Person-centred care in rheumatology nursing in patients undergoing biological therapy

Background: The life of patients with chronic inflammatory arthritis (CIA) undergoing biological therapy is often lined by regular monitoring of both disease and biological therapy. The rheumatology nurse´s role has developed from that of an expert advisor to a co-actor, where the patients are necessary and equal participants. A rheumatology nurse with a person-centred care approach respects, supports and encourages patients to become co-actors and the rheumatology nurse is a complement to rheumatologists and other professionals in the multidisciplinary team.

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

Method: Focuses was on patients with CIA who were undergoing biological therapy at a rheumatology clinic in Sweden. Four studies were conducted and studies I and II had an explorative descriptive design with a phenomenographic approach. Interviews were conducted with 40 participants about their dependence on or independence of a nurse for the administration of their infusions or injections. The objective of the intervention in study III 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 and had a randomised controlled design involving 107 patients in the trial. The primary outcome was disease activity measured by Disease Activity Score 28. Study 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 (study I). Independence of a nurse for subcutaneous injections was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (study 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. 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 (study 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 (study IV).

Conclusion: Person-centred care is 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. Rheumatology nursing will be further developed by a person-centred care approach.