Clinical skills: evidence-based nursing care of people with rheumatoid arthritis

Uncovering essential skills for effective rheumatoid arthritis management: A qualitative grounded theory study

BACKGROUND

Effective management of rheumatoid arthritis (RA) relies on patients acquiring a specific set of skills. Patient education is a promising approach to achieve this. Despite extensive research in this area, a complete understanding of the necessary skills for persons living with RA remains elusive. This study aims to identify the essential skills required for individuals with RA, develop a hierarchical framework, and provide insights for targeted therapeutic education programs.

MATERIALS AND METHODS

A qualitative approach using constructivist grounded theory was employed. Semi-structured interviews were conducted with (23) medical professionals specializing in RA and (16) RA patients. The data were analyzed using Atlas.ti software.

RESULTS

Six major themes emerged: self-care and coping, emotional and psychological resilience, knowledge and literacy in RA, personal development, communication and relationship building, and self-learning and problem-solving. These themes suggest a hierarchical structure, with knowledge serving as the foundation and progressing to more complex skills such as problem-solving and communication.

CONCLUSION

This study provides an overview of the multifaceted nature of the skills required for optimal RA management. The proposed hierarchical structure offers a robust framework for developing targeted therapeutic education programs. The findings highlight the significance of a patient-centered approach in the effective management of RA.

Guidelines on the Role of Nursing in Patients with Chronic Inflammatory Arthritis: Do we "AGREE II"?

In the era of evidence-based practice, the role of the nurse in Rheumatology has broadened and became more complex, as a part of a multidisciplinary team. The European League Against Rheumatism (EULAR) has published recommendations for the role of the nurse in the management of chronic inflammatory arthritis in 2012, with an updated version in 2018. The objective of this study was to assess the methodological quality and reporting clarity of these recommendations using the AGREE II tool.

Anxiety and depression in Slovak patients with rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is significantly associated with psychiatric morbidity. Mental health conditions are often unrecognized and untreated in primary care.

AIMS

To assess prevalence of anxiety and depression and their impact on arthritis pain and functional disability in Slovak patients with rheumatoid arthritis.

METHODS

Anxiety was assessed by the Beck Anxiety Inventory (BAI), depression by the Zung self-rating depression scale (SDS), pain by the visual analog scale (VAS) and functional disability by the health assessment questionnaire - disability index (HAQ-DI) in 142 patients with rheumatoid arthritis. Spearman's rho was calculated to assess relations between variables. Stepwise linear regression analysis was used to assess impact of anxiety and depression on arthritis pain and functional disability.

RESULTS

High prevalence of anxiety and depression was observed in arthritis patients. Anxiety and depression were significant predictors of arthritis pain and functional disability. Sex, education, marital status, disease duration and comorbidity had no impact on arthritis pain and functional disability.

CONCLUSION

These findings support the notions that psychological negative affect can influence subjective perception of arthritis pain and disability. The regular screening of anxiety and depression and the psychological approaches can be useful for managing arthritis patients.

Practical guidance for nurses caring for stoma patients with long-term conditions

As the population ages and the number of people living with a long-term condition grows, it is likely that community nurses may be presented with increasing numbers of people requiring assessment, support, and advice for complex needs. Many of the long-term conditions affect the patient's ability to live and manage aspects of daily life independently and may affect the ability to manage a stoma. The purpose of this article is to consider how long-term conditions affect daily living and stoma care, and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma (ostomates) and a long-term condition have also been included. It is hoped that by reading this article, the nurse will become more familiar with the difficulties with dexterity associated with long-term conditions experienced by ostomates, and how they can be assisted in managing and living as independently as possible.

Knowledge sources for evidence-based practice in rheumatology nursing

As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

Caring for people with arthritis and a stoma

It is understood that 10 million people currently live with arthritis and that there are two main types: osteoarthritis and rheumatoid arthritis (Arthritis Care, 2013). As the numbers of people with arthritis grows, and the population ages, it is likely that nurses may be presented with increasing numbers of people who require advice, not only when they have their stoma fashioned, but later in their life. The purpose of this article is to consider the impact of arthritis upon stoma care and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma and arthritis have also been included. It is hoped that by reading this article the nurse will be more familiar with the impact that arthritis may have on a person with a stoma and how they can be assisted to manage as independently as possible.

Caring for people with arthritis and a stoma

It is understood that 10 million people currently live with arthritis and that there are two main types: osteoarthritis and rheumatoid arthritis (Arthritis Care, 2013). As the numbers of people with arthritis grows, and the population ages, it is likely that nurses may be presented with increasing numbers of people who require advice, not only when they have their stoma fashioned, but later in their life. The purpose of this article is to consider the impact of arthritis upon stoma care and make practical suggestions for stoma management. Sources of further help and information for people living with a stoma and arthritis have also been included. It is hoped that by reading this article the nurse will be more familiar with the impact that arthritis may have on a person with a stoma and how they can be assisted to manage as independently as possible.

Factors influencing the patient with rheumatoid arthritis in their decision to seek podiatry

INTRODUCTION

Despite the level of foot involvement in rheumatoid arthritis (RA), and the literature to support early assessment of foot care needs, local referral of patients to podiatry has been occurring too late to instigate certain preventative interventions. Preliminary fieldwork has highlighted that the primary responsibility for the instigation of this lies with the patient. The present study describes the factors that influence the patient with RA in their decision to self-report foot problems.

METHOD

A case study research strategy was employed. Nine patients attending the outpatient rheumatology department participated in the study and data were gathered through semi-structured interviews. This information was analysed using a framework approach.

RESULTS

The key themes derived from the data suggested that there are a variety of factors influencing the patient's decision to self-report foot concerns. Some will act to encourage the action and others will act to oppose it. Other factors can influence the decision either way, depending on the individual patient (psychological state, previous experience, body image changes). In addition, age, gender, and cultural and social aspects are also significant.

CONCLUSION

Due to the multitude of factors influencing the individual's decision to seek help, the patient cannot be given sole responsibility for their foot health if we wish to achieve timely and appropriate podiatry, as recommended in the literature. Responsibility should be three-way; the patient, the members of the rheumatology team and, once in the podiatry service, the podiatrist should maintain this.

EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

OBJECTIVES

The authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda.

METHODS

A task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures. The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda.

RESULTS

In total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A-3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda.

CONCLUSION

10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.

Characteristics and development of therapeutic patient education in rheumatoid arthritis: analysis of the 2003-2008 literature

OBJECTIVE

The aim of this study is to point out the recent characteristics and developments of therapeutic patient education (TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008.

METHOD

Studies were selected from major databases, using the following keywords: rheumatoid arthritis, patient education, self-management, programs. Three authors independently reviewed each study and selected the data using the patient education research categories (PERC). Articles consistently related to patient education in rheumatoid arthritis (37 among 109) were included.

RESULTS

The selected articles have been published in 23 scientific journals. The majority of them concern TPE for adult patients with rheumatoid arthritis. TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team. There are two types of programs: educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers to TPE are linked to cultural and socio-economic factors.

CONCLUSION

A large number of studies still assess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barriers to this practice have become a major issue for research.

Patients' perceptions of drug information given by a rheumatology nurse: a phenomenographic study

BACKGROUND

Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilize patients' experiences.

OBJECTIVES

The purpose of this study was to describe variations in how patients with rheumatic diseases perceive drug information given by a rheumatology nurse.

METHODS

The study had a descriptive qualitative design with a phenomenographic approach. Fifteen inpatients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed.

RESULTS

Three descriptive categories emerged: autonomy, power and security. Autonomy was based on patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

CONCLUSIONS

For patients with a rheumatic disease, drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases adherence to drug treatment.

Patients' dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study

BACKGROUND

Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.

AIM

The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.

METHOD

The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.

RESULT

Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).

CONCLUSION

The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients' needs should constitute the basis for the nurse's role in the provision of care.

Locating the evidence base for musculoskeletal nursing: An overview of the rheumatology nursing literature

The main aim of this study was to locate and classify publications, particularly research publications, produced by nurses working and/or researching in the area of rheumatology in order to develop a research strategy for a newly established academic and clinical nursing unit. Database searches were undertaken to identify journal articles. Theses, dissertations, research reports, conference abstracts and books were also included in the study. The publications once located were entered into a Reference Manager electronic database and the facilities of this package were used to analyse and classify the data. The findings of the study demonstrated that over the past 40 years nurses have been steadily increasing the publication output in this area and in the last 10 years there has been a substantial increase in all publications, but particularly research and investigative articles. However there is a lack of clinical research in this area and this needs to be addressed in future as nurses develop more advanced roles in this speciality. The main limitations was the difficulty in accurately identifying nursing publications because of inadequate details of authorship.