Article

Asia-Pacific initiative for rheumatology nurse education: An impact survey in China

Authors:
  • Susan Oliver Associates
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Abstract

Background/Objective: Asia-Pacific Initiative for Rheumatology nurse Education (ASPIRE) is a faculty-led initiative established to meet the educational needs of rheumatology nurses in Asia Pacific in recognition of the expanding role of nurses in daily rheumatology clinical practice. The objective of this study is to measure the impact of ASPIRE workshop training on nurses’ levels of knowledge, confidence, attitudes and beliefs using a Before-after-control-impact (BACI) survey.Methods: A total of 210 nurses who completed both pre- and post-surveys were included in the BACI analysis. The intervention group (n = 111) refers to nurses who attended the ASPIRE workshop training held during the China Chronic Disease Management Forum in Baotou, Inner Mongolia in September 2019 whereas the control group (n = 99) refers to Chinese nurses that have never attended the ASPIRE training. Results: Overall level of knowledge significantly increased by 30% (5.63 pre- vs. 8.34 post-survey; p < .001), and overall level of confidence significantly increased by 29% among nurses who attended ASPIRE training (5.83 pre- vs. 8.39 post-survey; p < .001). Nurses in the control group demonstrated no significant increase in knowledge (6.18 pre- vs. 6.50 post-survey; p = .097) or confidence (6.46 pre- vs. 6.71 post-survey; p = .169) over the same period.}Conclusions: Nurses who attended the ASPIRE training workshop reported a significant increase in their levels of knowledge and confidence compared with a control group of nurses who have never undergone ASPIRE training. Training rheumatology nurses to acquire more in-depth knowledge and skills can help optimize their role in clinical practice to meet the greater demands of disease monitoring and long-term management of rheumatology patients.

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... 18 The success of ASPIRE workshop trainings was evaluated by a before-after-control-impact survey, and a significant increase in knowledge (by 30%) and confidence (by 29%) (p < 0.001 on a participant level was observed. 19 ...
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... org/ educa tion_ page/ aspire/) [59]. To measure the success of ASPIRE workshop trainings on a participant level of knowledge, confidence, attitudes and beliefs using a before-after-control-impact survey was carried out, demonstrating a significant increase in knowledge and confidence [60]. ...
... org/ educa tion_ page/ aspire/) [59]. To measure the success of ASPIRE workshop trainings on a participant level of knowledge, confidence, attitudes and beliefs using a before-after-control-impact survey was carried out, demonstrating a significant increase in knowledge and confidence [60]. ...
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To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D. Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26. The results provide robust evidence to support non-inferiority of NLC in the management of RA. ISRCTN29803766.
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The authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda. A task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures. The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda. In total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A-3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda. 10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.
Article
This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs.
Article
Rheumatoid arthritis (RA) is a chronic disease with a complex underlying pathology and varied presentation in patients. Several novel biologic disease-modifying antirheumatic drugs have become available for the treatment of RA. Agents in late-stage clinical trials include golimumab and certolizumab, which are anti-tumor necrosis factor (TNF)-alpha agents; ocrelizumab, an anti-CD20 agent; and tocilizumab, an inhibitor of interleukin-6. As treatment options for RA expand, nursing care will play an increasingly important role in empowering patients through interventions such as patient education and adverse effect management.
Article
To identify the current practices of rheumatology nurse practitioners and ascertain their perceptions of how their role could be enhanced. A cross-sectional questionnaire study of currently employed nurse practitioners in rheumatology in the United Kingdom (UK) was undertaken. 200 questionnaires were distributed and 118 nurses responded. Ninety-five respondents met the inclusion criteria for undertaking an advanced nursing role. Typical conditions dealt with included: rheumatoid arthritis (96.8%); psoriatic arthritis (95.8%); osteoarthritis (63.2%); ankylosing spondylitis (62.8%); systemic lupus erythematosus (51.6%); and scleroderma (34.7%). Drug monitoring, education, counselling of patients and arranging basic investigations were routinely performed by more than 80% of respondents. A smaller proportion performed an extended role that included dealing with referrals, research and audit, the administration of intra-articular injections, and admission of patients. Specific attributes identified as being necessary for competence were: knowledge and understanding of rheumatic diseases (48.4%); drug therapy (33.7%); good communication skills (35.8%); understanding of the roles of the team (27.4%); working effectively (23.2%) as part of a multidisciplinary team; assessment of patients by physical examination (28.4%); teaching (26.3%), research (17.9%); organizational skills (14.7%); and the interpretation of investigations (9.5%). Factors that could enhance their role included: attendance at postgraduate courses (30.5%); obtaining further qualifications (13.7%); active participation in the delivery of medical education (41.1%); training in practical procedures (31.6%); protected time and resources for audit and research (11.6%); formal training in counselling (11.6%); and implementation of nurse prescribing (10.5%). Nurse practitioners already have a wide remit and play an invaluable part in the delivery of modern rheumatology services. An extended role could improve patient care and enhance nursing career pathways in rheumatology.
Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR recommendations
  • G E Fragoulis
  • L Edelaar
  • Vliet Vlieland
Fragoulis GE, Edelaar L, Vliet Vlieland TPM, et al. Development of generic core competences of health professionals in rheumatology: a systematic literature review informing the 2019 EULAR recommendations. RMD Open. 2019; 5: 2001028. PMid:31749985 https://doi.org/10.1136/rmdopen-2019-001028
Rheumatology nurses: Adding value to arthritis care. Australia: Australian Healthcare and Hospitals Association
  • Arthritis Australia
Arthritis Australia. Rheumatology nurses: Adding value to arthritis care. Australia: Australian Healthcare and Hospitals Association; 2017. Available from: https://arthritisaustralia.com.au/wordpress/wp-con tent/uploads/2017/09/Literature_review_-_Rheumato
ASPIRE initiative contributes to improvements in knowledge of rheumatology nurses. Poster session presented at: 20th Asia Pacific League of Associations for
  • S Oliver
  • K Yamamoto
  • G Kwok
Oliver S, Yamamoto K, Kwok G, et al. ASPIRE initiative contributes to improvements in knowledge of rheumatology nurses. Poster session presented at: 20th Asia Pacific League of Associations for Rheumatology Congress; 2018; Kaohsiung, Taiwan.