2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

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.

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

“…According to the 2018 update of the EULAR recommendations for the role of the nurses in the management of chronic IA (Bech et al, ), patients shall have access to a nurse for education to improve knowledge of IA and its management throughout the course of their disease. The results from this study, showing that patients' health status was stable over time, are valuable to discuss with patients in nurse consultations or in patient education, since many patients have fears related to the being chronically ill (Palominos et al, ).…”

“…Also, knowing that higher self‐efficacy scores are associated with lesser psychological distress and tiredness, underline that talking to patients about how to balance their activities and energy according to their individual situations (Grønning et al, ) is needed to support patients to become good self‐managers, (Bech et. al, , Chaleshgar‐Kordasiabi, Enjezab, Akhlaghi, & Sabzmakan, ; Dures et al, ; Ostlund, Björk, Thyberg, Valtersson, & Sverker, ) and that men and women may have different needs (Flurey et al, , , , ; Gruszczynska & Knoll, ).…”

Shared decision‐making in people with chronic disease: Integrating the biological, social and lived experiences is a key responsibility of nurses

“…In such circumstances, the physician may continue to focus on the first target while the other healthcare members, led by the nurse, ensure that both targets are met (Ferreira, Ndosi, de Wit, et al, ). This may represent a structural change in the organization of care in countries where nurses do not have extended roles (Bech et al, ). We seek to ensure that reaching the patient's remission is considered of equal value as biological remission as a hallmark of high‐quality person‐centred care.…”

“…Nursing is characterized by evidence‐based practice and SDM with the patient, and takes place in the context of a multidisciplinary team care (Bech et al, ). Therefore, nurses should have a pivotal role in assessing and managing the impact of disease and promoting SDM (Bala et al, ; Salisbury et al, ; Ventura, ).…”

A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients

“…It is difficult to implement these interventions in some RA patients, especially those working full time or living in rural and remote communities (Albano, Giraudet-Le Quintrec, Crozet, & d'Ivernois, 2010;Zuidema, Repping-Wuts, Evers, Van Gaal, & Van Achterberg, 2015). Telehealth has been recommended as a mode of delivery of patient education for inflammatory arthritis care (Bech et al, 2019;Zangi et al, 2015). Telehealth, defined as the remote delivery of health care by telecommunication tools, including telephones and the internet, enables accessible and appropriate care and has provided opportunities of communication with patients, support, and monitoring (Bech et al, 2019).…”