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Not being believed or seen could be because some informants lacked social support. One German study revealed that in comparison with healthy controls, patients with IBD had a significantly smaller social network, comprising fewer nonfamily members but deeper relationships with core family members. They also reported a significantly smaller number of persons from whom they received social support.

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Patients with active disease were generally less satisfied with the support received than those whose disease was in remission Sewitch et al. In the study by Rogala et al. However, the study showed that patients with IBD in remission had a similar rate of unmet needs as the community sample Rogala et al.

When the informants in our study experienced that they were not believed or seen, they withdrew from social life. Previous research found that the disease may contribute to major interference in terms of work and daily activities Rogala et al. The first author conducted all interviews and ensured that the informants focused on the same issues to guarantee validity because subtle changes in the wording of a question can lead to significant changes in the response.

The fact that all authors individually identified and categorized incidents contributed increased validity Flanagan, ; Norman et al. An accurate account of the data collection and analysis as well as a description of the informants strengthened the reliability and validity of the study based on recommendations by Morse, Barret, Mayan, Olson, and Spiers Validity was also strengthened by presenting relevant quotations from the transcribed text to further illustrate the categories Flanagan, ; Morse et al. The data analysis indicated that no further categories emerged after 23 interviews, which increased plausibility.

One limitation is that the method relies on the recollection of the informants and their ability to provide a detailed account of a critical incident. The authors had confidence in the informants' ability to tell their story, but it should be borne in mind that there is always a possibility of misconception Norman et al. The categorization of critical incidents is controversial and has been criticized for being subjective.

Although data can be categorized in more than one way, it is always possible to refer to the raw data Norman et al. The results of the present study are transferable to an IBD population in a western society, although according to Flanagan , it is always up to the reader to evaluate the transferability of the results.

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The uncertain nature of IBD creates critical incidents that rule life in a way that causes individuals to avoid social interaction, place considerable demands on the family situation, and may affect success in their profession. Consequently, there is a need for greater awareness of the situation of individuals with IBD.

Individuals who live with IBD must be able to use public transportation, have access to public toilets, and manage to combine career and family life on equal terms with healthy individuals. When healthcare professionals acquire this knowledge, one important task is advocacy to support and promote the interests of persons with IBD.


It is clear how the bowel ruled life for the informants in the study due to the complexity of living with a chronic disease such as IBD. The authors are grateful to the informants for their participation in this study. Katarina Pihl Lesnovska organized and carried out the interviews. We confirm that the article, data, and tables have not been previously published and are not being considered for publication elsewhere.

The authors declare no conflicts of interest. National Center for Biotechnology Information , U.

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Gastroenterology Nursing. Gastroenterol Nurs. Published online Feb Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jan 20; Accepted Jun 4. The work cannot be changed in any way or used commercially. This article has been cited by other articles in PMC. Abstract Crohn disease and ulcerative colitis, collectively known as inflammatory bowel disease IBD , are chronic and have a fluctuating clinical course that impacts daily life.

Background IBD involves limitations that preclude the ability to engage in normal daily activities Peyrin-Biroulet et al. Methods Design The critical incident technique CIT is a systematic method for eliciting information from respondents. TABLE 1. Background Data of the Informants. Open in a separate window. Analysis The analysis process was inductive and started by reading each interview several times in order to become familiar with the data. TABLE 2. Losing Bowel Control This category concerned critical incidents when informants had been unable to reach the toilet in time. Having a Body That Smells Informants described critical incidents where they felt that they smelled of feces although they washed and changed their underwear frequently which made them feel unattractive, as did leaking fistulas.

Being Unable to Meet Own and Others' Expectations The informants described critical incidents where their bowel problems affected their opportunity to live up to or realize personal goals in life. Not Being Believed or Seen The experience of not being believed was described as not receiving concrete answers from healthcare professionals or the care they required.

Experiencing Frustration Due to Side Effects and Ineffective Treatment Medication could also lead to side effects such as nausea, weight gain, and hair loss which caused critical incidents as well as frustration. Discussion This study describes the complexity of living with a chronic disease such as IBD. Limitations One limitation is that the method relies on the recollection of the informants and their ability to provide a detailed account of a critical incident.

Conclusions The uncertain nature of IBD creates critical incidents that rule life in a way that causes individuals to avoid social interaction, place considerable demands on the family situation, and may affect success in their profession. Living with an ostomy and short bowel syndrome: Practical aspects and impact on daily life. Journal of Wound Ostomy Continence Nursing , 28 , 96— Psychosocial aspects of inflammatory bowel disease.

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Biomedicine and Pharmacotherapy , 54 , — Concerns of patients with inflammatory bowel disease: A review of emerging themes. Digestive Diseases and Sciences , 45 , 26— Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns. Digestive Diseases and Sciences , 34 , — The epidemiology of IBD: A lot of data but little knowledge.

How shall we proceed? The critical incident technique. Psychological Bulletin , 51 , — Mind, code, and context: Essays in pragmatics. A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease. Journal of Pediatric Psychology , 35 , — The role of expectations in reasoning.

Heidelberg, Berlin: Springers. The Short Health Scale: A valid measure of subjective health in ulcerative colitis. Scandinavian Journal of Gastroenterology , 41 , — Living with an ostomy: Women's long term experience. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: A systematic review. Alimentary Pharmacology and Therapeutics , 16 , 51— Gender differences in the social functioning of adolescents with inflammatory bowel disease.

Journal of Clinical Psychology in Medicine Settings , 19 , — Verification strategies for establishing reliability and validity in qualitative research. International Journal of Qualitative Methods , 1 , 13— Developing Flanagan's critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses.

Journal of Advanced Nursing , 17 , — Faecal incontinence in inflammatory bowel disease: Associations and effect on quality of life. Journal of Crohn's and Colitis , 7 , e—e Development of the first disability index for inflammatory bowel disease based on the international classification of functioning, disability and health. Gut , 61 , — Inflammatory and Bowel Diseases , 16 , 15— Gastroenterology Nursing , 33 , 37— Nursing research generating and assessing evidence for nursing practice.

Population-based controlled study of social support, self-perceived stress, activity and work issues, and access to health care in inflammatory bowel disease. Inflammatory Bowel Diseases , 14 , — Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. Nursing school offers a multitude of material to master and high expectations for your performance.

But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.

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One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. Nursing students often find that there are multiple correct solutions to a problem. Using the nursing process, students can narrow down their options to select the best one. When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be.

Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach. Peers and fellow healthcare professionals are not in the chain of command.

Clear understanding and proper utilization of the chain of command is essential in the workplace. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision making. The more you practice it, the better you will become and the more naturally it will come to you.

Learn about how else you can position yourself to climb the ranks in your nursing career in our article, " Nursing Career Advancement: 7 Ways to Stand Out in Your Scrubs. It has since been updated to include information relevant to Kristina is a Digital Writer at Collegis Education where she creates informative content on behalf of Rasmussen College. She is passionate about the power of education and enjoys connecting students to bright futures. Related: Criticality ; in the nuclear sense, ; critically s, "accurately;" , "in a critical situation".

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In nuclear science, critical mass is attested from Synonyms for critical demanding analytical belittling biting calumniatory captious carping caviling cavillous censorious censuring choleric condemning critic cutting cynical demeaning derogatory diagnostic disapproving discerning discriminating disparaging exacting exceptive finicky fussy hairsplitting humbling hypercritical lowering nagging niggling nit-picking overcritical particular penetrating reproachful sarcastic satirical scolding severe sharp trenchant withering MOST RELEVANT.

It was at this critical moment that Cassidy entered from the opposite side of the office.