Nurses are important members of the VHA, which employs more nurses than does any other system—89,000. Nursing care is patient-centered, whole person, and multidisciplinary. Nurses enhance access to care through alternative communication strategies, such as telemedicine. 1,2 Besides clinical care, nurses focus on health promotion, disease prevention, health education, attentiveness, and counseling. 2 Nurses working in the Multiple Sclerosis Centers of Excellence (MSCoEs) adopt the precepts of the Patient Aligned Care Team of the VA. Also, nurses who care for patients with multiple sclerosis (MS) establish, maintain, and sustain care that is culturally sensitive and wellness focused and incorporates family and community resources with the goal of living well with MS. 3
Establishing Care
Educating patients and their families about MS, its symptoms, and self-management skills at the time of diagnosis is paramount. That said, nurses are less concerned with MS immune pathology and white matter lesion count and are more concerned with helping patients maintain hope and optimism. 4 Patients abilities to adapt to chronic disease, manage symptoms and drug adverse events (AEs), and participate fully in life are essential after receiving a diagnosis of MS. Establishing care for patients with MS should be focused on relationship building, open communication, sharing information, and building trust. Developing partnerships becomes the goal, and ongoing assessment builds the case for the continuum of care. 4,5
William's Story
As William walked into the nurse’s office, careful to allow one finger to linger on the wall and backs of furniture, the nurse recognized a young man heavy with a new MS diagnosis. William was tentative, bristly, and trying to maintain his balance. The nurse noted William’s too-big clothes, part army fatigues, part athletic wear. William stated he was there only because his primary care provider wanted him to get a diagnosis for his balance problems. Developing a trusting relationship was paramount in caring for William.
William boasted of his athletic prowess and strength. Indeed, William was strong with full power in all extremities. He recounted that poor balance kept him from competing successfully in an athletic event requiring that he walk across a plank over electrified water. As the nurse listened, she recognized William’s reticence to accept his MS diagnosis. The nurse understood that previous history could affect his ability to accept a diagnosis and the treatment plan at this time. The nurse’s role was to help William navigate the VA health care system and access its resources. William was encouraged to participate in My HealtheVet (https://www.myhealth.va.gov) in order to exchange secure messages with the nurse. His messages revealed a lonely, angry man, distant from family and friends.
William acknowledged problems with balance and thinking. He quit a job he had held for 5 years as a financial advisor for fear that coworkers would discover he could no longer think clearly. He also quit his position as a Boy Scout leader for fear people would discover his poor balance. He stopped interacting with his family; he felt badgered by their probing questions about his health. William suspected that his family was gleeful he was no longer the smartest and wealthiest sibling. The nurse and William together defined and developed mutual goals, including management of his primary concerns of balance and thinking.