The Social Aspect Impact of Rheumatoid Arthritis - Essay Example

Effectiveness of Rheumatology Nurses in Assisting Patients with Rheumatoid Arthritis in Maintaining Mobility and Quality of Life Rheumatoid arthritis (RA) is the most prevalent form of musculoskeletal disease. It is an inflammatory and systemic disease chiefly of the lining of the joints or the synovium. It is marked by pain and stiffness lasting for more than 1 hour in the morning or after a rest, and loss of function in the joints. It is a chronic autoimmune disease that results to alterations in the synovial membrane and articular structures, extensive fibrinoid degeneration of the collagen fibres in mesenchymal tissues, and by atrophy and rarefaction of bony structures. As the disease progresses, it causes deformities which are lumps (called rheumatoid nodules) usually in the wrist joints and the finger joints closest to the hand in a symmetrical pattern which means occurring similarly on both sides of the body (2003). Rheumatoid arthritis is one of the major sources of chronic pain and disability affecting the mobility and quality of life of millions of people worldwide. In Australia, as of June 2000, approximately 3.1 million of the populace is suffering from RA. This estimate accounts to approximately 16.5% of the population (Access Economics Pty Limited, 2001) Almost 60% of Australians suffering from RA belong to the workforce ages 15-64 years and this fact has a significant impact on socioeconomic aspect by subtracting from Australia’s productive potential. It hits women three times more than men. It is estimated that 15.8% of the female population have arthritis (Access Economics Pty Limited, 2001) Arthritis has a major economic impact. The figures above correlate to a considerable cost to the healthcare system and to the patient in terms of direct (medical expenses) and indirect costs (loss of earnings, early retirement). In general as of June 2000, the economic impact of arthritis costs the Australian economy roughly 9 billion dollars per year (1.4% of gross domestic product or $A469 per Australian) as estimated by (Access Economics Pty Limited, 2001). Out of pockets expenditures of all patients related to healthcare on the average is approximately $A1513 yearly. Notably, women spent more than men and the group below 65 years old spent considerably more than the older group. Expenditures cover prescription and non-prescription medication, assistive devices, tests and professional consultations (Lapsley et al., 2002) With regards to the social aspect impact of RA, Lapsley et al. (2002) showed that sixty-five (65%) of the 81 participants testified that rheumatoid arthritis impinged on their social relationships. Consequently, the most common outcome was reduced opportunity for social interaction, seconded by reduced opportunity for sports or outdoor activity. Forty-six (46%) of the participants reported getting aid and support from family. relatives, and friends in the performance of various activities such as domestic indoor duties, shopping, carrying heavy items, domestic outdoor, driving and transport, opening jars and personal hygiene. Many patient suffering from RA are referred to Rheumatology departments. RA is typified by remissions and exacerbations of the disease process. Up to present, there is still no known cure to RA which is chronic (Arthur, 1994). Since RA is one of the most prevalent and painful chronic disease worldwide, a clinical approach with specialty team is likely consisting of physician/rheumatologist, orthopaedic surgeon, physical and occupational therapists, nurses, psychologists, social workers, dietitians, and bioengineers (Feng, 1989). Because of the growing number of patients with RA, it is likely that disease and care management will be a fundamental part of the extended nursing roles. Nurses play a vital role in improving the delivery of healthcare. With the advent of primary care trusts, nurse prescribing and extended roles, the role and function of nurses has evolved (Gallez, 1998). This is particularly significant in chronic disease management and the birth of Rheumatology nursing as a specialty unit or a subspecialty unit of rehabilitation, orthopaedic or medical-surgical (Pigg, 1990). Assessment done by the nurse include patient information and teaching, helpline support, pain and symptom management, medication review and blood monitoring (Oliver, 2003). In the book by Gallez (1998), the author suggested that understanding the unique care to patients suffering from rheumatoid arthritis has been found to be associated with positive outcomes. A rheumatology nurse should therefore be equipped with knowledge, competent skills and experiences who employ evidence for practice, assumes accountability for complex situations, demonstrate leadership in all practice settings, collaborate with the health team, and center on improving the health and well-being of individuals and groups (Grahame and West, 1996) There are a number of roles that a professional rheumatology nurse assumes in providing care for the person with rheumatoid arthritis. The scope of practice of each distinct role is influenced by the official licensure and certification, as well as by an individuals know-how and competence (MacIsaac et al., 2005) It is expected of the rheumatology nurse to be well educated about the disease processes and principles of practice which are relevant to rheumatology. Rheumatology nurses should also be able to recognize and manage the different problems that patients with rheumatoid arthritis may meet (e.g. pain, stiffness, fatigue, restricted ambulation, ineffective coping, disturbance in self-concept). They should be sensitive of the patient’s view on illness and self-care abilities. In addition to these, nurses should be able to work in partnership with other disciplines in the management of the patient’s problems (MacIsaac et al., 2005) Literature searches revealed that rheumatology nurses face a challenging extended role in the care of patients suffering with RA. The concept of nurses working an extended role resulted to an array of job titles such as a specialist or rheumatology practitioner (Pigg, 1990). There are several evidence-based studies that support the fact that the involvement of nurses in both clinical and community practice settings make a difference to patients suffering from rheumatoid arthritis in reducing the morbidity, mortality and in improving their quality of life. Rheumatology patients view their real and perceived disability with cynicism and pessimism and they often have erroneous view of their illness. They experience physical and emotional affliction, hindrances to daily activities and exasperations in obtaining health care. Changes in their lifestyles and lives is taking a toll on them too (Hewlett, 1994). With these draining feelings, the nurse can be of assistance to patients by giving sensible and optimistic support and recommendation (Fair, 2003). Nurses can also seek out ways to encourage hopefulness by assisting patients set realistic goals and plan out a scheme to meet them (Chandrasekaran, 1986). Patients with RA live through a significant amount of pain that impinge on quality of life. Pain is subjective and is both physical and psychological in nature (Oliver, 2003). An effective nurse is keen in pain management in a rheumatology department. Pain should be evaluated and handled using a holistic approach. As part of role extension, the rheumatology nurse is accountable for drug monitoring used in the treatment. The nurses’ treatment goals include reducing trauma on involved joints, restricting physical disability, preserving joint function, reducing pain to a manageable level and avoiding drug intoxication (Fair, 2003). Helping patients to cope with RA poses a big challenge to specialist nurses. Mental and emotional stressors greatly influence the outcome of the illness. Assisting patients muddle through with stressors is an essential concept in nursing care delivery (Newbold, 1996). Nurses therefore need to mull over the emotional consequences of the chronic illness in addition to the physical signs (Ryan, 1998). Building a therapeutic relationship in rheumatology care is one of the essences of rheumatology nursing. Empathy is therefore equally important in the psychological care of patients with chronic disease (Hill, 1997). It is thus logical to advocate that rheumatology nurses be key players in the process of dealing with RA (Newbold, 1996). Promoting independence or re-establishing self-management in those afflicted with chronic diseases are ways of mounting quality of life (Frich, 2003). Maintaining mobility and improving the quality of life of RA sufferers entails teaching them how to cope with disease-related issues (Sierakowska et al., 2005) In a study undertaken by Hill (1997) in a nurse-led rheumatology clinic setting, she measured the satisfaction of the patients using the parameters: provision of information, empathy of nurse to the patient, attitude towards the patient, access to and continuity with the caregiver, technical quality and competence, and overall satisfaction. Hill (1997) defined satisfaction with care in her study as “the degree which patients perceive their needs are met.” Hill (1997) noted in her conclusion that although patients were initially satisfied with the care they have received from the consultant rheumatologists, towards the end of the study however they showed significantly increased satisfaction scores when they began seeking consultation at the nurse-led clinics because they find the nurses more amicable, easy to talk with and more compassionate than their physicians. In a similar study, Arthur and Clifford (2004) aimed to identify the different aspects of rheumatology patient satisfaction in relation to preferences and expectations. Results revealed that empathy, specialization, information provision, technical aspects, time spent with patients and continuity of care as important components in the care of patients. Patient’s satisfaction influences whether the patient continues the patient-practitioner relationship, seek out medical advice, and conform to the treatment and medication programs (Hill, 1997). In another study (Hill et al., 1994) the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic was evaluated. Results demonstrated that subjects managed by the rheumatology nurse practitioner showed significant differences as compared to the subjects managed by the consultant rheumatologist. Low levels of pain, greater acquired knowledge and more satisfied with care are results seen with patients managed by rheumatology nurse. In a separate undertaking, according to Arvidsson et al.(2006) in their study, patient empowerment in a nurse-led clinics is the result of teaching, regular review and attention. Empowerment is defined in many ways. It is sometimes described as being in control of their own lives. Empowerment is encouraging, recognizing and boosting one’s abilities to meet their own needs, resolve their problems, and mobilize the needed resources. Patient empowerment is being able to resolve existing problems by themselves and being able to make judgment about what is needed and what can be done. Teaching is category 1 described in this study as gaining insight and receiving information. The nurse furnishes the patient with information about the disease with the intention to supplement knowledge and understanding. And this directs them to adjust and adapt to the consequences of their disease of their everyday lives. They recognize that it was acceptable to follow their preferences to be at ease in their life situations. In receiving information, patients learn about the current information on medicines and researches. Patients have trouble-free addressing their queries to the nurses than to their physicians (Arvidsson et al., 2006). In category 2 is regular review consisting of receiving security, realizing regularity and achieving accessibility. The patient is given a chance to collaborate with the nurse regarding follow-up visits frequency and agenda of every visit. Familiarity and acquaintance with the nurse gave the patient a sense of security. The patient recognizes that a calm and caring atmosphere gives the patient the liberty to ask about anything. Regularity means being taken cared of the same nurse on every visit and this gives the patient the feeling of reassurance (Arvidsson et al., 2006). This last category has three components: getting holistic appraisal, receiving harmonized care, and getting ample time described how the patient gained knowledge regarding their disease. Getting a holistic assessment is obtaining information from patient’s previous experience and listening to present problems. Receiving coordinated care is being referred to other members of the team for further care. Getting sufficient time is how the nurse took the time to listen conscientiously for the patient to tell about whatever the patient wants to say (Arvidsson et al., 2006). A nurse-led rheumatology clinic is a valuable setting where the rheumatology nurse can teach, direct and support patients in planning strategies. Patients suffering from RA realized that they gained awareness about their disease that helped them improve their understanding. Recognizing their abilities to act on their makes them feel respected. It is important to involve patients with chronic diseases in their own care management. Coordinated care leads to positive relationship between the patient and the nurse (Arvidsson et al., 2006). Patient satisfaction is a multi-faceted concept that relates to expectations and preferences for care. There are compelling evidences that patient satisfaction is central in gauging the outcome linked with improved health status, strict compliance and continuity of attendance for treatments (Arthur and Clifford, 2004). Patient satisfaction is also found to be a valuable means to evaluate consultations and patterns of communication. Lastly, information on satisfaction can serve as a guide in implementing changes in the organization and provision of health care (Hill, 1997). Bibliograghy: ACCESS ECONOMICS PTY LIMITED (2001) The Prevalence, Cost and Disease Burden of Arthritis in Australia. Canberra, The Arthritis Foundation of Australia. ARTHUR, V. (1994) Nursing care of patients with rheumatoid arthritis. Br J Nurs, 3, 325-7, 329-31. ARTHUR, V. & CLIFFORD, C. (2004) Rheumatology: the expectations and preferences of patients for their follow-up monitoring care: a qualitative study to determine the dimensions of patient satisfaction. J Clin Nurs, 13, 234-42. ARVIDSSON, S. 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