In the JournalsPerspective

EULAR: Nurses should be part of rheumatology disease control

Nurses should participate in comprehensive disease management to reduce symptoms and improve outcomes, according to updated EULAR recommendations on the role of nurses in treating inflammatory arthritis.

“In 2012, the [EULAR] recommendations for the role of the nurse in the management of chronic inflammatory arthritis, confined to rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, or spondyloarthritis, were published,” Bianca Bech, of the Center of Rheumatology and Spine Diseases, Rigshospitalet – Glostrup, in Denmark, and colleagues wrote. “The 10 recommendations have provided a basis for improved and more standardized levels of professional nursing care across Europe.”

“Evaluation of these recommendations showed a high level of agreement across countries and regions, but large differences in application, suggesting that they are not widely implemented,” they added. “Moreover, some of the recommendations were based on a low level of evidence. Since publication of the recommendations, several studies on rheumatology nursing have been published, which contribute to increased insight and better evidence.”

Photo of a nursing student with a cell phone 
Nurses should participate in comprehensive disease management, according to updated EULAR recommendations.
Source: Adobe

To update EULAR’s recommendations for the role of nurses in managing chronic inflammatory arthritis, Bech and colleagues formed a task force with members representing 17 countries. They included 15 nurses, three rheumatologists, two patient research partners, a physiotherapist, a psychologist, an occupational therapist and a medical student. Members of the task force conducted a systematic literature review of articles published from August 2010 to Dec. 1, 2017. Relevant abstracts from the American College of Rheumatology and EULAR 2016 and 2017 annual meetings were also included.

The literature search netted 2,609 records, of which 51, mostly on the subject of RA, were included in the task force’s analysis. Members of the task force met to discuss changes to the recommendations, with consensus on each item achieved through voting. Following the meeting, members determined their level of agreement on each item through email. The draft recommendations were reviewed by all members of the task force and approved by the EULAR executive committee.

According to the task force, only one of the original 2012 recommendations remains unchanged in the update — that nurses should be encouraged to take on extended roles after undergoing specialized training, in accordance with national regulations. Among the other original recommendations, six were reworded, two were merged together and one was reformed into an overarching principle. The task force also drafted two new overarching principles, resulting in a total of three overarching principles and eight recommendations.

The overarching principles emphasize that nurses are part of the rheumatology care team, that they provide evidence-based care, and that nursing should be based on shared-decision making with the patient. In the updated recommendations, EULAR states that patients with chronic inflammatory arthritis should have access to a nurse who can provide consultations and education on the management of their condition. In addition, nurses should participate in disease management aimed at controlling disease activity, reducing symptoms and improving outcomes.

“The previous recommendations were translated into several languages and efforts were made to implement them in different countries,” Bech and colleagues wrote. “Similar initiatives to implement these updated recommendations are important and need national and international support from stakeholders such as EULAR. ... The updated recommendations can further emphasize and optimize rheumatology nursing and contribute to more standardized levels of professional nursing across Europe.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

Nurses should participate in comprehensive disease management to reduce symptoms and improve outcomes, according to updated EULAR recommendations on the role of nurses in treating inflammatory arthritis.

“In 2012, the [EULAR] recommendations for the role of the nurse in the management of chronic inflammatory arthritis, confined to rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, or spondyloarthritis, were published,” Bianca Bech, of the Center of Rheumatology and Spine Diseases, Rigshospitalet – Glostrup, in Denmark, and colleagues wrote. “The 10 recommendations have provided a basis for improved and more standardized levels of professional nursing care across Europe.”

“Evaluation of these recommendations showed a high level of agreement across countries and regions, but large differences in application, suggesting that they are not widely implemented,” they added. “Moreover, some of the recommendations were based on a low level of evidence. Since publication of the recommendations, several studies on rheumatology nursing have been published, which contribute to increased insight and better evidence.”

Photo of a nursing student with a cell phone 
Nurses should participate in comprehensive disease management, according to updated EULAR recommendations.
Source: Adobe

To update EULAR’s recommendations for the role of nurses in managing chronic inflammatory arthritis, Bech and colleagues formed a task force with members representing 17 countries. They included 15 nurses, three rheumatologists, two patient research partners, a physiotherapist, a psychologist, an occupational therapist and a medical student. Members of the task force conducted a systematic literature review of articles published from August 2010 to Dec. 1, 2017. Relevant abstracts from the American College of Rheumatology and EULAR 2016 and 2017 annual meetings were also included.

The literature search netted 2,609 records, of which 51, mostly on the subject of RA, were included in the task force’s analysis. Members of the task force met to discuss changes to the recommendations, with consensus on each item achieved through voting. Following the meeting, members determined their level of agreement on each item through email. The draft recommendations were reviewed by all members of the task force and approved by the EULAR executive committee.

According to the task force, only one of the original 2012 recommendations remains unchanged in the update — that nurses should be encouraged to take on extended roles after undergoing specialized training, in accordance with national regulations. Among the other original recommendations, six were reworded, two were merged together and one was reformed into an overarching principle. The task force also drafted two new overarching principles, resulting in a total of three overarching principles and eight recommendations.

The overarching principles emphasize that nurses are part of the rheumatology care team, that they provide evidence-based care, and that nursing should be based on shared-decision making with the patient. In the updated recommendations, EULAR states that patients with chronic inflammatory arthritis should have access to a nurse who can provide consultations and education on the management of their condition. In addition, nurses should participate in disease management aimed at controlling disease activity, reducing symptoms and improving outcomes.

“The previous recommendations were translated into several languages and efforts were made to implement them in different countries,” Bech and colleagues wrote. “Similar initiatives to implement these updated recommendations are important and need national and international support from stakeholders such as EULAR. ... The updated recommendations can further emphasize and optimize rheumatology nursing and contribute to more standardized levels of professional nursing across Europe.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Carrie Beach

    Carrie Beach

    The 2018 updated EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis emphasizes the evolving role of the rheumatology nurse. Research has shown that nurses, specific to management of patients with rheumatologic conditions, have a significant impact on patient education, satisfaction of care, psychosocial support and promotion of self-management of a patient’s disease.

    The treatment of patients with rheumatic conditions, as well as the role of the rheumatology nurse, has become increasingly complex with the evolution of biologics and, more recently, biosimilar medications. With a workforce shortage in the field of rheumatology in our near future, I think that these updated recommendations from EULAR highlight the increasingly essential role of the rheumatology nurse in the management of chronic, autoimmune diseases and recognize the nurse as a valued member of the health care team.

    • Carrie Beach, BSN, RN-BC
    • Historian, Rheumatology Nurses Society
      Nursing education coordinator
      Columbus Arthritis Center

    Disclosures: Beach reports no relevant financial disclosures.