Predictive Factors And Mechanism Of Irritable Bowel Syndrome Among Clinical Nurses In Tertiary Hospital Of Shandong Province

BackgroundIrritable Bowel Syndrome(IBS)is a common functional gastrointestinal disease with a positive rate of 10%-15%,which vary according to population characteristics,regions,and diagnostic/screening criteria.Although IBS is not a life-threatening condition,it will affect the quality of life and social function of individuals,resulting in the consumption of a large number of medical resources.Studies showed that the occurrence of IBS is not only affected by biological factors such as infection,but also by a variety of psychological and sociological factors,such as stress,negative emotions and so on.As a special professional group,nurses are susceptible to IBS because of their high work stress,poor regularity of life habits,anxiety and depression,etc.IBS affects the physical and mental health of the nurses,which in turn affects the quality of nursing care.However,there are few large-sample based prevalence surveys of IBS among nurses.Previous studies have shown that IBS has regional differences;it is necessary to carry out targeted research on different populations in different areas.As a province with a large number of registered nurses,Shandong province has not yet retrieved a large-scale epidemiological survey on IBS among nurses in Shandong Province.In addition,the occurrence,development and prognosis of IBS were influenced by Biological-Psychosocial Determinant Model.However,IBS's path model of psychosocial related factors has not yet been retrieved.Study AimsThe purpose of this study was to investigate the epidemiological situation of IBS and its impact factors;to analyze the path model of psychosocial factors in IBS among clinical nurses.Therefore,this study will provide scientific basis for developing strategies focus on reducing the occurrence of IBS and improving the health status of clinical nurses.MethodsFrom January to May 2017,participants were recruited by stratified and random sampling.Firstly,based on five geographical regions of Shandong Province(middle,east,south,west and north),We randomly selected 2 tertiary hospitals in each region using spss 19.0 software.Secondly,we classfied the departments of each hospital into 10 categories:internal medicine,surgery,emergency,intensive care,gynecology,obstetrics,pediatrics,operating room,outpatient service and other specialties.Then we randomly selected 12 units from each hospital base on the proportion of 2:2:1:1:1:1:1:1:1:1.Thirdly,the nurses in the selected units were numbered,and the assigned amounts of eligible nurses were randomly selected as the research objects.According to the inclusion and exclusion criteria.They were invited to participate in the survey with self-administered questionnaire.The research tools mainly include:general Information questionnaire,Lifestyle questionnaire,Roman ? Standard IBS Diagnostic questionnaire Chinese version,Nurse job stress inventory scale(NJSI),Perceived Social Support Scale(PSSS),Life Event Scale(LES),The hospital anxiety and depression scale(HADS),Maslach burnout inventory(MBI),and Simple coping style scale,etc.The positive rate of IBS,anxiety and depression,job burnout,work stressors,social support,coping style and life events were measured respectively by these scales.In this study,data entry and statistical analysis were carried out using SPSS 19.0(SPSS,Inc.Chicago,ILand USA)statistical software.Descriptive statistical analysis,independent sample t-test,chi-square test and Logistic regression analysis were applied.The path model of IBS psychosocial related factors was constructed and analyzed by Rlavaan analysis package..The level of statistical significance was set at bidirectional P<0.05.ResultsIn this study,5000 nurses were surveyed and 4600 of them returned back the questionnaires,among which 4580 were valid questionnaires,and the effective survey rate was 91.6%.1.According to the survey results of Rome ? standard,the positive rate of IBS was 11,2%(n=514).Of the four subtypes of irritable bowel syndrome,the number of constipation type IBS(Irritable bowel syndrome with constification IBS-C)was 189,the number of IBS(Irritable bowel syndrome with IBS-D)was 112,and the number of mixed IBS(Mixed Irritable bowel syndrome IBS-M)was 45.The number of IBS(Undefined irritable bowel syndrome IBS-U)was 168.In the IBS positive group,36.8%,21.7%,8.8%and 32.7%.2.There was significant difference in the positive rate of IBS among the geographical distribution(middle,east,south,west and north of Shandong)(?2=0.33,2.14,8.54,P>0.05).There was no significant difference in the positive rate of IBS among nurses with different gender,different marital status and different education level(P>0.05),and there was also no significant difference in the positive rate of IBS among different age groups(?2=6.97,P=0.073).There were significant differences in the positive rate of IBS among nurses with different professional titles,head nurses and working years(?2=13.34,6.10,15.53,P<0.01).There was a significant correlation between the history of enteritis and the positive rate of IBS(?2=24.63,114.65,0.01 P<0.01)·3.The Logistic regression analysis was carried out using demographic variables as independent variables and positive as dependent variables.The results showed that:Nurses in East region of Shandong(OR=2.081),Southern region of Shandong(OR=1.660),and Western region of Shandong(OR=1.896)were more likely to have IBS than those inNorthern region of Shandong.Clinical nurses with 4?10 years clinical experience were more likely to suffer from IBS than those who worked for more than 21 years(OR=1.641).Nurses whose close relatives have intestinal diseases(OR=1.301)and those with enteritis in in the past 6 months(OR=2.576)were more likely to suffer from IBS.4.The results of Logistic regression analysis showed that eating pure milk or yogurt caused abdominal discomfort or pain(OR=1.781),and had a history of food allergy(OR=1.286),people with overeating habits(OR=1.358),self-rated poor or bad sleep(OR=1.997,2.490)increased the risk of IBS.5.Regard the psycho-social stress factors as independent variables,the occurance of IBS as dependent variables,the results of Logistic regression analysis showed that the working stress source of "problems with patient care"is related to the higher risk of IBS(OR=1.018);on the contrary,the higher the level of social support is,the lower the risk of IBS is(OR=0.981).6.The results of Logistic regression analysis showed that the higher the score of anxiety symptom,the higher the risk of IBS(OR=1.121);on the contrary,the higher the score of positive coping,the lower the risk of IBS(OR=0.804).7.The significant variables of 3-6 mentioned above were fitted in the IBS related factor model.The results of Logistic regression analysis showed that geographical distribution,working experience(years),enteritis within the past 6 months,cold food eating habit,abdominal discomfort or pain caused by pure milk or yoghurt consuming,overeating habits,social support and anxiety were significantly associated with theoccurance of IBS.8.The results of IBS path model showed that the work stressors derived from patient care could increase the risk of IBS by raising the level of anxiety symptoms.Social support can reduce the risk of IBS by increasing the level of positive coping and then reducing the level of anxiety symptoms.It can also directly reduce the risk of IBS by reducing the level of anxiety.There was a direct negative correlation between social support and IBS,that is,the lower the social support,the higher the risk of IBS.The model fitted well with fitting index of CFI=0.998,TLI=0.998,and RMSEA=0.017(90%CI=0.001?0.034).Conclusion1.IBS is more common among nurses in tertiary hospital of Shandong Province,and the positive rate is 11.2%.2.Living regions,working years,close relatives with intestinal diseasesand enteritis within the past 6 months were the risk factors of IBS,and lifestyle,especially diet habits,were also related to the occurrence of IBS.High job stress,low social support,high anxiety and low positive coping styles are risk factors for IBS.3.There is a certain mechanism between the psychological and sociological factors and IBS.Work stress from patient care increases the risk of IBS by increasing the anxiety level.Low social support can directly increase the risk of IBS,but also indirectly affect IBS by increasing the level of anxiety symptoms and/or reducing the risk and raising the level of positive coping IBS.The fit of the final model indicated thatthe bio-psycho-social IBS predictive models can be explained by the nurses sample from Shandong Province.