The role of the nurse in rheumatology varies widely among countries, in large part because of differences in legal regulations, as well as nurses’ educational background and funding issues related to overall health care provision.
However, a new set of recommendations aims to standardize – and optimize – nursing care for patients with arthritis.
The recommendations, presented May 25 at the annual European Congress of Rheumatology by Yvonne van Eijk-Hustings, were developed by the EULAR Nursing Task Force, which consists of nurses, rheumatologists, an occupational therapist, a physiotherapist, a psychologist, an epidemiologist, and patient representatives from 14 European countries.
Yvonne van Eijk-Hustings
"The role of the nurse in rheumatology is undergoing great changes," said Ms. van Eijk-Hustings. "Nurses should participate in comprehensive disease management to control disease activity, reduce symptoms, and improve outcomes."
The panel conducted a systematic literature search of the Medline, Embase, Cochrane library, CINAHL, and PscychINFO databases, plus abstracts from the last three American College of Rheumatology and EULAR conferences. They ultimately consulted a total of 54 studies.
In general, said Ms. van Eijk-Hustings, the researchers’ findings support the conclusion that nurses play an important part of a necessarily multidisciplinary team of caregivers that – in addition to rheumatologists – also includes physical therapists, occupational therapists, and psychologists.
"Being involved in the disease process provides nurses with the opportunity to recognize and point out problems in an early stage, which ensures timely interventions and timely referral to other members of the multidisciplinary team," said Ms. van Eijk-Hustings of the department of integrated care at Maastricht (the Netherlands) University Medical Centre.
However, "our project showed that the contribution of nurses to multidisciplinary care is not clearly stated and that competencies and skills of nurses are often not optimally used," according to Ms. Van Eijk-Hustings.
Ultimately, the panel developed 10 recommendations, 7 of which deal with nurses’ ideal contribution to the areas of patient education, satisfaction with care, access to care, psychosocial support, disease management, self-management, and efficiency of care.
Three additional recommendations outline the need for professional support for nurses, including increasing the availability of guidelines or nursing protocols, increasing access to education, and encouraging nurses to undertake extended roles in rheumatology.
"In general, it is of importance that patients have access to rheumatology nurses for various reasons and that rheumatology nurses have access to appropriate training and education in order to maintain and improve their knowledge and skills," said Ms. Van Eijk-Hustings, a registered nurse and doctoral candidate whose own current research deals with the evolving roles of nurses in changing health care systems in different countries.
"This includes advanced, more autonomous roles for nurses, as well as substitution of tasks in the management of chronic disorders without loss of typical nursing skills," she added.
The task force also highlighted ten topics for future research, including the need for high-quality quantitative and qualitative studies with clear descriptions of nursing roles and interventions.
"One important area to mention is the contribution of the nurse in improving patient-preferred outcomes," added Ms. Van Eijk-Hustings.
The researchers cautioned that although the recommendations are likely to be applicable to the role of nurses in other rheumatic diseases, "in the present project, we focused on rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, and most evidence was found with regard to rheumatoid arthritis."
EULAR support is needed for further dissemination and evaluation of the recommendations, she added.
The researchers reported having no disclosures to make in relation to this study.