Harmonising competences and training of specialist nurses in - PowerPoint PPT Presentation

Harmonising competences and training of specialist nurses in rheumatology Mwidimi Ndosi, PhD, MSc, BSc, RN Member of EULAR Health Professionals in Rheumatology Leadership Senior Lecturer Rheumatology Nursing University of the West of England, Bristol

Background ...over 200 diseases Five groups - Degenerative/mechanical arthritis e.g. OA - Inflammatory arthritis e.g. RA, PsA, AS, JIA - Connective tissue disease e.g. SLE, SSc, dermatomyositis - Soft tissue musculoskeletal pain e.g. FMS - Back pain

Background ...over 200 diseases Rheumatology specialist nurses deal mostly with IA and CTDs Five groups ….over the last 2 decades - Degenerative/mechanical arthritis e.g. OA - Better understanding of these disease - Inflammatory arthritis e.g. RA, PsA, AS, JIA - Better diagnostics and measurements - Connective tissue disease e.g. SLE, SSc, dermatomyositis Treatment goals – aim at remission - - Better outcomes for patients - Soft tissue musculoskeletal pain e.g. FMS - Increased monitoring in outpatient clinics, - Back pain now remote consultations (e-Health)

Rheumatology Nursing Service delivery and Governance and Clinical Supportive co-ordination leadership • Addressing patients’ needs • Clinical assessments, • Referral to physicians or • Audits, service and/or concerns planning, implementations wider MDT improvement, research and evaluation • Patient education and • Communication and • Vision, planning, leading training • Disease management coordinating patient care • Support learning • Promoting or supporting – Investigations, imaging across different providers self-management • Developing guidelines – prescribing or treatment • Administrative changes • Psychosocial support to – Joint injections the patient and/or family Setting Outpatient clinic, Home, e-Health or Remote consultation Informed by: Bech B, et al. Ann Rheum Dis 2020;79:61 – 68. http://dx.doi.org/10.1136/annrheumdis-2019-215458

Rheumatology Nursing Service delivery and Governance and Clinical Supportive co-ordination leadership • Clinical assessments, • Addressing patients’ • Referral to physicians or • Different dimensions, experience, job planning, • Audits, service needs and/or concerns wider MDT implementations and improvement, research grade and associated skills level • Patient education and • Communication and evaluation • Vision, planning, leading training coordinating patient care • Disease management - Registered practitioner across different • Support learning • Promoting or supporting – Investigations, imaging providers - Specialism specific practitioner self-management • Developing guidelines – prescribing or treatment • Administrative • Psychosocial support to changes - Advanced level practitioner the patient and/or family – Joint injections - Consultant level practitioner Setting Outpatient clinic, Home, e-Health or Remote consultation Informed by: Bech B, et al. Ann Rheum Dis 2020;79:61 – 68. http://dx.doi.org/10.1136/annrheumdis-2019-215458

Evidence for rheumatology nursing (2011-19) Ndosi et al (2011) Int J Nurs Stud;48(5)642-54 – Meta-analysis Van Eijk-Hustings et al (2012) Ann Rheum Dis, 71(1)13-9 – Systematic review Garner et al (2017) J. Rheumatol; 44 (6)757-765 – Systematic review De Thurah et al (2017) RMD Open ; 3: e000481 – Meta-analysis De Sousa et al (2017) Rev de Enfermagem Ref; 4 (13):147-56 – Meta-analysis Vivienne & Michael (2018) Rheumatol Int ;38(11)2027 – 36 – Systematic review Bech et al (2019) Ann Rheum Dis 2020; 79 :61 – 68 – Systematic review Primdahl J et al (2012) Patient Educ Couns ; 88 (1):121-8 RCT Denmark Clinical yr 1 Primdahl J et al (2014) Ann Rheum Dis ; 73 (2):357-64 RCT Denmark Clinical yr 2 Sørensen J (2015) Scand J Rheumatol ; 44 (1):13-21 RCT Denmark Cost Koksvik HS et al (2013) Ann Rheum Dis ; 72 :836-843 RCT Norway Clinical Larsson I et al (2014) J adv nurs ; 70 (1):164-75 RCT Sweden Clinical Larsson I et al (2015) BMC Musculoskelet Disord; 16 :354 RCT Sweden Cost Ndosi M et al (2014) Ann Rheum Dis ; 73 (11):1975-82 RCT UK Clinical & cost De Thurah et al (2018) Arthritis Care Res ; 70 (3):353-60 RCT Denmark Clinical

Need for training… Informed by • Rheumatology - basic, advanced and extended EULAR survey of health professionals (2015) level of practice Vliet Vlieland TPM, et al. (2016) RMD Open 2:e000337. http://dx.doi.org/10.1136/rmdopen-2016-000337 • Aetiology , pathophysiology , epidemiology , clinical features and diagnostics of common EULAR recommendations for generic core competences (2019) RMDs Edelaar L, et al. Ann Rheum Dis . 2020;79(1):53-60. http://dx.doi.org/10.1136/annrheumdis-2019-215803 • Disease management , pharmacologic and non- EULAR recommendations for the role of the nurse (2012, 2018) pharmacologic interventions Bech B, et al. Ann Rheum Dis 2020;79:61 – 68. • Risk management and health promotion http://dx.doi.org/10.1136/annrheumdis-2019-215458 UK Nationwide survey (2018) • Service evaluation and improvement British Society for Rheumatology (2019) Specialist nursing in rheumatology - State of play report, London, BSR. https://www.rheumatology.org.uk/news- • Leadership , financial awareness and business policy/details/Specialist-nursing-in-rheumatology-the-State-of-Play planning RCN Rheumatology Forum survey (2019) • Succession planning , training and raise the RCN Rheumatology Nursing Workshop: London, RCN ARMA profile of rheumatology nursing http://arma.uk.net/rcn-rheumatology-forum-workshop-2019/

Competences approach Competence Edelaar L, Nikiphorou E, Fragoulis GE, et al 2019 EULAR (defined by EULAR task force for generic recommendations for the generic core competences of competences) health professionals in rheumatology. Ann Rheum Dis. 2020;79:53-60. (Generic) A set of knowledge, skills and Chance-Larsen K, Backhouse MR, Collier R, et al . attitudes that concern the consistent Developing a national musculoskeletal core and appropriate use of capabilities framework for first point of contact communication, knowledge, skills, practitioners, Rheumatol Adv Pract. 2019; 3 (2)rkz036. (Generic) clinical reasoning, emotions, values and reflection on practice, for the Royal College of Nursing – A Competency Framework for Rheumatology Nurses (Mar 2020) (Nurse specific) benefit of people with RMDs and the community Edelaar et al (2020) 8 22/06/2020

EULAR generic competences 1. HPRs should have knowledge of the aetiology, pathophysiology, epidemiology , clinical features and diagnostic procedures of common RMDs , including their impact on all aspects of life 2. Using a structured assessment , HPRs should identify aspects that may influence individuals with Nurses RMDs and their families, including: (a) clinical characteristics, risks, red flags and comorbidities, (b) limits to their activity and participation and (c) personal and environmental factors Physiotherapists Occupational 3. HPRs should communicate effectively : to make contributions to other healthcare providers and stakeholders in RMD care and to collaborate with other healthcare providers, signpost or refer where therapists appropriate to optimise the interdisciplinary care of people with RMDs 4. HPRs should have an understanding of common pharmacological and surgical therapies in RMDs, including their anticipated benefits, side-effects and risks, and use this knowledge to advise or refer as appropriate 5. HPRs should provide advice on non-pharmacological interventions , treat or refer as appropriate, based on the evidence , expected benefits, limitations and risks for people with RMDs 9 22/06/2020

EULAR generic competences – cont. 6: HPRs should assess the educational needs of people with RMDs and their carers to provide tailored education using appropriate modes of delivery, relevant resources and evaluate their effectiveness 7: HPRs should take responsibility for their continuous learning and ongoing professional development to remain up-to-date with the clinical guidelines and/or recommendations on the management of RMDs Nurses 8: HPRs should support people with RMDs in goal setting and shared decision making about their care (eg, identify, prioritise, address their needs and preferences and explain in lay Physiotherapists terms) Occupational 9: HPRs should support people with RMDs in self-management of their condition. This therapists encompasses selecting and applying the appropriate behavioural approaches and techniques to optimise their health and well-being (eg, engagement in physical activity, pain and fatigue management) 10: HPRs should be able to select and apply outcome measures for people with RMDs, as appropriate, to evaluate the effectiveness of their interventions 10 22/06/2020

RCN Competency Framework Aims to support: • Personal and continuous professional development • Succession planning and service development • Development of a standard nationwide curriculum • Benchmarking tool for all rheumatology nurses Published: March 2020 Defines: For review: March 2023 • Specific rheumatology nursing qualities and outcomes Endorsed by • Pathways for career development e.g. clinical specialities, management, leadership, teaching, education and research. Use alongside other competency frameworks and guidelines e.g. prescribing, assessing and monitoring biologic therapies and subcutaneous methotrexate 11 22/06/2020