Introduction

Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic gastrointestinal disorder characterized by relapsing inflammation and significant psychological burden [1]. Patients with IBD often experience depression, anxiety, and reduced quality of life [2]. However, emerging research highlights posttraumatic growth (PTG)—positive psychological transformation following trauma—as a potential outcome in chronic illness [3].
PTG arises from cognitive restructuring after traumatic events, with rumination playing a key role [4]. Rumination includes intrusive rumination (unwanted, distressing thoughts) and deliberate rumination (purposeful reflection). While deliberate rumination typically fosters PTG, findings on intrusive rumination are inconsistent, with some studies reporting negative, positive, or null effects [5].

Results & Findings

A cross-sectional survey of 237 Chinese IBD patients. Intrusive rumination was negatively associated with PTG (β = -0.33; 95% CI: -0.61, -0.04), with education level impacting this effect (P for interaction < 0.05). Deliberate rumination showed a positive linear relationship with PTG (β = 0.87; 95% CI: 0.57, 1.17). Above a threshold of 17, intrusive rumination had a stronger negative impact (β = -1.01; 95% CI: -1.73, -0.30).

Summary & Discussion

This finding aligns with cognitive theories of trauma processing, which suggest that excessive intrusive thoughts may overwhelm an individual's cognitive and emotional resources, impeding adaptive meaning-making [6]. Below this threshold, intrusive rumination may serve as an initial, albeit distressing, step in cognitive processing, whereas higher levels may entrench negative thought patterns[9].This non-linear association helps reconcile conflicting findings in the literature [7]. Future research should explore whether interventions (e.g., mindfulness, cognitive restructuring) facilitate a transition toward deliberate rumination and subsequent PTG.
In contrast to intrusive rumination, deliberate rumination demonstrated a robust positive association with PTG across all models[8]. For IBD patients, who often experience fluctuating symptoms and emotional distress, facilitating deliberate cognitive processing may help them reframe their illness narrative, enhancing resilience and adaptive coping.
Individuals with lower education levels may lack the cognitive resources and flexibility needed to transform intrusive rumination into constructive meaning-making, making them more susceptible to negative emotional cycles that hinder PTG [9].

Conclusion

In conclusion, a nonlinear relationship between intrusive rumination and PTG in patients with IBD was found. When intrusive rumination exceeded a threshold of 17, it was negatively correlated with PTG. Additionally, deliberate rumination was positively associated with PTG, highlighting its potential as a facilitator of psychological growth.

References

1. Barberio B, Zamani M, Black CJ, et al. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370.
2. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471.
3. Joseph S, Murphy D, Regel S. An affective-cognitive processing model of post-traumatic growth. Clin Psychol Psychother. 2012;19(4):316-325.
4. Allen N, Hevey D, Cogley C, et al. A meta-analysis of the association between event-related rumination and posttraumatic growth: the event-related rumination inventory and the posttraumatic growth inventory. J Trauma Stress. 2022;35(6):1575-1585. https://doi.org/10.1002/jts.22875
5. Jones SR, Fernyhough C. Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model. Behav Res Ther. 2009;47(1):54-59.
6. Hill EM, Watkins K. Women with ovarian cancer: Examining the role of social support and rumination in posttraumatic growth, psychological distress, and psychological well-being. J Clin Psychol Med Settings. 2017;24(1):47-58
7. Tedeschi RG, Shakespeare-Finch J, Taku K, et al. Posttraumatic growth: Theory, research, and applications. Routledge. 2018.
8. Niemeyer H, Bieda A, Michalak J, et al. Education and mental health: Do psychosocial resources matter? SSM Popul Health. 2019;7:100392.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Introduction

The legal responsibility of nurses is a key element in the healthcare sector, especially in complex areas such as digestive endoscopy. This role requires advanced technical skills and a deep understanding of legal implications. Nurses must follow protocols, ethical standards, and laws to ensure patient safety and prevent complications. Despite adherence to protocols, unusual complications can occur. Nurses have an autonomous position of guarantee towards the patient, based on their professional autonomy, which implies an essential task of health protection.

Results & Findings

The systematic literature review examined documented clinical cases in the field of digestive endoscopy, consulting clinical databases for situations where nursing responsibility was crucial. Precise data were obtained to provide specifics on nursing responsibility in endoscopy. However, from the analysis of collected clinical cases and available data, it emerges that about 50%-60% of the responsibilities are attributable to non-compliance with good care practices. Ineffective communication, both within the healthcare team and with patients, represents about 20%-30% of the issues in particularly complex contexts. Finally, suboptimal management of a complex environment, including organizational and technological factors, contributes to the remaining 10%-20% of difficulties.

Summary & Discussion

The results of this review highlight the importance of nursing responsibility in digestive endoscopy. The main cause of liability is the failure to adhere to good care practices, indicating the need to improve training and adherence to protocols. Ineffective communication represents a significant portion of the issues, emphasizing the importance of developing effective communication skills. Finally, suboptimal management of complex environments requires attention to organizational and technological factors to improve the quality of care.

Conclusion

From the clinical cases considered, common issues emerge, including the failure to apply good practices, inadequate consideration of the complex environment in which nurses work, and communication difficulties. These factors impact the quality of care and highlight the need to invest in tools and training. Focusing on effective communication strategies and appropriate protocols could improve nursing responsibility.

References

Endoscopia digestiva e responsabilità dell'infermiere-http//www.Nurse24.it;Endoscopia digestiva e responsabilità dell'infermiere-http//wwwDocsity.com;Survey Nazionale di Anote-Anigea -infermiere online;Irti G, L'infermiere di endoscopia oggi: compiti e responsabilità. Ipasvi Roma 2000; studio centrato sulla letteratura della responsabilità in endoscopia –http//tesi.univpm.it

Introduction

​Anastomotic leak is a major complication following upper gastro-intestinal (UGI) surgery and is associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a promising method - we aimed to evaluate the treatment success in our treated population, and describe the nurse interventions that allows procedure efficiency

Results & Findings

We included 34 patients, 29 of them were male. The average age at surgery was 67,9 years; 9 patients were diagnosed with Squamous cell carcinoma; 21 with Adenocarcinoma, 1 with melanoma and 3 patients had iatrogenic benign surgery complications 8 received neoadjuvant chemotherapy, 19 received both chemo and radiotherapy. The median size of fistula opening was 11mm (average 19,9mm). A median of 6 interventions was performed per patient. EVT therapy was the first line of treatment in 23 patients while stent placement was performed previously in 12 patients. The average intervals between leak diagnosis and first treatment when EVT was the first line (was 4,77 days); 19 patients had complete closure of the defect, while 5 had partial closures (followed by stent placement in 4). We had two migrations. Due to pulmonary disease, we had to stop the treatment in one patient.

Summary & Discussion

All cases were in patients (4 needed Invasive mechanical ventilation and were in the Intensive Care Unit and 30 underwent therapy at Gastroenterology unit). Nurse staff prepared all the equipment and necessary materials; confirmed all anesthetic safety requirements (fasting, dental prosthesis, current medication, allergies); checked the bottle contents, cut the sponge according to the size of the cavity (when necessary) and wrapped it in lubricant gel. The nurse also secured the overtube while the gastroenterologist pushed the sponge into the cavity and held the forceps used to convert the draining tube from oro- to nasogastric. The sponge was then connected to the vacuum bottle. All connections were verified and sealed with waterproof tape before switching on the vacuum device, this is a very important step because it prevents the loss of vacuum pressure. It was necessary to confirm the pressure level. During the period that patients had EVT, gastroenterology nursing staff communicated with in patient nursing staff, giving all the indications, support and necessary training.

Conclusion

EVT is a safe and effective treatment for management of anastomotic leaks following esophageal surgery. Trained nursing staff improves the outcomes of this therapy, allows the efficiency of the procedure, and reduces anesthetic risks.

Disclosure

No conflit of interest