On William’s next visit, he sported a T-shirt that read, “Fight the Bully.” William explained that MS was the bully, and he would never give up the fight. The nurse suggested that the best fighting strategy was disease-modifying therapy (DMT). The nurse reinforced the information given to him about DMTs by the neurologist and reviewed the current research on treatments. The nurse offered strategies for remembering to take medication, sent secure messages, and phoned frequently to assess and encourage William and to announce availability if needed.
Continuing Care
The nurse role in the continuum of care is to assess patient self-management skills and provide, when needed, interventions to restore self-management to the highest level. 4 Although William told the neurologist he was not having any difficulty injecting the DMT, William told the nurse he stopped the DMT. “This drug is not helping my balance, I fall all the time,” he told the nurse.
William reported that his family said not to believe the doctors at the VA. “They are giving you experimental medication—be careful—don’t take their drugs.” Finally, William admitted that he hated injecting himself and had painful injection-site reactions. The nurse recognized an opportunity for teaching and reinforced realistic expectations of the DMT, which do not improve MS or its symptoms but may reduce the rate of relapse, slow disease progression, and limit white matter lesions seen on magnetic resonance imaging.
The nurse invited family members to come to the clinic, and William’s brother and sister attended a group education event. They both had many questions about MS. William was very quiet, as it became evident that his family wanted information and to help. The family was not the hindrance to care as William previously described. The nurse helped William reframe his attitude toward the role of his family in his care.
William talked about something he learned in an MS chat room about natural therapies. The nurse provided evidence-based and reliable information, including the MSCoE website (http://www.va.gov/ms), containing information for professionals as well as patients with MS. 6
William refused to go back to an injectable DMT. The nurse therefore discussed several oral medication options; however, William wanted to “fight” MS with alternative therapies. He said that exercise, a plant-based diet, and magnet therapy were all he needed. Those choices provided the opportunity to discuss complementary and alternative medicine (CAM) and use the latest American Academy of Neurology guidelines on CAM. 7 The nurse encouraged and validated William’s desire to treat his MS with diet and exercise but focused the conversation on evidence-based therapies. He ultimately decided to initiate an oral DMT.
William had an opportunity to participate in the VAsponsored Winter Sports clinic. His roommate at the games, John, was also a veteran with MS, and William developed a relationship with John. John was taking an oral DMT to manage his disease. William returned from the games and requested the same DMT that John used.
The nurse recognized the importance of peer-to-peer influence and helped William feel in control of his MS. He was grieving lost abilities. Continuing care meant boosting William’s self-esteem, enhancing coping, allaying misconceptions and false beliefs, reframing life events, decreasing feelings of chronic sorrow, and offering hope. 4