Rheumatology telephone advice line - experience of a Portuguese department

BACKGROUND

Telephone helplines for patients are tool for information and advice. They can contribute to patient's satisfaction with care and to the effectiveness and safety of treatments. In order to achieve this, they need to be adequately adapted to the target populations, as to incorporate their abilities and expectations.

AIMS

a) Evaluate the adherence of patients to a telephone helpline managed by nurses in a Portuguese Rheumatology Department, b) Analyse the profile of users and their major needs, c) Analyse the management of calls by the nurses.

MATERIAL/METHODS

The target population of this phone service are the patients treated at Day Care Hospital and Early Arthritis Clinic of our department. Nurses answered phone calls immediately between 8am and 4pm of working days. In the remaining hours messages were recorded on voice mail and answered as soon as possible. Details of the calls were registered in a dedicated sheet and patients were requested permission to use data to improve the service, with respect for their rights of confidentiality, anonymity and freedom of decision.

RESULTS

In 18 months 173 calls were made by 79 patients, with a mean age of 47.9 years (sd=9.13). Considering the proportions of men and women in the target population, it was found that men called more frequently (M= 32.7% vs F= 20.4%, p=.016). The reasons for these calls can be divided into three categories: instrumental help, such as the request for results of complementary tests or rescheduling appointments (43.9% of calls); counselling on side effects or worsening of the disease/pain (31.2 %); counselling on therapy management (24.9%). Neither sex nor patient age were significantly related to these reasons for calling. Nurses resolved autonomously half (50.3%) of the calls and in 79.8% of the cases there was no need for patient referral to other health services.

CONCLUSIONS

About a quarter of patients adhered to the telephone helpline.. Patients called to obtain support in the management of disease and therapy or to report side effects and/or symptom aggravation in addition to reasonable instrumental reasons. This suggests that this service may provide important health gains, in addition to comfort for the patient.

[The role of the nurse in pediatric rheumatology]

With regard to the care of children with a rheumatic pathology, the nurse is notably responsible for taking charge of patients and their family and leading therapeutic education workshops for parents and children. She teaches the parents or the child how to administer injections, respect hygiene rules and use analgesic methods.

Characterizing the clinical practice and professional behaviour of rheumatology nurse specialists: a pilot study

BACKGROUND

There is a need to characterize the practice of nurse specialists, for several reasons: to identify the skills and knowledge required for the role, to safeguard the role and to facilitate appropriate remuneration of activities.

OBJECTIVE

To develop an instrument, which characterizes the clinical and professional activities of rheumatology nurse specialists (RNSs).

METHODS

A questionnaire was produced, informed by the Nursing and Midwifery Council (NMC), to assess competencies in advanced nursing practice and completed by senior clinical rheumatology nurses in the UK undertaking an MSc in rheumatology nursing. Consenting respondents were also interviewed, to enable triangulation of the data.

RESULTS

A 38-item questionnaire was produced. It comprised four sections: clinical activities, non-patient-based activities, professional behaviour and perceived confidence in a number of areas of practice. Thirteen nurses completed the questionnaire and seven of these took part in a telephone interview. All RNSs were engaged in the follow-up care of patients with rheumatoid arthritis, providing education, psychological support, monitoring and changing of drug treatments, and referrals to other health professionals. The RNSs produced guidelines, conducted audits and provided mentorship. They had low levels of confidence in seeing new patients, presenting the results of an audit at a conference, and writing a business case.

CONCLUSIONS

We have begun the process of developing a questionnaire that can identify the clinical activities, perceived self-competence and professional behaviour of RNSs. This method of characterizing advanced nursing practice offers potential as a model for nurse specialists in other disciplines. Further work is required to validate the questionnaire on a large cohort of RNSs.

Patients' perceptions of drug information given by a rheumatology nurse: a phenomenographic study

BACKGROUND

Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilize patients' experiences.

OBJECTIVES

The purpose of this study was to describe variations in how patients with rheumatic diseases perceive drug information given by a rheumatology nurse.

METHODS

The study had a descriptive qualitative design with a phenomenographic approach. Fifteen inpatients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed.

RESULTS

Three descriptive categories emerged: autonomy, power and security. Autonomy was based on patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse.

CONCLUSIONS

For patients with a rheumatic disease, drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases adherence to drug treatment.

Update on rheumatology: part 2

Ms. J. is a 60-year-old woman with severe Raynaud's phenomenon, bibasilar pulmonary fibrosis, gastroesophageal reflux disease (GERD) with dysphagia, and muscle weakness. What is a possible rheumatological diagnosis and what might the home health clinician do next?

Rheumatology nurses' work-related empowerment

OBJECTIVE

The purpose of the study was to investigate rheumatology nurse specialists' work related empowerment.

METHOD

Nine nurses undertaking graduate studies were asked to write an essay on 'What work related skills does the rheumatology nurse need to master?' In addition, one interview was conducted. The material was analysed using the method of inductive content analysis.

RESULTS

The following key areas of work related empowerment were identified as important: knowledge about rheumatic diseases; treatments and follow up monitoring care; knowledge about patient education and counselling; collaboration and the ability to co operate; mastery of manual skills and development of the quality of nursing care for patients with rheumatic disease.

CONCLUSION

The study contributes to a better understanding of work related empowerment among rheumatology nurses. The results of the study can be used to develop the role components of healthcare professionals who attend patients with rheumatic disease.

Human becoming-guided patient-centered care: A new model transforms nursing practice

Nurses working on an orthopedic surgery and rheumatology unit in a large teaching hospital in Canada participated in a 24-month research project to evaluate what happens when nurses are provided 20% of their time for the purpose of learning and self-development. Half of the teaching-learning was aligned with the commitment of the organization to advance patient-centered care, and in particular patient-centered care guided by the nursing theory, human becoming. The other half was self-directed by nurse participants according to their learning interests and self-development priorities. The purpose of this column is to describe the teaching-learning and mentoring processes in which the nurses were engaged and to highlight the subsequent changes in nursing practice that have happened on the unit from the perspectives of nurse participants.

Risk assessment of skin in rheumatic disease

Patients with a rheumatic disease are considered to be at high risk of developing skin problems because of their restricted mobility, vascular complications and the type of medication they are taking.

HIV nursing consultants: patients' preferences and experiences about the quality of care

AIM AND OBJECTIVES

We were interested to find out how human immunodeficiency virus (HIV)-patients judge the quality of care received from their HIV nursing consultants, compared with the care delivered by HIV specialists and general practitioners. Furthermore, we were interested in how the opinions of HIV patients on the HIV nursing consultant compared with the opinions of patients with rheumatic diseases on the care they receive from their specialized nurses.

BACKGROUND

The role of nurses has changed over the years. For patients with chronic diseases there seems to be an increasing role for nursing consultants in the delivery of care. In evaluating quality of care, patients' views are considered important especially for the chronically ill who can be seen as experts by experience.

METHODS

Between February 1999 and June 2000, 250 patients, receiving care from both general practitioner and specialist, received a questionnaire [Quality of Care Through the Patient's Eyes (QUOTE)-HIV] to assess HIV-related quality of care, as perceived by them. Aspects were formulated as "importance" and "performance" statements. Items were scored on 4-point scales. A ratio score (R(ij) = P(ij)/I(ij)) was calculated by dividing the perceived performance score (P) of an individual patient (i), on a health service (j) by his importance score (I). A comparison was made with patients with rheumatic diseases by using data from the QUOTE-Rheuma.

RESULTS

Patients judged the quality of care from the HIV nursing consultant as predominantly good. Five aspects showed an unfavourable ratio score (R < 1.0) which indicates room for improvement. On the dimensions "professional performance" and "attitude of the professional" the HIV nursing consultant scores between the general practitioner and the HIV specialist. Patients with rheumatic diseases seemed to be more satisfied than HIV patients with the care from their nurse consultant.

CONCLUSIONS

The HIV nursing consultants have an important role in the care of patients infected with HIV. The HIV nursing consultants are judged as good and are ranked in between the general practitioner and the HIV specialist. Given the orientation towards a more integrated care for chronically ill patients, there should be more attention paid to the position of the HIV nursing consultant.

RELEVANCE TO CLINICAL PRACTICE

In the Netherlands and in the United Kingdom there is a tendency to a greater degree of differentiation of tasks in health care. This study shows that there is room for a position like the nursing consultant and that this is highly valued by patients.

A point of contact for patients and staff

The concept of nurses working in an extended role was formally introduced by the UKCC 12 years ago, but the role of the rheumatology practitioner had been evolving sporadically over the previous decade. This had resulted in a variety of job titles, including specialist and rheumatology practitioner, with accompanying different levels of resposibility. The changes to junior doctors' hours have meant that more nurses are taking on extended roles. Practitioners have also come from physiotherapy or occupational therapy backgrounds.

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.

Nurse-led drug monitoring in the rheumatology clinic

For rheumatology nurses, role extension means taking responsibility for monitoring the drugs used in the treatment of inflammatory arthritis. This article describes how nurseled monitoring works in one clinic, and how it may offer a more holistic type of care.