Background There is evidence of the effectiveness of rheumatology nurse led clinics, but little research about the nature of the scope of the nursing activity undertaken.
Objectives The aim of the study was to explore the work of the rheumatology specialist nurses in order to describe the strategies and interventions they use in the outpatient clinics to support the rheumatoid patients, including the nurses' perception of their work.
Methods The venue was a large UK tertiary hospital. Rheumatology patients came to the nurse led clinic once they had being diagnosed and the therapeutic path had been established. A qualitative case study design was used with non- participant observation of nurse led clinics (12) and semi-structured interviews with the specialist rheumatology nurses after the observations (5). Interviews were transcribed verbatim and data were analysed using Taylor & Bogdan's three steps framework: discovery, coding and discounting data.
Results The clinical background of the clinic patients observed varied, and included long term pain, progressive joint deterioration, sudden appearance of RA symptoms and flares.
Three major categories emerged from data analysis: the time of diagnosis, the long road to stabilization and the turning points (flare ups and remission). These were the main areas in which the nurse specialists focused their consultations.
Drug counseling is a major activity in the nurse-led clinic. The nurse role here is to reinforce the necessity of treatment and to assure the patient that he or she is not alone. Symptom control is another battle to fight in daily life. Nurses ask systematically about fatigue, stiffness and pain, as they go through the aching joints looking for swelling and tenderness. The appropriateness of specialist nurses' skills saves time to patients (avoiding double-appointment, with the doctor and the nurse) and gives confidence to the rest of the Rheumatology team.
The advice line is considered to be very helpful for patients and nurses. Both feel it allows quick communication without going through a lot of go-betweens and it is a good instrument to enhance continuity of care and to provide ongoing support.
Flares provoke a state of uncertainty and anxiety in RA patients, because it usually involves increasing the number of tablets they take, and another step to climb in the therapeutic strategy. Nurses are also concerned with flares, because they might imply an admission to hospital. The main aim of RA treatment is to reach a target of remission or low disease activity as soon as possible. Even when patients reach remission, nurses keep them under observation, once a year, to detect and prevent comorbidities.
Conclusions As health care organizations increasingly seek to contain costs and improve efficiency, having patients competent in the managing of their own disease is a target for the health care system. In the clinic, it was clear that the specialist nurses individualised their consultation and aimed to help patients cope with their condition by ensuring that the patients reached a good understanding of their health issues and were competent in the management of their own care.
Disclosure of Interest None declared