Background Several studies have highlighted the added value of nurses in the management of patients with chronic inflammatory arthritis[1,2], which led the EULAR Nursing Task Force to formulate a set of recommendations for the role of nurses in this particular context. Rheumatology as a nursing specialty does not exist in Portugal, and this may constitute an important barrier for the implementation of these recommendations.
Objectives We aimed to evaluate the level of agreement of Portuguese nurses working in rheumatology departments with the EULAR recommendations and the degree of their applicability in routine clinical practice.
Methods During January 2012, a questionnaire was sent to all Portuguese Rheumatology centers inviting practicing nurses to answer anonymously to a closed-type set of questions that addressed the level of agreement with each of the recommendations (1 – total disagreement to 5 – total agreement), the recommendations’ application in practice (not applied (0), partly (1) or full applied (2)) and the level of confidence in the applicability of each of the recommendations (0-not at all confident; to 5 totally confident). Chi2 and Mann-Whitney tests were used to plot the results.
Results A total of 42 nurses (83% female; 4.8±4.4 years of practice) from 10 rheumatology centers were included. Twenty-eight (67%) worked at the outpatient clinic, 7 at the inpatient clinic and 7 at both places. Only twelve (29%) worked exclusively at rheumatology departments. Although all nurses stated to be interested in getting more training in rheumatology and 67% would like to have the formal specialty in rheumatology, only eleven (45%) had received some type of training. On average, the level of agreement with all the EULAR recommendations was 4.9±0.2 (with averages for the individual recommendations ranging from 4.6±0.7 to 5±0). In the majority of cases (76.2%) these recommendations were partly applied in practice and the level of confidence in their full applicability was 3.7±0.9 (with averages for the individual recommendations ranging from 3.1±1.5 to 4.3±0.9). Comparing nurses with and without specific training in rheumatology, a significantly higher proportion of those who received training totally agreed with providing care based on protocols and guidelines (94% vs 63%, p=0.02) – Recommendation 7. Similar results were found among nurses working at day-care units when compared to the others (87% vs 50%, p=0.03). A significantly higher proportion of nurses from day-care units showed total agreement with Recommendation 9, which states that nurses should be encouraged to undertake extended roles after specialised training, according to national regulations (97% vs 67%, p=0.02). The level of confidence in the applicability of recommendation 7 was also significantly higher in those two subgroups.
Conclusions There is a high level of agreement with the EULAR recommendations for rheumatology nursing management in Portugal, despite the fact that most of the nurses are working in partial dedication to rheumatology and without specific training. The highest level of agreement was verified among nurses with specific training and working at day-care units, underlining the importance of specific training for future commitment.
Hill et al. Br J Rheumatol 1994; 33:283-8.
Ryan et al, J Adv Nurs 2006;53:277-86.
Eijk-Hustings et al. Ann Rheum Dis 2012; 71:13-19.
Disclosure of Interest None Declared