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Fusama M, Nakahara H, Gregg M, Kuroe Y, Urata Y, Kawahata K, Kawahito Y, Kojima M, Sugihara T, Hashimoto M, Miyamae T, Murashima A, Mori M, Yajima N, Matsui T. Challenges faced by nurses engaged in rheumatology care in Japan. Mod Rheumatol 2024; 34:711-719. [PMID: 37540545 DOI: 10.1093/mr/road079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aimed to identify the challenges faced by nurses engaged in rheumatology care in Japan. METHODS We conducted a questionnaire survey of nurses in Japan in 2020 on challenges experienced in rheumatology care. The participants were nurses certified by the Japan Rheumatism Foundation. Participants' answers were coded and categorized based on relevant phrases and words. Content analysis was performed on the findings. RESULTS Responses were collected from 162 participants, and a total of 228 issues were identified. Eighteen categories with 56 subcategories emerged from the data analysis, which were grouped into five types of challenges: (1) communication, (2) understanding, (3) expertise, (4) system, and (5) collaboration. In particular, the results highlighted deficiencies in needs-based multidisciplinary team care. CONCLUSION This study elucidated issues experienced by rheumatology nurses in clinical settings in Japan. Furthermore, this investigation revealed the necessity of patient-centred multidisciplinary team care, including health professionals, patients, and other relevant individuals. This study provided practical directions to facilitate the implementation of effective care focused on improving patients' quality of life.
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Affiliation(s)
- Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Misuzu Gregg
- Graduate School of Nursing, Meio University, Nago, Japan
| | - Yuriko Kuroe
- Kansai University of Nursing and Health Sciences, Hyogo, Japan
| | - Yukitomo Urata
- Department of Rheumatology, Tsugaru General Hospital, Aomori, Japan
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayo Kojima
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiko Sugihara
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
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Fusama M, Motonaga T, Kuroe Y, Nakahara H. Psychological support and patient-centered care for patients with rheumatoid arthritis: Nurses' opinions and practice in Japan. Int J Rheum Dis 2023; 26:1779-1787. [PMID: 37452602 DOI: 10.1111/1756-185x.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/11/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
AIM To investigate nurses' opinions and practices regarding psychological support and patient-centered care (PCC) for patients with rheumatoid arthritis. METHOD Registered nurses engaged in rheumatic care in Japan were asked to complete the questionnaire regarding nurses' perceived necessity, understanding, and implementation of psychological support, and six patient supports related to PCC, using a seven-point Likert scale. Correlation on practice between psychological support and PCC was evaluated. RESULTS A total of 53 nurses participated. Nurses indicated high necessity of providing psychological support, whereas implementation was statistically significantly lower than necessity and motivation. Nurses' answers showed significantly lower implementation compared with understanding regarding basic concepts of psychological support: listening, empathy, acceptance, open questions, and closed questions. Most nurses (54.7%) sometimes provided psychological support, followed by often (34.0%), always (5.7%), and not at all (5.6%). Perceived necessity of PCC was rated high. However, its implementation was significantly lower than necessity for all evaluated cares, such as patients' need-based support and support to patients' families, related to PCC. Positive correlations were observed between the implementation of psychological support and PCC. Nurses stressed the importance of psychological support for patient education and shared decision-making. CONCLUSION This preliminary study indicated that most nurses considered psychological support and PCC necessary, but their implementation was relatively low. As psychological support is also crucial to shared decision-making, in addition to PCC, barriers to its implementation should be addressed to improve patients' outcomes and quality of life.
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Affiliation(s)
- Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | | | - Yuriko Kuroe
- Faculty of Nursing and Rehabilitation, Konan Women's University, Hyogo, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
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3
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Bednarek A, Klepacz R, Bodys-Cupak IE. The Role of the Nurse in the Care and Management of Patients with Rheumatic Diseases Arising from the Current EULAR Recommendations: A Literature Review. Healthcare (Basel) 2023; 11:2434. [PMID: 37685467 PMCID: PMC10486762 DOI: 10.3390/healthcare11172434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
In some countries, restructuring of the healthcare system has contributed to the introduction of a new domain in professional nursing-the Advanced Practice Nurse (APN). In order to provide the highest quality of care to patients, nurses working at the advanced level are expected to develop knowledge and to initiate services and practices carried out in collaboration with other professionals. In 2018, the European League Against Rheumatism (EULAR) updated its recommendations for the role of the nurse in the management and care of patients with rheumatic conditions. The objective of the study was a presentation of the scope of medical services provided by nurses for patients with rheumatic diseases based on current EULAR recommendations. A review of the literature on the participation of nurses, as members of a multidisciplinary team, in the education, management, psychosocial support, and promotion of self-care in patients with rheumatic diseases was presented. The expert group formulated three overarching principles and eight recommendations. The literature review and expert recommendations indicated that nurses' tasks in relation to patients with rheumatic diseases should include an initial assessment of health needs, routine follow-up care, and counseling for patients on self-care and lifestyle changes. In the EULAR recommendations, nursing care is also defined as a practice model in which nurses, in collaboration with physicians, provide support, education, and disease monitoring to patients with rheumatic conditions. The requirement for extended nursing education at the advanced practice level, aimed at acquiring diagnostic, therapeutic, caring, and educational knowledge and skills was highlighted, particularly with regard to the EULAR recommendations.
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Affiliation(s)
- Anna Bednarek
- Department of Health Promotion, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland
| | - Robert Klepacz
- Department of Clinical Pathomorphology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Iwona Elżbieta Bodys-Cupak
- Department of Nursing Fundamentals, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
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Pallua J, Schirmer M. Identification of Five Quality Needs for Rheumatology (Text Analysis and Literature Review). Front Med (Lausanne) 2021; 8:757102. [PMID: 34760902 PMCID: PMC8573257 DOI: 10.3389/fmed.2021.757102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background: While the use of the term "quality" in industry relates to the basic idea of making processes measurable and standardizing processes, medicine focuses on achieving health goals that go far beyond the mere implementation of diagnostic and therapeutic processes. However, the quality management systems used are often simple, self-created concepts that concentrate on administrative processes without considering the quality of the results, which is essential for the patient. For several rheumatic diseases, both outcome and treatment goals have been defined. This work summarizes current mainstreams of strategies with published quality efforts in rheumatology. Methods: PubMed, Cochrane Library, and Web of Science were used to search for studies, and additional manual searches were carried out. Screening and content evaluation were carried out using the PRISMA-P 2015 checklist. After duplicate search in the Endnote reference management software (version X9.1), the software Rayyan QCRI (https://rayyan.qcri.org) was applied to check for pre-defined inclusion and exclusion criteria. Abstracts and full texts were screened and rated using Voyant Tools (https://voyant-tools.org/). Key issues were identified using the collocate analysis. Results: The number of selected publications was small but specific (14 relevant correlations with coefficients >0.8). Using trend analysis, 15 publications with relative frequency of keywords >0.0125 were used for content analysis, revealing 5 quality needs. The treat to target (T2T) initiative was identified as fundamental paradigm. Outcome parameters required for T2T also allow quality assessments in routine clinical work. Quality care by multidisciplinary teams also focusing on polypharmacy and other quality aspects become essential, A global software platform to assess quality aspects is missing. Such an approach requires reporting of multiple outcome parameters according to evidence-based clinical guidelines and recommendations for the different rheumatic diseases. All health aspects defined by the WHO (physical, mental, and social health) have to be integrated into the management of rheumatic patients. Conclusion: For the future, quality projects need goals defined by T2T based initiatives in routine clinical work, secondary quality goals include multidisciplinary cooperation and reduction of polypharmacy. Quality indicators and standards in different health systems will provide new information to optimize patients' care in different health systems.
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Affiliation(s)
- Johannes Pallua
- University Hospital for Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.,Fachhochschule Gesundheit, Health University of Applied Sciences Tyrol, Innsbruck, Austria
| | - Michael Schirmer
- Department of Internal Medicine, University Clinic II, Innsbruck Medical University, Innsbruck, Austria
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Doumen M, Westhovens R, Vandeputte M, Van Melder R, Van der Elst K, Pazmino S, Bertrand D, Stouten V, Van Laeken E, Creten N, Neys C, Verschueren P, De Cock D. The perception of stakeholders on the applicability of nurse-led clinics in the management of rheumatoid arthritis. Rheumatol Adv Pract 2021; 5:ii45-ii52. [PMID: 34755028 PMCID: PMC8570152 DOI: 10.1093/rap/rkab052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives RA should be treated to target in a process of shared decision-making with patients. Person-centred care is essential to meeting specific patient needs. Nurse-led clinics, where a nurse is responsible for care, have demonstrated added value in some countries but are still not implemented widely. This study aimed to explore stakeholders’ perceptions of advantages, disadvantages and conditions for the implementation of nurse-led clinics for RA in Belgium. Methods We performed a cross-sectional qualitative study consisting of five semi-structured focus group interviews. Rheumatology nurses, patients with RA and rheumatologists were interviewed as stakeholders. The analysis was carried out by three researchers according to the Qualitative Analysis Guide of Leuven (QUAGOL), formulating a conceptual framework of overarching themes and deconstructing this into perceived advantages, disadvantages and conditions. Results Two focus groups with nurses (total n = 16), two with patients (n = 17) and one with rheumatologists (n = 9) were conducted. The interview synthesis resulted in five overarching themes across stakeholders: efficiency of care, disease management, legal and organizational requirements, the conventional role of the nurse and the extended role of the nurse. All stakeholders perceived additional education for nurses as essential, but rheumatologists debated nurses’ abilities to lead a rheumatology clinic. Furthermore, patients preferred care protocols to guide nurses, and care providers approached this reluctantly. Generally, patients with a well-controlled disease were perceived as the ideal candidates for nurse-led care. Conclusion Nurse-led clinics could provide many benefits but require additional nurse education and a legal and organizational framework before being implemented widely and successfully.
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | | | - Rani Van Melder
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven
| | | | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | - Veerle Stouten
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | | | | | | | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
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Oliver S, Tam LS, Suet-Kei Kwok G, Fusama M, Nakahara H, Zhang CY, Yamamoto K, Furtner D. The Asia-Pacific Initiative for Rheumatology Nurse Education: Current gaps, programme development and future outlook. Musculoskeletal Care 2020; 18:397-403. [PMID: 32302046 DOI: 10.1002/msc.1473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Susan Oliver
- Rheumatology Nurse Consultant, Susan Oliver Associates, Barnstaple, Devon, UK
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | | | - Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Sciences, Osaka, Japan
| | - Chun-Yan Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Kazuhiko Yamamoto
- Center for Integration Medical Sciences, RIKEN Yokohama Institute, Yokohama, Japan
| | - Daniel Furtner
- Janssen, a Division of Johnson & Johnson Private Limited, Singapore
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Bech B, Primdahl J, van Tubergen A, Voshaar M, Zangi HA, Barbosa L, Boström C, Boteva B, Carubbi F, Fayet F, Ferreira RJO, Hoeper K, Kocher A, Kukkurainen ML, Lion V, Minnock P, Moretti A, Ndosi M, Pavic Nikolic M, Schirmer M, Smucrova H, de la Torre-Aboki J, Waite-Jones J, van Eijk-Hustings Y. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2019; 79:61-68. [DOI: 10.1136/annrheumdis-2019-215458] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/08/2019] [Accepted: 06/23/2019] [Indexed: 12/14/2022]
Abstract
To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.
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