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Patients' dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study
Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.ORCID iD: 0000-0002-4341-660X
Research and Development Centre, Spenshult Hospital, Oskarström, Sweden.
School of Health Sciences, Jönköping University, Jönköping, Sweden.
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
2009 (English)In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 7, no 2, p. 93-105Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.

AIM: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.

METHOD: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.

RESULT: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).

CONCLUSION: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients' needs should constitute the basis for the nurse's role in the provision of care.

Place, publisher, year, edition, pages
London: Whurr Publishers , 2009. Vol. 7, no 2, p. 93-105
Keywords [en]
intravenous anti-TNF therapy, phenomenography, rheumatology nurse
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-2262DOI: 10.1002/msc.140PubMedID: 18777511Scopus ID: 2-s2.0-67650716924Local ID: 2082/2664OAI: oai:DiVA.org:hh-2262DiVA, id: diva2:239480
Available from: 2010-10-28 Created: 2009-02-11 Last updated: 2018-03-23Bibliographically approved
In thesis
1. Person-centred care in rheumatology nursing in patients undergoing biological therapy: An explorative and interventional study
Open this publication in new window or tab >>Person-centred care in rheumatology nursing in patients undergoing biological therapy: An explorative and interventional study
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.

Method: This thesis focuses on patients with chronic inflammatory arthritis (CIA) who were undergoing biological therapy at a rheumatology clinic in Sweden. Papers I and II had an explorative descriptive design with a phenomenographic approach. The 40 participants were interviewed about their dependence on or independence of a nurse for the administration of their infusions or injections. Paper III had a randomised controlled design involving 107 patients in the trial.  The objective of the intervention was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care. Paper IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.

Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (paper I). Independence of a nurse for subcutaneous injections was understood by the patients in different ways and was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (paper II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic, as measured by the Disease Activity Score 28. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (paper III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (paper IV).

Conclusion: This thesis contributes a valuable insight into person-centred care as the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to play an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients’ resources and needs in focus serves as an important guide during their healthcare journey.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, Jönköping University, 2013. p. 87
Series
Doctoral Thesis. Jönköping: School of Health Sciencese, Jönköping University, Dissertation Series, ISSN 1654-3602 ; 41
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-25025 (URN)978-91-85835-40-9 (ISBN)
Public defence
2013-05-17, Forum Humanum, Hälsohögskolan, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-08-18 Created: 2014-04-11 Last updated: 2016-02-05Bibliographically approved

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Larsson, IngridBergman, StefanArvidsson, Barbro

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