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VBCR - June 2014, Volume 3, No 3 - The Rheumatology Nurse
Deanna L. Owens, MSN, RN
Director of Infusion & Clinical Services, Low Country Rheumatology
Charleston, SC; and Historian, Rheumatology Nurses Society

Patients with rheumatic, immune­mediated, inflammatory diseases require extensive and ongoing assessments of their disease state in response to treatment, providing opportunities for nurse-patient education. Evolution of healthcare has led from treatment on an acute-care basis to patients receiving comprehensive care of their chronic condition in a specialized clinic.

The growth of rheumatology as a specialty led to the recent publication of Rheumatology Nursing: Scope and Standards of Practice developed by the Rheumatology Nurses Society (RNS).1 The rheumatology registered nurse provides individualized care through in-depth health assessments, medication monitoring, and patient education related to rheumatic disease.

Treatment for rheumatic disease is aimed at managing symptoms to prevent disease progression and damage while improving the patient’s overall quality of life. By identifying the needs of an individual patient, education from a rheumatology registered nurse increases patient compliance and improves disease outcomes.

Patient Education Leads to Compliance
With compliance in mind, developing a nursing plan focused on patients’ understanding of their disease is critical to foster participation and facilitate adherence to their treatment plan.

It is necessary to properly assess the multiple learning needs of each individual to accurately balance what the patient wants to know versus what they need to know. Patients are typically concerned with treatment options, medication side effects, and quality of life, while healthcare providers often concentrate on safety, prevention of disease progression, and treatment plan adherence. The rheumatology registered nurse uses evidence-based knowledge to bridge the gap between patient concerns and provider focus, thus empowering patients to engage in individualized discussions, understand written materials, and participate in behavioral change counseling.

To facilitate this dialogue, the varying levels of patient educational and cultural background must be taken into consideration, using both existing resources and developing new tools as necessary. A qualitative study revealed nurses providing medication information resulted in patients feeling in control and “described the importance of being involved in decisions about their medication,” leading to enhanced adherence.2 Tailoring instructions specifically to the individual creates a sense of security that contributes to the patient’s overall confidence and self-awareness necessary to comprehend disease management.

Patient Compliance Leads to Improved Outcomes
Autoimmune diseases are often unpredictable, requiring continuous follow-up visits, and ongoing monitoring of various labs and disease activity scores. Recurring visits to an outpatient specialty clinic provide exposure to necessary resources, enhancing patients’ knowledge about their disease activity and treatment goals.

Rheumatology registered nurses are integral in providing education during office visits, ensuring that patients understand the value of their compliance in the effectiveness of their treatment plan. A systematic review of 63 studies that focused on the impact of educational intervention in the rheumatoid arthritis population revealed positive short-term effects of patient education targets for patients with rheumatoid arthritis.3 Although long-term effects of patient education were inconclusive, the short-term benefits demonstrated in the study provide a solid foundation to continue the development of quality patient resources.

In another review, multiple studies involving nurse-led rheumatology clinics found that patient knowledge and satisfaction increased while pain and fatigue decreased.4 Furthermore, a 2013 study by Ndosi and colleagues showed that patients receiving nurse-led care achieved better disease activity scores compared with patients receiving rheumatologist-led care.5 In addition, nurse-led care provided patient education more frequently than did rheumatology-led care.5 The authors’ findings further solidify the importance of the rheumatology registered nurse’s role in improving patient outcomes by providing valuable education.

Benefits of Continued Education for the Healthcare Team
Successful treatment of complex autoimmune disorders requires a multi­layered approach that integrates the expert knowledge of the rheumatology registered nurse and a tailored educational plan to increase patient compliance and improve outcomes.

Although additional research is needed in this area, the benefits of nurse–patient educational interventions are clear. The goal of treatment is adequate disease management and patients experiencing symptomatic relief and increased quality of life will also result in additional referrals and recognition of the practice as a leader in the treatment of rheumatic disease.

The level of education and counseling required to achieve improved patient outcomes highlights the importance of creating an organized team of healthcare providers dedicated to becoming a valuable resource. Through support from professional organizations like the RNS, rheumatology registered nurses are provided continued education opportunities to expand their evidence-based knowledge––benefiting patients, their families, and the community.

  1. The Rheumatology Nurses Society. Rheumatology Nursing: Scope and Standards of Practice. Accessed May 20, 2014.
  2. TLarsson I, Arvidsson S, Bergman S, Arvidsson B. Patients’ perceptions of drug information given by a rheumatology nurse: a phenomenographic study. Musculoskeletal Care. 2010;8:36-45.
  3. TNiedermann K, Fransen J, Knols R, Uebelhard D. Gap between short- and long-term effects of patient education in rheumatoid arthritis: a systematic review. Arthritis Rheum. 2004;51:388-398.
  4. THill J, Thorpe R, Bird H, et al. Outcomes for patients with RA: a rheumatology nurse practitioner clinic compared to standard outpatient care. Musculoskeletal Care. 2003;1:5-20.
  5. TNdosi M, Lewis M, Hale C, et al. The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Ann Rheum Dis. 2013 Aug 27. Epub ahead of print.
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Last modified: May 21, 2015
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