Exploring the competencies of inflammatory bowel disease nurses in Italy: a cross-sectional survey

Introduction

Inflammatory bowel disease (IBD) is characterized by recurrent chronic intestinal inflammation, which can lead to flare-ups, severe complications, and functional, physical and psychological disability [1,2]. In industrialized countries, the incidence and prevalence of IBD are steadily increasing, highlighting a significant healthcare and socioeconomic impact [3]. Optimal management of IBD requires a multidisciplinary approach, where healthcare professionals, particularly nurses, play a crucial role in empowering and supporting patients in managing their condition [4].

Nurses, often the first point of patient contact, are central in organizing care. Nursing management of IBD involves a combination of fundamental and advanced clinical skills, leadership abilities, and a profound understanding of the psychological and social dynamics influencing patients’ quality of life [5]. Within this context, nursing leadership emerges as a key element, with nurses actively coordinating care, fostering effective communication and promoting high standards of care [6]. Nursing leadership is reflected in competencies such as timely and informed decision-making, efficient healthcare resource management, continuous professional development and patient advocacy [7].

The chronic nature of IBD requires patients to adapt to long-term therapies and incorporate these new demands into their lifestyles [8]. Specialized IBD nurses, with advanced training in areas such as IBD pathophysiology, diagnosis and treatment, provide holistic support that addresses clinical conditions and individual patient needs. Recent studies highlight that employing specialized IBD nurses reduces patients’ need for outpatient visits, emergency department access and hospital admissions, while improving their mental health and overall satisfaction [9].

The Second Consensus of the Nurse European Crohn and Colitis Organisation (N-ECCO) clearly outlines the fundamental and advanced competencies of the specialized IBD nurse, including the ability to deliver health education, emotional support and practical guidance [10]. However, this professional role tends to be undervalued and underused, probably because of limited awareness among patients and within the healthcare system [11]. Operating in accordance with updated clinical guidelines, IBD nurses exhibit a deep understanding of disease pathophysiology, together with advanced skills in education, organization and research [12,13].

In Italy, the IBD nurse is gradually gaining recognition. There is a growing focus on specific training and expanding competencies [14,15]. This professional is increasingly present in various settings, including outpatient clinics, endoscopy units, clinical trials and surgical wards, significantly contributing to integrated IBD management and improved patient outcomes [15]. There is no formal training for becoming an IBD nurse in Italy. There are only educational courses, such as the N-ECCO program and other dedicated ECM courses, but no specific certification training exists.

This study aimed to analyze and evaluate the competencies of IBD nurses in Italy, focusing on their current level of training, clinical practice, and the implementation of this professional role within IBD units. The study sought to identify areas for improvement and opportunities for development within the national healthcare context.

Materials and methods

A cross-sectional observational study was conducted using an online survey administered through the Google Forms platform from June 5 to August 14, 2024. An anonymous electronic questionnaire was developed and distributed. IBD nurses participating in this survey were selected from the Internal Database of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). The survey was emailed, asking recipients to share it with other colleagues not yet included in IG-IBD.

The survey was designed ad hoc (Supplementary material) by a panel of experts, based on the statements of the Second N-ECCO Consensus. The expert panel included 2 nurses (ES and DN) with recognized expertise in IBD care and 2 experienced gastroenterologists (FS and DP) with numerous publications.

All Italian IBD Nurses who had played that role for at least 6 months were enrolled in this survey. It consisted of 53 questions divided into 4 sections:

Results

The sample analyzed consisted of 50 participants, predominantly female (92%), with an average age of 48.38±9.7 years. From a geographical perspective, the participants were relatively evenly distributed across Italy’s 3 central regions: specifically, 30% from the North, including areas such as Lombardy, Piedmont, Veneto and Emilia-Romagna; another 30% from the Center, represented by regions such as Lazio, Tuscany, Umbria and Marche; and 40% from the South and Islands, encompassing regions like Sicily, Sardinia, Campania and Puglia.

In terms of academic background, the educational level was notably high. Most participants (94%) held a bachelor’s degree, 6% had earned a master’s degree, while none possessed a PhD. This highlights the intense academic preparation of the group (Table 1).

Table 1 Sociodemographic and professional characteristics

Institutional and clinical features

Among the 50 participants, 64% were dedicated IBD nurses, while the remaining 36% were involved in managing IBD patients, primarily through the administration of biological therapies. These nurses often worked in broader clinical settings, providing care for patients with other chronic conditions requiring similar treatments, such as rheumatology or dermatology units. Most worked in hospitals (52%), but 78% needed more and better resources and protocols to work with this disease. Engagement in endoscopy (36%) and research (32%) was relatively low (Table 2).

Table 2 Institutional and clinical features

Fundamental nursing competencies

Fundamental competencies generally had higher average scores than advanced competencies, which is to be expected given their more specialized nature.

In the assessment of nurses’ fundamental competencies (Fig. 1), the highest average scores were observed for “awareness of the emotional and psychological impact of IBD on patients” (4.06) and the “ability to establish an empathetic relationship with the patient” (4.06), followed closely by “awareness of the physical impact of IBD” (3.94). The lowest average scores among fundamental competencies were found in “competence in managing perianal disease” (2.72) and “knowledge of sexual health aspects related to IBD” (3.06).

Figure 1 Fundamental skills

Advanced nursing competencies

In the evaluation of advanced competencies (Fig. 2), the highest scores were achieved for the ability to provide “health education to caregivers” (3.56), followed by competence in “providing multidisciplinary care” (3.40), the ability to “inform and educate patients to recognize and develop coping skills” (3.38), and recognizing symptoms related to chronic anemia (3.36). These represent the areas of most substantial advanced competence. The lowest-scoring advanced competencies were the “ability to manage a pediatric patient with these conditions” (2.30) and the “ability to provide support during the transition from pediatric to adult care” (2.46), highlighting areas that require particular attention and development.

Figure 2 Advanced skills

IBD, inflammatory bowel disease

Several other advanced competencies, such as supporting the management of patients in the pre- and post-gestational phases (3.1), informing patients about travel and treatment needs away from their residence (3.12), knowledge of vaccination requirements for these patients and the ability to provide related information (3.18), and understanding significant comorbidities and extraintestinal manifestations associated with these conditions (3.24), exhibited relatively uniform distributions around a score of 3. This indicates an average level of competence with room for improvement. The competence related to “knowledge of clinical research guidelines and the ability to manage a patient enrolled in a research protocol” (2.72) demonstrated a polarized distribution, suggesting significant variability in proficiency among participants. These detailed insights can be leveraged to identify strengths and areas needing improvement, aiding in designing targeted and effective training programs for IBD nurses.

The analysis revealed several significant correlations between participants’ professional characteristics and their perceived competencies in IBD management. Years of work experience in IBD units were positively associated with greater awareness of the physical impact of IBD on patients (r=0.40, P=0.034) and, to a lesser extent, with awareness of its emotional and psychological effects (r=0.22, P=0.042). Additionally, experience in IBD units correlated with an enhanced ability to support patients in managing chronic pain (r=0.21, P=0.047).

Knowledge of therapeutic pathways for IBD was strongly linked to awareness of the physical impact of the disease (r=0.54, P=0.006) and the perceived ability to assist patients in pain management (r=0.45, P=0.009). These relationships suggest that a deeper understanding of therapeutic processes improves practical and supportive care capabilities.

Competence in providing telematics support, such as email or phone-based services for patients, was strongly correlated with the ability to educate patients in developing coping strategies (r=0.75, P<0.001) and proficiency in managing technological innovations (r=0.74, P<0.001), underscoring the importance of digital tools in modern patient care.

Finally, knowledge of patients’ vaccination needs was closely associated with an understanding of comorbidities and extraintestinal manifestations (r=0.78, P<0.001) and the ability to guide patients regarding travel and treatment requirements (r=0.75, P<0.001).

Discussion

The study aimed to provide a snapshot of the “state of the art” of the IBD nurse in Italy. The objective was to have a starting point for defining this professional figure, given that there is currently no validated instrument capable of providing information about the skills such an experienced figure should have. For this reason, our questionnaire was based on the Second N-ECCO Statement, the official document of the N-ECCO. The sample analyzed showed good geographical representativeness, with a slight predominance of southern regions and islands. The average age of the participants was 48.38 years, a sign that these are personnel with experience behind them—though not necessarily specific to the sector, as the average number of years of service in the IBD unit was 8.28 years—and this result is partly correlated with the percentage of study participants who were selected for this type of work because of the skills they had acquired (36%) or because they were exempt from other services (22%). The prolonged stay of the nurses in the specific field showed a correlation with the acquisition of certain specific skills, also due to greater motivation, as demonstrated in other studies [16].

Another significant finding is the academic training of the sample, as none of the respondents had a PhD, and only 6% had a Master’s degree. This finding represents the lack of involvement of IBD nurses in clinical research, confirmed by the questionnaire result, which depicted participation in this field as a deficient area of work [17,18]. However, a good percentage of the sample stated that they participate in refresher courses (11%), continuing medical education courses on the topic (22%) or both (46%), or with the addition of Master’s courses on the subject (4%).

An analysis of the data showed that the competencies defined as fundamental had proportionally higher and more uniform average scores than those for advanced competencies, where a more significant variability of scores was evident. This is in part due to these skills being those most commonly used in patient management—so much so that even the official document used to draw up the questionnaire has undergone structural changes, casting as fundamental skills that in principle should be considered advanced (such as the management of biological therapies) [10,19,20].

The core competencies that registered the highest averages were the ability to establish an empathic relationship with patients and the awareness of the emotional and social impact these pathologies have on patients’ lives, as already demonstrated in other studies [21,22]. The core competence with the lowest score was related to the knowledge and management of perianal disease. This result is worthy of further investigation, but it is also in line with the rest of Europe, where the role of the nurse in the management of perianal disease often consists of facilitating communication between the patient, gastroenterologist and surgeon, representing the patient’s interests in multidisciplinary meetings and exercising an educational role in the prevention of sepsis [13,23]. The participation of the IBD nurse in multidisciplinary discussions is, therefore, an essential source of learning and increased knowledge in managing these diseases. On the other hand, as previously mentioned, the competencies perceived as more complex, particularly those related to advanced clinical skills, showed greater variability in responses, suggesting differences in training, exposure, or institutional roles that may influence nurses’ confidence and proficiency in these areas.

Interestingly, the advanced skill for which the highest average was recorded was the educational role of caregivers, a further sign that the academic role is predominant in nursing [24,25].

Another preponderant role is communication. Indeed, the other advanced competence that reached higher averages was collaborating with colleagues of different specialties to provide multidisciplinary care to patients. This was followed by the one related to educating the patient in developing coping strategies. Empathic communication, a core competence in which high averages were recorded, is a characteristic of the nursing profession that enables these professionals always to protect the interests of patients when necessary [26].

Interestingly, the inferential analysis revealed a significant correlation between work experience in IBD units and a good percentage of core and advanced skills, with a strong component of communication skills. In particular, the 2 core skills that correlated most strongly with unit-specific years of service were those related to understanding the social and work impact of these diseases on patients’ lives, and those associated with managing biological therapies. This confirms the need for a prolonged presence in the service in order to better understand the type of patient, and how to manage the various aspects of the pathology in a correct and timely manner.

On the other hand, regarding advanced skills, the item most significantly correlated with specific years of service was competence in stress and emergency management skills. This finding also confirms the need for staff members who are well acquainted with these pathologies, through experience favored by prolonged periods of service that provide opportunities to increase personal knowledge. Another important aspect concerns the integration of telematics support in the management of IBD. Digital platforms and telenursing can improve access to care, reduce waiting times and improve therapeutic adherence [27]. The results of the present study show a strong correlation between the provision of telemedicine support and the ability to educate patients in developing coping strategies. However, despite the acknowledged importance of telemedicine, there is a need to develop the technological skills of nurses further in line with the recommendations of the N-ECCO guidelines to exploit the full potential of these tools in managing IBD.

Another strength is the correlation between demographic and professional variables and perceived competencies, which indicates the impact of work experience on the quality of care. This kind of data is beneficial for developing targeted training and retraining programs. Finally, integrating technological skills, such as telematics support, represents an innovative dimension of the study, in line with emerging trends in digital health care.

The role of specialist nurses in IBD is an area of growing interest globally, with numerous studies highlighting their importance in managing chronic bowel disease. The existing literature has highlighted how specialist nursing care can improve not only patients’ clinical outcomes, but also their quality of life, by reducing the number of hospital admissions and improving the management of flare-ups [24]. In this context, this study’s results align with previous research highlighting the importance of psychological and emotional support in managing IBD [14]. Previous studies have shown that empathic support from nurses can significantly reduce anxiety and depression in patients, improving adherence to treatment and management of the acute stages of the disease [28,29]. In line with these findings, the ability of Italian nurses to establish an empathic relationship with patients emerges as an essential component of nursing care. It increases with increasing years of service in the IBD unit, making them specialized nurses.

Advanced skills, such as managing pediatric and adult patients, require constant updating and specific training. Managing the transitional phases from childhood to adulthood is crucial to ensure continuity of care and prevent long-term complications [30,31]. However, the study results show that Italian nurses’ advanced skills are still limited, particularly in managing pediatric patients and transitions. This finding is consistent with other research suggesting that nurses often receive less training on specific patient populations, such as pediatric patients [6].

Finally, the literature highlights the importance of the nurses’ role in the multidisciplinary team. Nurses have been identified as central figures in the interdisciplinary management of IBD, facilitating communication between gastroenterologists, surgeons, nutritionists and psychologists [15,32,33]. The results of this study confirm the importance of the multidisciplinary role of Italian nurses. However, there is still room for improvement in their ability to interact with other specialties and to manage complex clinical situations. This is a crucial aspect in ensuring integrated and comprehensive care for patients with IBD.

One of the main strengths of this research is its ability to provide a comprehensive overview of the competencies of IBD nurses in Italy. The questionnaire used, based on N-ECCO guidelines, allowed the collection of detailed data on a broad spectrum of competencies, both fundamental and advanced, clearly indicating areas of strength and weakness. In addition, the study benefited from the participation of a heterogeneous group of nurses from different Italian regions, which increases the representativeness of the results and makes it possible to identify geographical differences in the implementation of nursing competencies.

This study represents a starting point for future targeted education initiatives and professional development programs for IBD nurses. Investing in advanced skill development, improving continuing education and promoting more structured multidisciplinary collaboration could significantly improve the quality of care for IBD patients.

Despite its strengths, this study has some limitations that must be considered. Firstly, the sample size is relatively small, with 50 participants, which may limit the generalizability of the results nationally. However, the reduced sample size aligns with the limited representation of the IBD nurse role across Italy. Nearly 140 IBD centers have been officially registered in the country, yet only 50% of them have a dedicated IBD nurse. This limitation reflects the early stage of the profession’s development in Italy, which we hope to address in future studies. Furthermore, the self-reported nature of the questionnaire responses may introduce a subjectivity bias, with participants possibly overestimating their skills. Thus, another limitation concerns the need for an objective assessment of competencies, based on direct observation or practical tests, which could have provided a more accurate measure of nurses’ actual skills. Lastly, the predominance of advanced skills in managing pediatric patients as an area of weakness suggests the need for further investigation focused on this specific population, which may need to be adequately represented in the study sample.

This research has provided an in-depth overview of the competencies of IBD nurses in Italy, highlighting areas of strength and areas for improvement. The role of the IBD nurse is evolving, and their importance in the holistic management of patients is being recognized more and more. However, data suggest that further efforts are needed to improve continuing education and the implementation of advanced skills, especially in complex clinical settings and in the management of patients with special needs. Although patient involvement could offer valuable insights, our study focused on nurses’ self-assessment of their professional skills—an essential component of competency development and self-awareness. Future research should incorporate multi-source evaluations, including patient feedback and objective assessments, to comprehensively understand IBD nurse competencies.