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VBCR - October 2014, Volume 3, No 5 - The Rheumatology Nurse
Deanna L. Owens, MSN, RN
Director of Infusion & Clinical Services, Low Country Rheumatology
Charleston, SC; and Historian, Rheumatology Nurses Society
Sheree C. Carter, PhD, RN, RN-BC
Past President
Rheumatology Nurses Society
Birmingham, AL

Louisville, KY—Rheumatology nurses and healthcare providers gathered from across the United States, Canada, Puerto Rico, and Kenya to “Join the Race to Rheumatology” at the 7th Annual Rheumatology Nurses Society (RNS) Conference. The conference—which had the largest attendance in the or­ganization’s history—provided networking opportunities and inspired rheumatology nurses to achieve excellence in the care of the rheumatology patient across the life span.1

The RNS identified 5 key elements serving as the basis of education, ensuring that session content was focused on the latest in the standards of care in rheumatology nursing. These 5 elements were: essentials, evaluations, efficiencies, evidences, and engagements.1

Essentials

The essentials of rheumatology nursing include differentiating between rheumatic disease diagnoses, understanding common biologic and disease-modifying medications, and demonstrating comprehensive assessments of rheumatology patients during their life span.

By taking it back to the basics of immunology and pharmacology, novice nurses and experienced practitioners alike gained exposure to new perspectives on delivery of care. Topics included rheumatology 101, pharmacology updates, intravenous techniques, basic immunology, rheumatic disease in the pediatric population, and coding with the International Classification of Diseases, Tenth Edition (ICD 10). In one session, Christine Stamatos, RN, DNP-C, Long Island Regional Arthritis and Osteoporosis Care, Inc, Babylon, NY, reviewed the latest staggering financial costs associated with rheumatic diseases. Citing data from Ong and colleagues,2 and Aletaha and colleagues,3 she pointed to a 53% increase in the cost of treatment for rheumatic disease in the past decade. Since the time of these studies, this figure equates to $377 billion in direct and indirect costs for an average of 16 workdays missed for individuals suffering with rheumatic diseases.

This rise in the cost of care for chronic rheumatic diseases is more than diabetes, heart disease, and cancer combined in the United States.

Evaluations

The evaluation sessions introduced recent developments in science and evidence-based research, which, along with essential rheumatology-specific skills, improve long-term outcomes for patients with rheumatic conditions.

In particular, Lisa Christopher- Stine, MD, MPH, Co-Director of The Johns Hopkins Myositis Center, Baltimore, MD, discussed myositis and related inflammatory myopathies. Dermatomyositis, which was once thought of as polymyositis with a rash, has very specific criteria for diagnosis, she explained during a presentation. Using Bohan and Peter Diagnostic Criteria for Polymyositis/Dermatomyositis,4 the following 5 criteria can be used for diagnosis:

  • Symmetric proximal muscle weakness
  • Elevated muscle enzymes (ie, creatinine phosphokinase, aldolase, transaminases, lactate de­­hydro­­genase)
  • Myopathic electromyography abnormalities
  • Typical changes on muscle biopsy
  • Rash typical of dermatomyositis

Polymyositis is a definite diagnosis if patients meet 4 of 5 criteria; a probable diagnosis is given if a patient meets 3 of 5 criteria. Dermatomyositis is diagnosed as definite with a rash and 3/4 criteria; probable with a rash and 2/4 criteria. Dr Christopher-Stein further explained that skin lesions in dermatomyositis may precede myopathy or persist well after the myositis is quiescent. Furthermore, the course of skin lesions does not always parallel that of muscle disease.

In addition, rheumatology nurses gained clinical exposure through case studies, diagnostic parameters, and explanation of current treatments.

Efficiencies

The Affordable Care Act (ACA) has been a hot topic of discussion among providers across the country anticipating the decisions it will lead to in healthcare facilities.

Angela Golden, DNP, FNP-C, FAANP, mesmerized attendees in a presentation about the ACA and discussed the importance of the closing of the gap for Part D and how it will affect medications, especially biologic treatments, and lead to a potential decrease in outpatient diagnostic treatments, and rheumatology radiologic services. Nurses were also reminded of the Institute of Medicine’s 2010 report, "The Future of Nursing: Leading Change, Advancing Health,"5 where it is stated that nurses should work with all others to redesign healthcare in the United States.

Nurses were provided with additional resources for their role as patient advocates in response to changes in insurance plan benefits and limitations.

Evidences

Nurses also had the opportunity to attend a poster session focused on research projects specific to nursing. patient-focused topics, including interventions linking exercise efficacy and fatigue in the osteoarthritis population, to presentations centered on establishing the role of the rheumatology registered nurse.

A study led by Iris Zink, NP, President-Elect and Conference Committee Chair, RNS, presented a case series evaluating oral versus subcutaneous methotrexate (MTX) in the treatment of patients with rheumatoid arthritis (RA) and a gastric bypass. Three patients in the study were successfully switched to subcutaneous MTX and 2 were given alternative treatments because they refused subcutaneous MTX. Five of 6 patients with RA in this case series needed to discontinue oral MTX associated with intolerance and inefficacy. More research is needed in this area of study.

Engagements

In addition to promoting research, the conference took networking a step further this year by designating a section specifically to interaction, tying in the element of engagement. Rheumatology nurses from across the globe used this session as an opportunity for collegial exchanges and collaborations across specialties, including advanced practitioners, infusion nurses, and nurses beginning their career in rheumatology.

In addition, a clinical skill-building session allowed nurses to observe and practice how to perform joint counts while other presentations encouraged promotion of self-management for pain. Ms Zink provided the attendees with some very frank talk about intimacy and chronic illness, an often overlooked and sometimes uncomfortable topic to approach in practice.

Ms Zink reminded attendees that it is imperative for patients to maintain a healthy intimate relationship, especially when under the constraints of chronic rheumatic diseases. Specific exercises to recommend and knowledge of resources were highlighted in order to care for patients holistically and respectfully. Some areas of practice can benefit from referrals to the American Association of Sexuality Educators Counselors and Therapists6 or recommendation of books such as The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness.7

Conclusion

With rheumatology nursing first gaining recognition as a specialty in 2012 and the publication of the Scope and Standards of Practice in 2013, the RNS is gaining momentum.

This year’s drive delivers the exciting announcement that the RNS has partnered with the American Nurses Credentialing Center (ANCC) to develop a certification process by portfolio. The credentialing process encourages nurses to build a compilation of their career accomplishments, knowledge, and abilities, leading to recognition as an expert in the field of rheu­matology nursing. In addition to partnering with the ANCC, the RNS released a projected publication date for the Rheumatology Core Curriculum—the end of this year. This textbook is authored by expert rheumatology nurses expanding on the diagnosis and unique delivery of care to both pediatric and adult rheumatology patients. Furthermore, the publication of the Rheumatology Core Curriculum will serve as a valuable resource for nurses preparing for portfolio certification.

The “Race to Rheumatology” came to a close with an exciting invitation to next year’s conference, which is being held August 6-8 in Orlando, FL, and calls for all nurses to Dive Deep into Rheumatology in 2015.8

Ms Owens is Director, Infusion and Clinical Services, Low Country Rheumatology, Charleston, SC; and Member, Board of Directors, Rheumatology Nurses Society; Dr Carter is Assistant Clinical Professor, The University of Alabama in Huntsville; and President, Rheumatology Nurses Society.


References

  1. Rheumatology Nurses Society. 2014 Annual Conference. http://rnsnurse.org/conference/2014-annual-conference. Accessed October 15, 2014.
  2. Ong KL, Wu BJ, Cheung B, et al. Arthritis: its prevalence, risk factors, and association with cardiovascular diseases in the United States, 1999 to 2008. Ann Epidemiol. 2013;23:80-86.
  3. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria. An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-2581.
  4. Bohan A, Peter JB, Bowman RL, et al. A computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore). 1977;56:255-286.
  5. Institute of Medicine of the National Academies. The Future of Nursing: Leading Change, Advancing Health. www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed October 15, 2014.
  6. American Association of Sexuality Educators Counselors and Therapists. www.aasect.org/. Accessed October 15, 2014.
  7. Kaufman M, Silverberg C, Odette F. The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness. 2nd ed. Berkeley, CA: Cleis Press; 2007.
  8. Rheumatology Nurses Society. Member Perspective: Running the Race of Rheumatology Nursing. http://rnsnurse.org/blog/rns-newsrheum/member-perspective-running-race-rheumatology-nursing. Accessed October 15, 2014.
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