Rheumatology: a study of patient satisfaction with follow-up monitoring care

BACKGROUND

This paper reports the findings of a quantitative study to determine the satisfaction of rheumatology patients receiving follow-up monitoring care within primary and secondary locations.

AIMS AND OBJECTIVES

The aim of the study was to compare and contrast the satisfaction of patients with rheumatoid arthritis following two different routes of care. The objective was to explore the dimensions of care identified in an earlier qualitative study.

DESIGN

A convenience sample of 80 participants was used; 40 from each care location.

METHODS

Data were collected using the Leeds Satisfaction Questionnaire, which explores the dimensions of satisfaction previously identified as being important to this group of patients.

RESULTS

The secondary care group showed significantly higher levels of satisfaction in respect of general satisfaction, provision of information and continuity of care and a significant difference in relation to empathy, technical ability and attitude to the patient.

CONCLUSIONS

While patients from both locations were satisfied with the care they received, those receiving specialist nursing care in the secondary location were more satisfied.

RELEVANCE TO CLINICAL PRACTICE

Increased emphasis on care in the community and the evolution of nurse specialist roles indicate the need for further qualitative work to inform the future planning of care provision for rheumatology patients in this area.

[Nursing without and with essential oils: a controlled study of patients in an acute rheumatologic department]

Before introducing essential oils in nursing in a whole clinic, a controlled pilot study was performed. Within the study frame, forty voluntary patients of a rheumatology ward in the City Hospital Triemli (Zurich, Switzerland) had each an indicated nursing intervention without and with essential oils. The main criteria of the nursing activities were physical contact between patient and nurse; no medication besides the prescribed ones, same procedure with and without essential oils. Data recorded immediately before and 30 to 45 minutes after nursing comprised the general well-being of patients in their own and their nurse's ratings, the patient's rating of his/her state with respect to all study nursing indications, and the nurse's self-rating with respect to her mental well-being. At discharge patients commented on their in-patient stay as well as on nursing with essential oils. The general well-being of study participants was comparable before either type of nursing intervention with the exception of the aspect of well-being due to which the intervention was done: ratings of these intervention-specific aspects were much worse in relation to nursing with than without essential oils. However, specific well-being significantly improved only due to nursing with but not without essential oils. The larger the intervention-specific effect of nursing with essential oils, the significantly more positive were the comments on nursing with essential oils at the patients' discharge.

INTERPRETATION

Nursing with essential oils has specific effects, but does not improve the general well-being. Nursing with essential oils is more efficacious than when oils are not applied.

Assessment of strategies in families tested by Finnish families

The aim of this paper was to describe testing a Finnish version of the assessment of strategies in families (ASF) instrument and its construct validity and reliability in Finnish families. The ASF instrument is based on Friedemann's framework of systemic organization and the version used in this study consists of 25 items, each containing three statements. The instrument was developed to estimate family functioning in reaching the four targets of the framework of systemic organization. It provides sub-scores for the targets, family stability (system maintenance and coherence), family growth (system change and individuation), control (system maintenance and system change) and spirituality (individuation and coherence). Data were collected from patients attending the outpatient clinics of pulmonary and rheumatic diseases (N=196). Questionnaires were given to patients capable of understanding the questions and they returned questionnaires by mail directly to researchers. Construct validity was tested with exploratory factor analysis. Factor analysis was done with 22 items. The four factor solution was best suited. Two items were eliminated because of low factor loadings and crossloading. The total of 20 items were left in the instrument. Crohnbach's alpha was used to measure internal consistency. It was computed for each target separately and the total tool. There were discrepancies in the assignment of process dimensions which were expected because of cultural perceptions. The total instrument had a reliability of 0.85. The result of the analyses was a pretested tool with subscales for stability, growth, control and spirituality that have acceptable reliability and concept validity. Less satisfactory was the small number of items representing individuation. Another weakness is the lack of statistical distinction between system maintenance and coherence. The instrument is also usable in these subscales, but it needs further development and retesting. Items need to be added to express individuation, possibly some others. The new items will be formulated freely, paying attention to culture. However, the tool appears good enough to be used as measurement in various research studies.

Intra-articular and soft tissue injections by nurses: preparation for expanded practice

Administration of intra-articular and soft tissue injections for rheumatic disease represents an expansion of the nurse's role. To achieve the benefits of improved care for patients, and enhanced practice and job satisfaction for practitioners, preparation for the role must be rigorous and systematic. Here the authors describe a course designed to meet these criteria. They set out the content and outcomes of the course and consider some of the ethical and legal issues surrounding such role expansion.

Quality and continuity of care in Dutch nurse clinics for people with rheumatic diseases

OBJECTIVE

Recently a new form of nurse clinic for people with rheumatic diseases has been introduced into Dutch health care. This study gives insight into: (i) patients' perceptions about the quality and continuity of care given at these (transmural) nurse clinics; and (ii) specialized rheumatology nurses' and rheumatologists' perceptions about the quality and continuity of care in the clinics.

DESIGN

Validated measurement tools (QUOTE and QCC) were used, before and after patients visited a clinic, to determine patient perceptions about the quality and continuity of care. Semi-structured interviews with professionals were used to gather information about their perceptions.

SETTING

The study was carried out at five locations in The Netherlands where a home care organization and a general hospital collaborated closely and had joint responsibility for a transmural rheumatology nurse clinic.

STUDY PARTICIPANTS

A total of 128 patients, six specialist rheumatology nurses and four rheumatologists.

INTERVENTION

Transmural nurse clinics for people with rheumatic diseases.

RESULTS

In general, patients were positive about the quality and continuity of care given at the clinics. Some continuity aspects, like the presence of a locum nurse and providing the locum with sufficient information could be improved. Professionals were positive about the information given at the clinics, which is additional to the information given by a rheumatologist. Professionals were less positive about some of the clinics' preconditions.

CONCLUSION

In this study, a control group (e.g. patients who received standard rheumatologist care) was not available. However, in comparison with patients' experiences of standard medical care in other (comparable) research, patients' experiences in this study were very positive. It was concluded that Dutch transmural nurse clinics, to a large extent, meet patients' and professionals' expectations and were a positive development in the care of rheumatic patients.

Laboratory aspects of rheumatologic disease

Assessment of laboratory values is an important function of nursing practice. Rheumatologic laboratory assessment, in particular, can be complex because few findings are actually pathognomonic. This article provides a perspective on an interpretive approach to laboratory assessment of rheumatologic disease. In conjunction with the patient's clinical status, these values can provide helpful information for monitoring or predicting the course of disease.

Nurses' and physicians' narratives about long-term non-malignant pain among men

The aim of this study was to illuminate the meaning of skilled nurses' and physicians' lived experiences in their encounters with men suffering from long-term, non-malignant pain of at least 6 months duration. Seventeen nurses and four physicians participated in the study. A phenomenological-hermeneutic method was used. In the analysis three themes, 'needing to be manly', 'struggling for relief from pain' and 'needing human support' emerged. The phenomenon 'confirmation' was especially important in all three themes. This study indicates that confirmation of the theme 'needing to be manly' means that nurses' and physicians' must have such a relationship with these men that they really feel respected. Confirmation of the theme 'struggling for relief from pain' means that the care givers must convince these men that they really believe each unique individual's narratives. Confirmation of the theme 'needing human support' means that nurses and physicians have to behave in such a way that these men are convinced that the caregivers really care about them. When the men felt confirmation they dared to disclose their pain experiences more honestly. This is a preliminary prerequisite for nurses' and physicians' potential to help these men.

The essence of rheumatology nursing

Arthritis and rheumatism are the most frequently self-reported conditions in the UK, costing the NHS 1,200 Pounds million a year (OPCS 1980). Nurses caring for patients with these chronic illnesses need to consider the emotional consequences as well as the physical manifestations. This article identifies the important factors in the therapeutic relationship in rheumatology care.

Evaluation of information given to rheumatology patients using non-steroidal anti-inflammatory drugs

This paper reports the findings of a study of information given to rheumatology patients using non-steroidal anti-inflammatory drugs. One hundred and twenty patients were randomized to three groups. Group A received an information leaflet, Group B received both a leaflet and a verbal explanation and Group C received only a verbal explanation. Information was gathered on demography, knowledge base, sources of information, satisfaction with the leaflet and further information requirements. Data were collected by questionnaires which were completed before randomization and 8-12 weeks later. Analysis indicates the potential benefits of giving information to patients although the full implications of these benefits are not clear and further research is indicated in this important area.