An exploratory study using video analysis of rheumatology specialist nurses conducting methotrexate education consultations with patients

Abstract

Background: Prior to commencing methotrexate, patients routinely attend an education consultation with a rheumatology nurse. The purpose of the consultation is to discuss the patients' expectations and concerns related to commencing methotrexate, the benefits of treatment, potential side effects and monitoring requirements. The aim of this study was to use video analysis to assess the structure, content and mode of delivery of the consultation. Methods: Video recordings of 10 patient-nurse consultations, involving four specialist rheumatology nurses, were analysed and transcribed. The consultations were compared with the Calgary-Cambridge (CC) consultation model. Transcripts were thematically analysed. Data were quantitatively assessed for verbal and nonverbal behaviours.Findings: Assessment of the video data using the CC model demonstrated good structure, content and flow of the consultation, influenced by the use of an information leaflet. Consultations generally consisted of communication from nurse to patient rather than a dialogue; the nurse spoke for 69%-86% of the time; clarification of the patient's understanding of the information did not take place in any of the consultations. Thematic analysis also showed that the nurse agenda dominated and the nurse was aware of 'overloading' the patient with information. Cues from the patients to discuss items of importance were often missed. Conclusion:Video analysis can be used to identify the aspects of the consultation that work well and those areas of the consultation that could be improved with specific training.

Towards a consensus for nurse education of methotrexate for people with rheumatic and musculoskeletal diseases: A scoping review

“…The education and training of nurses were also studied as this is an important topic for ensuring that patients receive the best possible care (Robinson, 2021;Robinson et al, 2017Robinson et al, , 2018Vlieland et al, 2016). A study conducted in the UK found that most nurses lacked knowledge and confidence in managing patients taking MTX (Robinson et al, 2017).…”

“…Studies, mostly from the United Kingdom (UK), indicate that the training received by nurses to educate patients to start MTX is very varied, influencing nurses' confidence and competencies (Robinson, 2021; Robinson, Adams, et al., 2021). Confidence came with experience, took many months to develop, and standard training was seen as helpful (Robinson et al., 2017).…”

“…Confidence came with experience, took many months to develop, and standard training was seen as helpful (Robinson et al., 2017). Another concern reported by nurses is that most consultations focus on transmitting information with little opportunity for interaction and clarification of patient doubts (Robinson, 2021). Using standardised written information to guide the consultation's structure and content is also seen as helpful (Robinson et al., 2018).…”