutical intervention by ensuring the nurses are adequately educated, ensuring the patient understands fully the intentions of this study and must be willing to be fully committed to the process. Also, nurses must employ precautions when managing the intervention to ensure that the patient will be fully stimulated to embrace lifestyle changes for the best outcomes.

Resources required for the pilot project.

The organizational resources required in the pilot project are volunteers, nutritionists, educating clinical staff and patients. There are other significant resources such as family support in helping the patients during the transition phase and educational support such as: pamphlets or handouts, meal plans, cooking classes, individual nutritional counseling, and resources on how to obtain affordable plant-based food or financial help the patient may need.

How the Outcome of the Intervention will be Measured?

The outcome of the intervention will be measured by recognizing the variables that can be used to forecast the diet program the patient is comfortable with, which will aid a nursing practice to overcome this problem. Such evidence must be gathered from several data derived from clinical assessment in nursing procedures. The outcomes will also be measured by ascertaining whether the patient has achieved positive improvements and complications such as inflammation and irritation have decreased greatly or have disappeared completely.

Conclusion

Crohn’s disease cases have been increasing in the United States. However, plant-based intervention has been found to be effective reducing complications among patients within six months. Therefore, implementing this EBP pilot project on Crohn’s patients will offer insight into the effectiveness of the interventions in reducing symptoms among patients.

References

Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., Grimshaw, J. M., Lawton, R., & Michie, S. (2017, June 21). A guide to using the theoretical domains framework of behaviour change to investigate implementation problems - implementation science. BioMed Central. Retrieved February 7, 2022, from https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0605-9 

Centers for Disease Control and Prevention. (2021, November 9). Data and statistics. Centers for Disease Control and Prevention. Retrieved February 7, 2022, from https://www.cdc.gov/ibd/data-statistics.htm 

Holcomb, J., Ferguson , G. M., Sun, J., Walton, G. H., & Highfield, L. (2021, March 22). Stakeholder engagement in adoption, implementation, and sustainment of an evidence-based intervention to increase mammography adherence among low-income women. Journal of cancer education: the official journal of the American Association for Cancer Education. Retrieved February 4, 2022, from https://pubmed.ncbi.nlm.nih.gov/33754327/ 

Johns Hopkins Nursing Evidence-based practice: Practice question. Subject Guides. (2021, December 23). Retrieved February 6, 2022, from https://guides.upstate.edu/c.php?g=1023176&p=7411256 

Karlsen, M. C., & Pollard, K. J. (2017, May). Strategies for practitioners to support patients in plant-based eating. Journal of geriatric cardiology: JGC. Retrieved February 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466940/ 

Lichtenstein, G. R., Loftus, E. V., Isaacs, K. L., Regueiro, M. D., Gerson, L. B., & Sands, B. E. (2018, March 27). ACG clinical guideline: Management of crohn's disease in adults. The American journal of gastroenterology. Retrieved February 5, 2022, from https://pubmed.ncbi.nlm.nih.gov/29610508/ 

Seyedian, S. S., Nokhostin, F., & Malamir, M. D. (2019). A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. Journal of medicine and life. Retrieved February 7, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685307/