Makoto Tanaka

Aim: To explore the sociotechnical factors underlying the perceived benefits and challenges of nurse‐led telenursing for inflammatory bowel disease. Design: A qualitative study using a two‐phase analytic approach. Methods: Semi‐structured interviews were conducted with 20 registered nurses providing outpatient inflammatory bowel disease telenursing across 11 facilities in Japan between June 2023 and June 2024. Inductive content analysis identified perceived benefits and challenges, which were then mapped to sociotechnical system domains (people, processes, technologies and environment) to examine interactions and identify potentially modifiable system‐level levers. Results: Four themes were identified: clinical assessment challenges; variability in triage decision‐making; workload burden and workflow fragmentation; and barriers to access and patient‐context misalignment. Challenges and benefits reflected interactions among system components. Key issues included limitations of voice‐only symptom assessment, variability associated with the absence of standardised protocols, and inefficiencies arising from fragmented workflows. These interaction patterns highlighted potential system‐level levers, including information structuring, decision standardisation, workflow integration, and flexible care pathways. Conclusion: The quality of inflammatory bowel disease telenursing appears to depend on sociotechnical alignment rather than communication modality alone, particularly for timely recognition of and response to disease flares. Implications for Practice: Structured assessment, standardised but adaptable triage and workflow redesign may strengthen early identification and management of exacerbations in nurse‐led telenursing. Impact: This study presents a transparent qualitative approach linking frontline nursing experiences to system‐level insights that may inform telehealth service design in chronic disease care. Reporting Method: Standards for reporting qualitative research. Patient or Public Contribution: Patients and members of the public were not involved in the design, conduct, analysis, interpretation, or reporting of this study.

Background: Fatigue remains a major unresolved issue affecting the quality of life of patients with inflammatory bowel disease (IBD), even during clinical remission. Scalable psychological approaches are needed to support effective fatigue management. Objective: The aim of this study is to evaluate the effectiveness of a multicomponent mobile cognitive behavioral intervention package for fatigue management among patients with IBD in remission and to explore factors associated with engagement with the intervention and its effectiveness. Methods: This was an open-label, waitlist-controlled randomized controlled trial. Eligible participants were adults (≥18 years) diagnosed with Crohn disease or ulcerative colitis who met remission criteria and had at least mild fatigue. Participants were randomized 1:1 using stratified block randomization based on disease type, sex, and baseline fatigue severity. The intervention was a multicomponent mobile intervention package centered on a 7-week cognitive behavioral therapy–based educational course, supplemented by adjunctive support messages. The primary outcome was fatigue, measured using the Functional Assessment of Chronic Illness Therapy—Fatigue (FACIT-F), and the secondary outcome was self-efficacy, measured using the 13-item Inflammatory Bowel Disease Self-Efficacy Scale Short Form (IBD-SES13). A sample size of 175 participants per group was required. Results: Recruitment of participants began on July 28, 2025, and ended on February 24, 2026. A total of 502 patients with IBD in clinical remission agreed to participate and were assessed for eligibility. Among them, 351 met the eligibility criteria and were randomized, while 151 (30.0%) had FACIT-F scores of 40 or higher and were excluded. Currently, follow-up is ongoing. The clinical outcome data will be analyzed after follow-up is completed, and the results are expected to be submitted for publication in 2027. Conclusions: This study may contribute valuable knowledge regarding participant engagement and the potential impact of a multicomponent mobile cognitive behavioral intervention package on fatigue in patients with IBD. The findings will support future refinement of the intervention and inform large-scale evaluations and implementation efforts.

Aim: To explore concerns and coping experiences regarding sexual well‐being in inflammatory bowel disease and examine the relationship between these concerns and affected individuals' background factors. Design: Explanatory sequential mixed methods study. Methods: Recruitment flyers ( n = 1347) were distributed to individuals attending inflammatory bowel disease outpatient clinics in seven facilities. Participants completed a questionnaire assessing demographics, concerns and coping experiences related to their sexual well‐being. Those who provided consent participated in semi‐structured online interviews. Quantitative data were analysed descriptively, and qualitative data were analysed using content analysis. Results: A total of 551 participants completed the questionnaire, and 21 participated in the interviews. Among them, 251 (45.6%) reported experiences of concerns related to romantic relationships and marriage, sexual life, pregnancy, childbirth and childcare. The nature of these concerns varied by background factors: unmarried individuals more often reported relationship concerns; those with surgical or perianal history more often reported sexual concerns; and women, married individuals and individuals with Crohn's disease more often reported pregnancy‐related concerns. Coping experiences were categorized as (1) active barrier management, (2) partner and professional support, (3) passive or resignation coping and (4) cognitive reframing. Conclusion: Sexual well‐being is significantly affected among individuals with inflammatory bowel disease. Many participants reported understanding and support from significant others or relied on personal coping strategies; however, others reported an absence of coping experiences. Sharing these findings with individuals with inflammatory bowel disease and healthcare professionals may enhance awareness and promote support strategies to improve these individuals' sexual well‐being. Implications for the Profession and/or Patient Care: Concerns about sexual well‐being are influenced by both clinical and psychosocial factors, including treatment history, life stage and partner relationships. Healthcare professionals should provide individualised and comprehensive care that incorporates the partners and families of individuals with inflammatory bowel disease to better address sexual well‐being. Impact: This study presents the first large‐scale mixed methods evidence on how individuals with inflammatory bowel disease experience sexual well‐being, providing direct implications for improving quality of life. By illustrating both adaptive and absent coping strategies, the findings contribute essential insight to inform patient‐centred clinical practice and psychosocial care. Reporting Method: The Good Reporting of a Mixed‐Methods Study (GRAMMS) guidelines were followed. Patient or Public Contribution: No patient or public contribution.

Aim: To explore how nurses across international settings support the sexual wellbeing of people living with inflammatory bowel disease through their clinical practice. Design: Qualitative descriptive study. Methods: Online semi‐structured interviews and one focus group were conducted with nurses from Australia, Canada, Japan, the Republic of Ireland and the United Kingdom. The interviews were conducted in Japanese (for Japanese participants) and English (for the rest). A total of 28 nurses with extensive experience caring for people living with inflammatory bowel disease were recruited between May 2023 and December 2024 through snowball sampling. Data were analysed using thematic analysis. Results: The overarching theme identified was ‘careful exploration in real life practice’ with the following primary themes: (1) building the foundation for sexual wellbeing care, (2) addressing sexual wellbeing issues as a team, (3) identifying sexual wellbeing needs and (4) providing personalised nursing support. These themes highlighted the lack of sexual wellbeing care education in nursing, leading to unpreparedness and low confidence among nurses who nonetheless strived to support people living with inflammatory bowel disease despite limited training and communication barriers. Conclusion: Nurses supported the sexual wellbeing of people living with inflammatory bowel disease by building trust and working collaboratively. They offered individualised care based on each patient's life context, fostering open communication. Despite cultural taboos surrounding sex, similar challenges and training needs were reported across target regions. Implications for the Profession and/or Patient Care: This study highlights the importance of addressing sexual wellbeing as a key component of holistic care for people living with inflammatory bowel disease. To achieve this, sexual wellbeing should be treated as a routine and important aspect of everyday nursing practice. Furthermore, nurses need to be empowered to play an active role in supporting sexual wellbeing and work in environments that facilitate open and respectful discussions. Impact: This study addresses the long‐neglected issue of sexual wellbeing in inflammatory bowel disease care, which has rarely been explored in nursing research. Drawing on qualitative data from multiple countries, primarily Japan, it offers a new international perspective by illustrating how nurses engage with and support sexual wellbeing. The findings have implications for clinical practice, nurse education and global research on holistic chronic illness care. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research checklist was followed. Patient or Public Contribution: This study did not include patient or public involvement in its design, conduct or reporting.

The study aim was to clarify the physical condition of patients with inflammatory bowel disease (IBD), to clarify healthcare providers’ recommendatio

Background/Aims: Fatigue is a common symptom in patients with inflammatory bowel disease (IBD). The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale has demonstrated reliability and validity in assessing fatigue in patients with IBD and is used worldwide. This study aimed to examine the current state of fatigue among Japanese patients with IBD using the FACIT-F scale and to compare these findings with data from global studies through a systematic review.Methods: Data from 488 patients with IBD treated at a specialized IBD clinic were analyzed. Patient characteristics, such as sex, age, disease duration, disease activity, FACIT-F scores, and sleep duration, were collected. A literature search identified 8 studies that met our inclusion criteria for an international comparison. A meta-analysis was performed on the Fatigue Subscale (FS) scores of FACIT-F to estimate the pooled mean. Results: The mean FACIT-F (FS) score in this study was 39.9 ± 8.6. Four variables were significantly associated with fatigue: low Emotional Well-Being subscale scores, sleep duration < 6 hours, albumin level below the reference value, and being unmarried. The meta-analysis revealed that the pooled mean score was 40.2 (95% confidence interval, 39.5–40.9), and between-study heterogeneity was moderate (I2 = 41%). Conclusions: The FACIT-F (FS) scores and related factors in Japanese patients with IBD demonstrated a similar trend to those in other countries. These findings can be used to identify patients in need of support and to consider interventions for modifiable factors. This study will help promote international collaborative research.

Aim: This study aimed to identify sexual satisfaction and related factors in Japanese patients with inflammatory bowel disease, as well as the characteristics of patients who refrained from responding to the sexual satisfaction question. Methods: A questionnaire survey was administered to 499 patients, of whom 492 were available for the analysis. Sexual satisfaction was measured using 5‐point scale derived from “I am satisfied with my sex life” item in the Functional Assessment of Chronic Illness Therapy‐Fatigue. Patient characteristics (sex, age, marital status, and job status) were collected. Additionally, we obtained data from the scale regarding nonresponse to the sexual satisfaction, sleep deprivation status, emotional well‐being, and fatigue subscales, and collected information on disease status from the medical records, including the partial Mayo Score and Crohn's Disease Activity Index. Results: Regarding sex life satisfaction, the most common response was somewhat (24.8%). There were 173 (35.2%) patients who refrained from answering the sexual satisfaction question. Females and those of older age tended to avoid answering the question. Impaired sexual satisfaction was also significantly associated with older age, sleep deprivation, low emotional well‐being subscale scores, and greater effects of fatigue. Conclusion: Sexual satisfaction is related to chronic conditions in such areas as emotional well‐being, fatigue, and sleep deprivation in inflammatory bowel disease patients, even when they are in remission. These results suggest that patients with inflammatory bowel disease are sometimes reluctant to talk about sex. Therefore, it is important for medical staff to consider this issue, especially in Japan.

Aims: To develop a scale to assess difficulties that nurses experience when collaborating with physicians in responding to clinical deterioration during night shifts and identify factors associated with scoring using the developed scale.Methods: A web‐based questionnaire with a draft scale, the Nighttime Collaboration Difficulties between Nurses and Physicians for Nurses (NCDNP‐N), was distributed to nurses working night shifts in acute‐care hospitals across Japan. Data were collected between July and October 2023. Of 435 responses, 405 were examined for the NCDNP‐N's psychometric validation, including structural validity, criterion‐related validity, and reliability assessments. Multiple linear regression analysis was performed for 385 responses excluded by listwise methods to identify factors associated with NCDNP‐N scores.Results: The NCDNP‐N has 10 items and three domains: Domain 1, dissatisfaction with physicians' actions; Domain 2, burden of working with night‐shift physicians; and Domain 3, barriers to reporting during night shifts. Estimated reliability coefficients exceeded the recommended values. Multiple regression analyses demonstrated that more years of experience in the current ward and frequency of calling the covering physician at night were markedly associated with higher scores, whereas more nursing experience was associated with lower scores.Conclusion: We developed the NCDNP‐N and confirmed its validity and reliability. The study results suggest that the responsibilities and competence of nurses working night shifts and communication with the night‐covering physician are associated with difficulties in nighttime collaboration. The NCDNP‐N may help identify challenges in clinical settings as well as can be utilized in the evaluation study for improving nighttime collaboration.

Background: Patients with inflammatory bowel disease (IBD) experience difficulties in daily life and demanding self-care needs. The goal of our support for patients is to ease their difficulties and improve their belief in their capacity to self-manage their disease (self-efficacy), by increasing their ability for self-care. The nurse’s contribution is vital in empowering patients and supporting them to better manage their disease. There is evidence that higher nurse staffing levels are associated with better patient outcomes in acute care settings, but little is known about the outpatient setting. The objective of this study was to explore the impact of multidisciplinary team care with abundant nurse staffing levels on patient-reported outcome measures (PROMs) among patients with IBD, encompassing Crohn’s disease (CD) and ulcerative colitis (UC), in clinical remission. Methods: Patients with IBD in clinical remission were included because disease activity influences the patient’s subjective evaluation. A total of 499 valid responses from two different sources were analyzed: 318 from a specialized IBD clinic with abundant nurse staffing and a multidisciplinary care team (UC: 83, CD: 235) and 181 from an online survey panel (UC: 109, CD: 72). The IBD Self-Efficacy Scale (IBD-SES) and the difficulty of life scale (DLS) were used as disease-specific PROMs. Results: In two multiple regression models adjusted by background characteristics (age, sex, diagnosis [UC/CD], employment status, use of biologics, and disease duration) using the IBD-SES or DLS as a dependent variable, the responses from clinic patients showed a more favorable score (higher self-efficacy or lower difficulty) than the online responses. Conclusions: Multidisciplinary team care with abundant nurse staffing may improve self-efficacy and ease difficulties of life among patients with IBD in clinical remission. These results could help bring attention to nurse staffing in an outpatient setting, which has previously been overlooked, and be the first to provide evidence of its importance in encouraging enhanced staffing levels.

Background: Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores. Methods: We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics. Results: By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach’s alpha and McDonald’s omega coefficients were 0.81– 0.84 and 0.81– 0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician’s charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores. Conclusion: We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians’ characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.