Role of the Nurse in the Care and Management of Rheumatic Diseases - EULAR Review Save

In 2023, a EULAR subcommittee set out to assess the roles of nurses and Advanced Practice Nurses (APN) in the care of arthritis as outlined in published EULAR guidelines. The scope of APN practices was first proposed in 2012 and revised in 2018. EULAR updated its recommendations for the role of the nurse in the management and care of patients with rheumatic conditions. 

The goal was to define the scope of medical services provided by nurses and APNs based on current EULAR recommendations.  A systematic literature review was presented to a steering committee with experts from 17 European countries (task force), that included 15 nurses, 2 patients, a physiotherapist, a psychologist, an occupational therapist, a medical student, and 3 rheumatologists. 

These guidelines present the nurse as members of a multidisciplinary team, in the education, management, psychosocial support, and promotion of self-care in patients with rheumatic diseases. 

In 2018 they proposed three overarching principles and eight recommendations. Basically that they should be involved in the initial assessment of health needs, routine follow-up care, and counseling for patients on self-care and lifestyle changes. The EULAR recommendations define defined a practice model wherein nurses, in collaboration with physicians, provide support, education, and disease monitoring to patients with rheumatic conditions. The requirement for extended nursing education at the advanced practice level, aimed at acquiring diagnostic, therapeutic, caring, and educational knowledge and skills was highlighted.

These recommendations refer to the roles and responsibilities of the nurse, meaning advanced practice nurse, as members of a multidisciplinary team (that also includes the rheumatologist). Below are highlights of the review undertaken by the steering committee.

Overarching Principles

• Rheumatology Nurses Are Part of a Healthcare Team
• Rheumatology Nurses Provide Evidence-Based Care
• Rheumatology Nursing Is Based on Shared Decision-Making with the Patient

2018 EULAR Recommendations of Nurse’s Role in the Care of Rheumatologist Patients 

1. Patients should have access to a nurse
2. Patients should have access to nursing consultations/advice
3. Patients should be able to access the nurse quickly
4. Nurses should participate in comprehensive follow-up of the patient’s disease (managing the patient’s disease activity)
5. Nurses should provide support to patients with psychosocial problems
6. Nurses should support patients’ self-management skills
7. Nurses should have access to undertake continuing education in the specialty of rheumatology
8. Nurses should be encouraged to undertake extended/advanced roles following specialized training, in compliance with national regulations

2023 Literature Summary/Update of EULAR recommendations on the care of Rheumatological Patients by Nurses:

1. In the opinion of the patient, care provided by nurses is effective, safe and easily accessible. Rheumatology nurses are important members of the medical team caring for the patient.
2. Rheumatology nurses work in an interdisciplinary medical team, they constantly cooperate with the patient and his family in the field of care and treatment.
3. In professional practice, nurses use various sources of knowledge, i.e., scientific evidence, including protocols and guidelines, as well as their own experience gained while working with patients and their families.
4. In patient care, nurses rely on a variety of sources of knowledge, including scientific evidence, protocols, and guidelines. They are also guided by their own nursing experience resulting from the territorial context and take into account the needs and aspirations of patients.
5. The care provided by rheumatology nurses is effective and takes into account the health needs, values and preferences of patients. Patient education by nurses covers areas related to the disease, such as pain, quality of life, and adherence.
6. Patients are satisfied with the nursing care. They have a positive experience of maintaining a competent relationship with the nurse.
7. The holistic and professional approach of nurses to care inspires the trust of rheumatology patients in the knowledge of nurses, and also strengthens the supportive style of mutual relations.
8. In the patients’ opinion, teleconsultation by nurses provides them with a sense of individual support from a competent healthcare team. The quality of service provided by nurses is comparable to being observed by a physician in terms of disease control.
9. Rheumatology nurses have an important role in the early detection of inflammatory changes in the joints, the interpretation of laboratory test results, the follow-up of pharmacological treatment, and the monitoring of patients’ adherence to vaccination schedules.
10. Patients appreciate the opportunity to discuss various issues affecting their mental state with the nurse. Nurses provide support to patients with psychosocial problems in order to reduce the symptoms of anxiety and depression and motivate them to function effectively in the disease.
11. Nurses play an important role in the early detection of inflammatory changes in the joints, the interpretation of laboratory test results and the continuation of pharmacological treatment. Nurse-delivered care can reduce hospital admissions and lower the cost of care.
12. Identification of psychosocial problems of patients with rheumatological diseases by nurses and their support are important elements of nursing care for patients and their families. Nurse-led interventions can improve patients’ self-efficacy to cope with the disease in their daily lives.