Why See a Nurse?
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Patient Education     The Responsibilities of the Nurse     Specialist Practitioner     Nurse Led Clinics
The Rheumatology Team & who are the members of the team


Not everyone will need to see a nurse in the hospital you may be able to get lots of useful information and advice from your nurse in your doctor's surgery (often called a practice nurse or nurse practitioner). They should be able to give you specific advice on pain management and medications or practical advice that will help you cope and understand the type of arthritis you have. She should be able to provide you with local information about support groups or leaflets that you can obtain about your arthritis. Leaflets are also available from 

www.arthritisresearchuk.org

www.nras.org.uk

www.arthritiscare.org.uk

Some people will find it helpful to attend a clinic to receive advice on the type of arthritis they have or how to cope with the symptoms. In addition some clinics can provide information on how to avoid problems with joints and bones for instance avoiding the risks of osteoporosis or how to use advice so you can cope with one particularly difficult joint. This support may well be available from the local hospital, community clinic or interface or musculoskeletal triage service.

If you are going to be seen in a hospital for an assessment of your arthritis it is likely that you will be offered an opportunity to see a nurse especially if your arthritis requires treatment and regular monitoring. The type of nurse or practitioner that you might see will be called a 'Nurse Specialist or Specialist Practitioner'. The Nurse Specialist will work as part of the rheumatology team but may be working in the community or in a hospital. The Nurse Specialist has a specific responsibility for seeing people with arthritis who are about to start a new drug treatment or have a new diagnosis.

Sometimes people are asked to see the nurse if they need additional support with their care.

The nurse will provide you with the information that you need to know before starting treatment. Importantly the nurse will answer your questions and you can ask about your own worries and concerns. The information you are given at such times can ensure you are safe on your treatment and that you understand why you are regularly monitored while on treatment. Specialist Nurses may be trained to examine your joints, give you pain relieving injections into your joint, monitor your blood tests and adjust the tablets that you are taking. If you have a type of arthritis that requires long term treatment it is likely that the nurse will get to know you very well and provide regular support for you including access to a telephone advice line service. 


The responsibilities of the nurse often include:
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  • Regular reviews and assessments that take into account your needs and concerns whilst also advising you about your condition, treatment options and risks and benefits of treatment. One to one information sharing between you and the nurse will enable you to discuss and decide the best treatment options for you.

  • Additional Patient education - this includes information about the diagnosis, treatment required and how to access care. Sometimes extra education opportunities are offered to you. This can be as part of a group education programme or one to one sessions to help you manage your condition. This can be really helpful advising you how to rest your joints or deal with pain control.

  • Medications: Advice on medications, how you will be monitored on treatment and possible risks and benefits of treatment. To give consent to treatment you must understand the risks and benefits of treatment and then make an 'informed or educated' decision about your treatment. [see also Treatments]

  • Examination: The nurse is usually qualified in examining your joints to assess how well your disease is controlled. This assessment will include reviewing blood tests and asking you questions about how you have been since last attending clinic [see section on Assessment and Monitoring]

  • Screening and assessment. Sometimes nurses will see you before you might need to come into hospital for a specific treatment. Some of these treatments may require you to come into hospital although most of the time you will be seen in the outpatient clinical setting. You may be admitted to hospital in certain circumstances for a treatment that requires an infusion (a medication that is given to you with a bag of fluid and tubing that is administered by a needle into a vein). [see also Assessment and Monitoring]

  • Personal Issues: Nurses are aware of all the other problems that might affect how you manage your disease and cope with your life. They are skilled in talking to you about problems that relate to your daily life and listening to your needs. Sometimes people have problems with their personal relationships because of their arthritis particularly when pain and movement of joints are a problem. It is worth talking to your nurse about these problems as they do have an understanding about these problems and practical advice can be very helpful.

  • Practical support: The nurse can provide advice to support you with various problems. These include, how to manage 'flares' of your arthritis and the best ways of managing your pain, practical things around the house, and access to additional support that will help you such as referring you to the physiotherapist for information on exercises.

  • Many nurses have what are called 'nurse led clinics'. When you come to clinic you may be seen by a nurse, as long as you are in agreement. If a nurse has a qualification or special policy they may be able to alter your medication or provide a a prescription. They will also request bloods tests and x-rays and sometimes inject joints. They have the support of doctors should they require additional information or support. In some hospitals it is not possible to see the consultant rheumatologist every time and it may mean that you see another doctor working with the consultant. Patient with chronic arthritis have been found to appreciate the development of nurse led clinics. This is maybe because there is an opportunity to get to know the nurse well and as a result, the nurses has a better long term understanding about your arthritis and how you manage and what medications you have been on. In some circumstances having access to a nurse/practitioner led clinic can sometimes means you won't have to wait quite as long to be seen when you have a problem and need to be seen sooner than your planned appointment. These clinics might be held in the hospital or the community or doctors surgery.

  • Telephone Advice. Most departments provide a telephone advice line service and this is usually run by nurses. This is a valued service for individuals who have arthritis that need long term treatment and have to be seen regularly in hospital for their care. The advice line, particularly when you have just been diagnosed with arthritis, can be very important and reassuring to you. As you become more informed and learn to manage your disease, it will become a reassuring 'safety net' that can be helpful to guide you when you have a crisis that you cannot manage yourself. The advice line can also provide direct access to the Nurse Specialist when the nurse, or the team, need to keep in close contact about your treatment. Some patient support groups also run helplines for people who don't need to see the doctor or nurse at the hospital but might wish to have more information. Telephone helplines are run by Arthritis Care (www.arthritiscare.org.uk) and National Rheumatoid Arthritis Society (www.nras.org.uk).

  • Inpatient care: You may find that when you go into hospital the Nurse Specialist or one of the team will be around supporting and advising other nurses about your care. They sometimes oversee treatments or medications you receive as an inpatient. You should ask the ward that you have been asked to attend if there is a rheumatology specialist nurse/practitioner or a nurse who is experienced in caring for patients with arthritis. The nurses on the ward should be able to contact your specialist nurse to let them know you are in hospital.

  • Working as a member of the rheumatology team. Nurses can usually refer you to other members of the team to ensure you get the best care.


The Specialist Practitioner:
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Sometime instead of a specialist nurse may be called a specialist nurse practitioner you may also see someone called a 'specialist practitioner' who is a physiotherapist of occupational therapist who have developed specific expertise that used to be a traditional nursing role.

The Rheumatology Team
Rheumatology is a strong multi-disciplinary speciality. For some types of arthritis that require regular assessment and treatment decisions specialist teams either based in a hospital or in the community will provide the full support you need using a team approach. The team will meet regularly to discuss patients and their needs, refer patients to each other where appropriate and share knowledge and expertise. All members of the team recognise the value of educating individuals about their arthritis. The teams also work at educating other healthcare professionals.

In some areas you will notice that there are areas where all the team will have some expertise, this overlap means that all the team are able to identify problems and know when to ask another member of the team to take over one particular aspect of care. As in other specialities members of the team will have specific qualifications in their own field and then will have developed additional specialist skills relevant to the care of rheumatology patients. 


Who are the members of the team?
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Consultant Rheumatologist
This is a fully trained doctor with specialist training in rheumatology. Their role is to diagnose, manage and oversee medical treatment of patients have a disease that requires care from the rheumatology department. A large proportion of this work will be with inflammatory joint diseases (Rheumatoid Arthritis, Psoriatic Arthritis) and other forms of auto-immune diseases such as Lupus, Scleroderma and Mixed Connective Tissue Disease. In fact there are over two hundred diseases that come under the 'umbrella' of rheumatology. Many of the diseases mentioned can be adequately managed by your own doctor.

General Practitioner with a Specialist Interest (GPwSI)
These are doctor who you might usually see in your health centre but have a special interest and usually additional training in an area such as rheumatology. They are not as highly qualified in the specialist area (for example not as expert as the consultant for managing very complex care) but have lots of expertise in not only the special needs of those with arthritis but general medicine.

Physiotherapist
Physiotherapists are trained in the anatomy and physiology of the musculoskeletal system (muscles and bones). Having examined the musculoskeletal system they are able to identify problems or prescribe a course treatment (although usually this does not include treatment with tablets unless they have received additional training). Other advice and treatments can include exercise programmes or walking aids. They will then reassess you and review what benefits are achieved. Sometimes physiotherapists may suggest a course of hydrotherapy. Hydrotherapy is the use of very warm water to enable easier exercises that will strengthen the muscles. Other types of treatment physiotherapists may prescribe are: ultrasound, acupuncture and Transcutaneous electrical nerve stimulation (TENS). There are many physiotherapists working in the community or interface clinics.

Occupational therapist
The occupational therapist will have receive a broad training which enables the therapist to identify problems associated with the individual's problems in carrying out activities of daily life. This will mean they can assess not only problems in the home environment but also work and leisure activities. The therapist will work to improve each individual's functional ability. The aim is to maintain a safe, comfortable, independent environment. This can be achieved with the use of aids to reduce the amount of strain to joints or improve comfort and safety.

A large component of the occupational therapists' work will involve the assessment of joint function and the need to protect or prevent further damage to joints with the use of splints. Occupational therapists have close links with other agencies that can help patients. These include; social services departments, disability centres and vocational training schemes.

They may work closely with the nurses to ensure that the social and psychological consequences of your arthritis are cared for and maybe able to advise you on relaxation techniques and pacing strategies to help you cope with your arthritis. Occupational therapist may support or run specialist patient education programmes for inflammatory arthritis. 

The General Practitioner (local doctor) and practice nurse
The professionals that work at your local doctor's health centre are very important part of the rheumatology team. Many hospitals care for individuals using a 'shared' approach to care. Indeed many times you have a problem the first person you will see will be your local doctor or nurse. They need to be informed and supported in all aspects of your care so good communication between hospital and your local health centre are essential.

Orthotist
A piece of equipment called a 'prosthesis' is an aid designed to fit a patient's individual body and improve function. This could be a knee brace, corset or even especially made shoes. 

Podiatry
Podiatrists are more advanced specialists in chiropody who have expertise in managing foot problems related to illnesses. There are a number of diseases that affect the feet (e.g. Diabetes). Pain on walking, particularly the sensation of 'walking on pebbles' described by some people with rheumatoid arthritis can be disabling. Podiatrists will often assess the foot function and alignment to see the best way of relieving the stresses and strains experienced often this will help your overall ability to walk using your joints in the right way. The support of podiatry can sometimes reduce foot deformities, improve pain control and improve the normal position of the joints.


Pharmacist
There is often a pharmacist who is part of the team. Your hospital or local pharmacist can provide useful information and support on the medications you are prescribed. With an increasing in what are called 'over the counter products' (things you can buy yourself without prescription) the help of the pharmacist in advising you what you can and cannot take can be invaluable. Always check with your pharmacist if you are buying 'over the counter products' and you are also prescribed treatments by your doctor, the pharmacist will be able to tell you whether the two treatments are safe to be taken together.

Other members of the team that may be available:

Social Workers: Social Workers can provide information and advice about entitlements with benefits and how to access a range of other support services.
Dieticians: Information, support and guidance on a range of dietary issues including ensuring a well balanced diet, ensuring adequate calcium and vitamin D.
Psychologist: Occasionally it is helpful to understand more about your disease and how you see the problems related to your disease. It can be very helpful for additional support of a psychologist at times although in many areas nurses have expertise in providing psychological support.

feb08

Susan Oliver Associates

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© copyright Susan Oliver 2008