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The rheumatology community nurse

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VOL: 97, ISSUE: 33, PAGE NO: 38

Sarah Ryan, PhD, MSc, RGN, is consultant nurse (rheumatology), Staffordshire rheumatology centre, Haywood Hospital, Stoke-on-Trent

Arthritis/rheumatism is the most common chronic condition in Britain, with 8% of women and 4% of men claiming to suffer from it (Office of Population Censuses and Surveys, 1989). Although patients require specialist input, such as education on the condition, ongoing support and advice on self-management strategies, this does not always need to be medically led.

 

Arthritis/rheumatism is the most common chronic condition in Britain, with 8% of women and 4% of men claiming to suffer from it (Office of Population Censuses and Surveys, 1989). Although patients require specialist input, such as education on the condition, ongoing support and advice on self-management strategies, this does not always need to be medically led.

 

 

Staff at the Staffordshire rheumatology centre felt that the creation of a community rheumatology nursing post would provide clinical and educational support, reflecting the needs of the local population, and be in keeping with the objectives of existing health policy (Department of Health, 1999; 2000).

 

 

A shared care approach
In other chronic conditions, such as diabetes and asthma, hospitals and GPs often share the management of patients (Jones et al, 1991; Thorne and Russell, 1973). This is not yet the case in arthritis management, although the complex physical, psychological and social needs of all patients with a chronic illness are generally understood.

 

 

Ideally, shared care should include effective communication and agreed management guidelines between primary and secondary care teams. Staff at the centre felt that a rheumatology community nurse would strengthen this partnership.

 

 

After discussions between all those involved, the objectives of the rheumatology nurse were agreed as follows:

 

 

- To provide care management, education and support for patients and their families;

 

 

- To act as an educator and resource for members of the multidisciplinary team;

 

 

- To develop a coordinated care pathway for patients with rheumatoid arthritis.

 

 

Before taking up the post, the rheumatology nurse received in-house training which incorporated a wide multidisciplinary input and the completion of a reflective diary to ensure that learning objectives were achieved. The consultant nurse in rheumatology provided ongoing support and mentorship.

 

 

The developing role
Patients with inflammatory arthritis often require anti-rheumatic drug therapy, which involves regular monitoring to assess the safety and efficacy of the treatment. Forty patients have to attend the centre every day to be monitored, which can be an inconvenience because of the distances they have to travel. To resolve this problem, the community rheumatology nurse has begun the ongoing process of educating practice nurses so that they can offer this service at local GP clinics.

 

 

The rheumatology nurse has also established assessment clinics at various sites in the region for patients with inflammatory arthritis. These monitor drug treatment, enable patients’ physical and psychological well-being to be assessed and provide the ideal circumstances for ongoing education. The nurse can identify problems and refer the patient to the most appropriate source, such as an occupational therapist. In this way the nurse acts as a coordinator of care.

 

 

Another aspect of the role is the provision of home assessments. In a nine-month audit, 378 home visits were carried out after referrals from rheumatologists and GPs. A home visit allows the rheumatology nurse to make a clinical assessment of the patient’s condition in his or her own home, assess coping strategies and begin the educational programme. This comprehensive assessment of care often leads to simple interventions that can make a big difference to a patient’s quality of life (see Case study).

 

 

The community rheumatology nurse also coordinates patient care after discharge and operates a telephone helpline service. The helpline gives patients, GPs and primary care workers access to a designated practitioner for advice on all aspects of care. An audit of calls revealed that most related to concerns about medication and managing the symptoms of the condition.

 

 

The creation of this post has enabled patients to receive care in their own homes or at local clinics and has strengthened the partnership between primary and secondary care, resulting in integrated care management. The next step will be to establish educational programmes for patients to explore self-management and coping strategies.

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