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.

Rheumatology nursing supports patients to manage their lives and live as independently as possible without pain, stiffness and functional restrictions. When conventional drugs fail to delay the development of the rheumatic disease, the patient may require biological treatment such as self-administered subcutaneous anti-tumour necrosis factor (TNF) therapy. It is therefore important that the patient perspective focuses on the life-changing situation caused by the administration of regular subcutaneous injections. The aim of this study was to describe variations in how patients with rheumatic diseases experience their independence of a nurse for administration of subcutaneous anti-TNF therapy. The study had a descriptive, qualitative design with a phenomenographic approach and was carried out by means of 20 interviews. Four ways of understanding the patients' experience of their subcutaneous anti-TNF therapy and independence of a nurse emerged: the struggling patient; the learning patient; the participating patient; the independent patient. Achieving independence of a nurse for subcutaneous anti-TNF injections can be understood by the patients in different ways. In their strive for independence, patients progress by learning about and participating in drug treatment, after which they experience that the injections make them independent.

In this study, patients’ experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme “the nurse-led rheumatology clinic provided added value to patient care”. The participants’ experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care,making it more complete. Nurses and rheumatologists complemented each other,as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients inrheumatology units.