Rheumatology 2014;53:14911496 doi:10.1093/rheumatology/keu134 Advance Access publication 31 March 2014
RHEUMATOLOGY
Concise report Dissemination and evaluation of the European League Against Rheumatism recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients
Objectives. The aims of this study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the European League Against Rheumatism (EULAR) recommendations for the role of nurses in the management of chronic inflammatory arthritis (CIA) using a survey of nurses, rheumatologists and patients. Methods. A Web-based survey was distributed across Europe and the USA using snowball sampling. Levels of agreement and application were assessed using a 010 rating scale (0 = none, 10 = full agreement/application). Reasons for disagreement and potential barriers to application of each recommendation were sought. Regional differences with respect to agreement and application were explored. Results. In total, 967 nurses, 548 rheumatologists and 2034 patients from 23 countries participated in the survey. Median level of agreement was high in all three groups, ranging from 8 to 10 per recommendation. Median level of application was substantially lower, ranging from 0 to 8 per recommendation. Agreement and application were lowest in Eastern and Central Europe. The most commonly reported reasons for incomplete agreement were too many other responsibilities (nurses), doubts about knowledge of the nurse (rheumatologists) and fear of losing contact with the rheumatologist (patients). The most commonly reported barriers to the application were time constraints and unavailability of service. Rheumatologists responses suggested that nurses had insufficient knowledge to provide the recommended care. Conclusion. The EULAR recommendations for the role of nurses in the management of CIA have been disseminated among nurses, rheumatologists and patients across Europe and the USA. Agreement with these recommendations is high, but application is lower and differed across regions. Key words: nurses, rheumatology nursing, guideline, inflammatory arthritis.
1 Department of Patient and Care, 2Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, 3School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, 4Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, 5 Charite´ Universita¨tsmedizin, Department Rheumatology, Berlin, Germany, 6Service de Rhumatologie 4e HE, Hoˆpital Gabriel Montpied, Clermont-Ferrand, France, 7Clinica Reumatologica, Universita` Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, 8 Staffordshire and Stoke on Trent NHS Partnership Trust,
Rheumatology Centre, Stoke on Trent, UK, 9Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and 10Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain. Submitted 11 October 2013; revised version accepted 31 January 2014. Correspondence to: Yvonne van Eijk-Hustings, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: [email protected]
! The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]
CLINICAL SCIENCE
Abstract
Downloaded from http://rheumatology.oxfordjournals.org/ at University of North Dakota on May 31, 2015
Yvonne van Eijk-Hustings1,2,3, Mwidimi Ndosi4, Beate Buss5, Franc¸oise Fayet6, Antonella Moretti7, Sarah Ryan8, Carine Savel6, Marieke Scholte-Voshaar9, Jenny de la Torre-Aboki10 and Astrid van Tubergen2,3
Yvonne van Eijk-Hustings et al.
Introduction
Materials and methods The study was performed by means of a cross-sectional survey among the target population across Europe and the USA. The study was approved by the Medical Ethical Committee of Maastricht University Medical Centre, Maastricht, the Netherlands. If necessary, national ethical approval was asked for by the principal investigators (PIs) in the respective countries.
Development of questionnaires The survey was developed with three slightly different English versions of the questionnaire for nurses, rheumatologists and patients. The questionnaire items comprised the 10 recommendations, each followed by questions on the level of agreement, level of application and barriers to implementation. The levels of agreement and application were rated on a 010 scale, with 10 being the highest level of agreement or application. Reasons for incomplete agreement or incomplete application were sought. A predefined list with potential reasons or barriers was offered, based on the findings of a previous EULAR health professional survey [10] and on clinical experience from the members of the steering committee, with the opportunity for respondents to add items. The questionnaires were piloted among 18 nurses, 9 rheumatologists, 15 patients and 4 other health professionals from different countries. Their comments were used to refine the final versions of the questionnaire, which were then translated into 17 different languages and subsequently made available online (administered as a Web-based survey) to the target group between June and August 2012.
1492
A national PI and a key leading rheumatologist were appointed for each participating country across Europe and the USA. They were jointly responsible for translation of the questionnaires into their respective language (if applicable) and for dissemination of the questionnaires in their country. The participants in the survey were asked to send the Web link of this questionnaire to their colleagues or to fellow patients (snowball sampling technique) [11]. During the survey period, PIs and key leaders were reminded on two occasions to increase, where possible, dissemination of the questionnaires. Convenience sampling was used and as many participants as possible were included.
Statistical analysis Descriptive analyses were used to calculate conceptual agreement with, application of, reasons for incomplete agreement with and barriers to the application of each recommendation. The participating countries were grouped into six regions: Northern, Western, Southern, Eastern and Central Europe and the USA, and differences in the level of agreement and level of application between the regions were assessed with non-parametric KruskalWallis tests within the group of nurses, rheumatologists and patients, respectively. All analyses were performed using IBM SPSS Statistics version 20.0 (IBM, Armonk, NY, USA).
Results Population In total, 3594 persons responded: 967 nurses, 548 rheumatologists and 2034 patients, from 23 countries. The largest number of nurse respondents was from the USA (n = 142), while the largest number of rheumatologist (n = 65) and patient (n = 384) respondents was from France. The proportion of patients with access to nursing care varied widely across countries, from 5.1% in Cyprus to 88.9% in the UK (see supplementary Table S1, available at Rheumatology Online). Characteristics of the study population are presented in Table 1. The nurses had a mean of 10.4 years (S.D. 8.0) of clinical experience in rheumatology and for the rheumatologists this was 16.4 years (S.D. 9.7). The majority of the patients had RA with a mean disease duration of 14.4 years (S.D. 11.9).
Level of agreement and level of application Fig. 1 presents the level of agreement and the level of application per recommendation from nurses, rheumatologists and patients, respectively. Overall, the level of agreement was high (median 810) across the three groups, with rheumatologists’ responses displaying the largest variation. In contrast, the overall level of application was substantially lower (median 08) and the variation was much larger in each group and for each recommendation.
www.rheumatology.oxfordjournals.org
Downloaded from http://rheumatology.oxfordjournals.org/ at University of North Dakota on May 31, 2015
Recently, 10 European League Against Rheumatism (EULAR) recommendations have been developed for the role of the nurse in the management of chronic inflammatory arthritis (CIA) [1]. The recommendations aim to achieve harmonization in rheumatology nursing care across countries, covering the contribution of nurses to the care and management of patients with CIA and requirements for their professional performance. A successful change of clinical practice in accordance with these recommendations requires an effective implementation strategy in which the key stakeholders delivering and receiving care, i.e. nurses, rheumatologists and patients, are involved [2]. Apart from dissemination, this includes a multifaceted approach focussed on hindering factors for this care at the level of the health professionals and of the social, organizational, economic and political contexts [37]. In order to develop tailored interventions, knowledge about potential barriers for acceptance and application of the recommendations in daily practice is essential [3, 79]. The objectives of the present study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the EULAR recommendations for the role of nurses in the management of CIA among nurses, rheumatologists and patients.
Distribution of the questionnaires
Dissemination of recommendations for the role of the nurse
TABLE 1 Characteristics of the study population Rheumatologists (n = 548)
Patients (n = 2034)
45.6 (9.9) 10.4 (8.0) — —
46.2 (10.6) 16.4 (9.7) — —
49.2 (14.1) — 62.8:24.8:12.4 14.4 (11.9)
— 52.1 47.9 44.0 41.6 14.4
— — 100 58.9 31.2 9.9
29.0 33.2 37.8 41.6 40.9 17.5
—: not applicable.
Reasons for incomplete agreement and barriers to application The most frequently reported reasons for incomplete agreement (i.e. level of agreement
RHEUMATOLOGY
Concise report Dissemination and evaluation of the European League Against Rheumatism recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients
Objectives. The aims of this study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the European League Against Rheumatism (EULAR) recommendations for the role of nurses in the management of chronic inflammatory arthritis (CIA) using a survey of nurses, rheumatologists and patients. Methods. A Web-based survey was distributed across Europe and the USA using snowball sampling. Levels of agreement and application were assessed using a 010 rating scale (0 = none, 10 = full agreement/application). Reasons for disagreement and potential barriers to application of each recommendation were sought. Regional differences with respect to agreement and application were explored. Results. In total, 967 nurses, 548 rheumatologists and 2034 patients from 23 countries participated in the survey. Median level of agreement was high in all three groups, ranging from 8 to 10 per recommendation. Median level of application was substantially lower, ranging from 0 to 8 per recommendation. Agreement and application were lowest in Eastern and Central Europe. The most commonly reported reasons for incomplete agreement were too many other responsibilities (nurses), doubts about knowledge of the nurse (rheumatologists) and fear of losing contact with the rheumatologist (patients). The most commonly reported barriers to the application were time constraints and unavailability of service. Rheumatologists responses suggested that nurses had insufficient knowledge to provide the recommended care. Conclusion. The EULAR recommendations for the role of nurses in the management of CIA have been disseminated among nurses, rheumatologists and patients across Europe and the USA. Agreement with these recommendations is high, but application is lower and differed across regions. Key words: nurses, rheumatology nursing, guideline, inflammatory arthritis.
1 Department of Patient and Care, 2Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, 3School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, 4Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, 5 Charite´ Universita¨tsmedizin, Department Rheumatology, Berlin, Germany, 6Service de Rhumatologie 4e HE, Hoˆpital Gabriel Montpied, Clermont-Ferrand, France, 7Clinica Reumatologica, Universita` Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, 8 Staffordshire and Stoke on Trent NHS Partnership Trust,
Rheumatology Centre, Stoke on Trent, UK, 9Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and 10Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain. Submitted 11 October 2013; revised version accepted 31 January 2014. Correspondence to: Yvonne van Eijk-Hustings, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: [email protected]
! The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected]
CLINICAL SCIENCE
Abstract
Downloaded from http://rheumatology.oxfordjournals.org/ at University of North Dakota on May 31, 2015
Yvonne van Eijk-Hustings1,2,3, Mwidimi Ndosi4, Beate Buss5, Franc¸oise Fayet6, Antonella Moretti7, Sarah Ryan8, Carine Savel6, Marieke Scholte-Voshaar9, Jenny de la Torre-Aboki10 and Astrid van Tubergen2,3
Yvonne van Eijk-Hustings et al.
Introduction
Materials and methods The study was performed by means of a cross-sectional survey among the target population across Europe and the USA. The study was approved by the Medical Ethical Committee of Maastricht University Medical Centre, Maastricht, the Netherlands. If necessary, national ethical approval was asked for by the principal investigators (PIs) in the respective countries.
Development of questionnaires The survey was developed with three slightly different English versions of the questionnaire for nurses, rheumatologists and patients. The questionnaire items comprised the 10 recommendations, each followed by questions on the level of agreement, level of application and barriers to implementation. The levels of agreement and application were rated on a 010 scale, with 10 being the highest level of agreement or application. Reasons for incomplete agreement or incomplete application were sought. A predefined list with potential reasons or barriers was offered, based on the findings of a previous EULAR health professional survey [10] and on clinical experience from the members of the steering committee, with the opportunity for respondents to add items. The questionnaires were piloted among 18 nurses, 9 rheumatologists, 15 patients and 4 other health professionals from different countries. Their comments were used to refine the final versions of the questionnaire, which were then translated into 17 different languages and subsequently made available online (administered as a Web-based survey) to the target group between June and August 2012.
1492
A national PI and a key leading rheumatologist were appointed for each participating country across Europe and the USA. They were jointly responsible for translation of the questionnaires into their respective language (if applicable) and for dissemination of the questionnaires in their country. The participants in the survey were asked to send the Web link of this questionnaire to their colleagues or to fellow patients (snowball sampling technique) [11]. During the survey period, PIs and key leaders were reminded on two occasions to increase, where possible, dissemination of the questionnaires. Convenience sampling was used and as many participants as possible were included.
Statistical analysis Descriptive analyses were used to calculate conceptual agreement with, application of, reasons for incomplete agreement with and barriers to the application of each recommendation. The participating countries were grouped into six regions: Northern, Western, Southern, Eastern and Central Europe and the USA, and differences in the level of agreement and level of application between the regions were assessed with non-parametric KruskalWallis tests within the group of nurses, rheumatologists and patients, respectively. All analyses were performed using IBM SPSS Statistics version 20.0 (IBM, Armonk, NY, USA).
Results Population In total, 3594 persons responded: 967 nurses, 548 rheumatologists and 2034 patients, from 23 countries. The largest number of nurse respondents was from the USA (n = 142), while the largest number of rheumatologist (n = 65) and patient (n = 384) respondents was from France. The proportion of patients with access to nursing care varied widely across countries, from 5.1% in Cyprus to 88.9% in the UK (see supplementary Table S1, available at Rheumatology Online). Characteristics of the study population are presented in Table 1. The nurses had a mean of 10.4 years (S.D. 8.0) of clinical experience in rheumatology and for the rheumatologists this was 16.4 years (S.D. 9.7). The majority of the patients had RA with a mean disease duration of 14.4 years (S.D. 11.9).
Level of agreement and level of application Fig. 1 presents the level of agreement and the level of application per recommendation from nurses, rheumatologists and patients, respectively. Overall, the level of agreement was high (median 810) across the three groups, with rheumatologists’ responses displaying the largest variation. In contrast, the overall level of application was substantially lower (median 08) and the variation was much larger in each group and for each recommendation.
www.rheumatology.oxfordjournals.org
Downloaded from http://rheumatology.oxfordjournals.org/ at University of North Dakota on May 31, 2015
Recently, 10 European League Against Rheumatism (EULAR) recommendations have been developed for the role of the nurse in the management of chronic inflammatory arthritis (CIA) [1]. The recommendations aim to achieve harmonization in rheumatology nursing care across countries, covering the contribution of nurses to the care and management of patients with CIA and requirements for their professional performance. A successful change of clinical practice in accordance with these recommendations requires an effective implementation strategy in which the key stakeholders delivering and receiving care, i.e. nurses, rheumatologists and patients, are involved [2]. Apart from dissemination, this includes a multifaceted approach focussed on hindering factors for this care at the level of the health professionals and of the social, organizational, economic and political contexts [37]. In order to develop tailored interventions, knowledge about potential barriers for acceptance and application of the recommendations in daily practice is essential [3, 79]. The objectives of the present study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the EULAR recommendations for the role of nurses in the management of CIA among nurses, rheumatologists and patients.
Distribution of the questionnaires
Dissemination of recommendations for the role of the nurse
TABLE 1 Characteristics of the study population Rheumatologists (n = 548)
Patients (n = 2034)
45.6 (9.9) 10.4 (8.0) — —
46.2 (10.6) 16.4 (9.7) — —
49.2 (14.1) — 62.8:24.8:12.4 14.4 (11.9)
— 52.1 47.9 44.0 41.6 14.4
— — 100 58.9 31.2 9.9
29.0 33.2 37.8 41.6 40.9 17.5
—: not applicable.
Reasons for incomplete agreement and barriers to application The most frequently reported reasons for incomplete agreement (i.e. level of agreement
