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

▶
harmonising competences and
SMART_READER_LITE
LIVE PREVIEW

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

Jan 23, 2023 680 likes •857 views

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,

slide-1
SLIDE 1

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

slide-2
SLIDE 2

Background

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

...over 200 diseases

slide-3
SLIDE 3

Background

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

Rheumatology specialist nurses deal mostly with IA and CTDs ….over the last 2 decades

  • Better understanding of these disease
  • Better diagnostics and measurements
  • Treatment goals – aim at remission
  • Better outcomes for patients
  • Increased monitoring in outpatient clinics,

now remote consultations (e-Health)

...over 200 diseases

slide-4
SLIDE 4

Setting Outpatient clinic, Home, e-Health or Remote consultation

Rheumatology Nursing

  • Addressing patients’ needs

and/or concerns

  • Patient education and

training

  • Promoting or supporting

self-management

  • Psychosocial support to

the patient and/or family

  • Referral to physicians or

wider MDT

  • Communication and

coordinating patient care across different providers

  • Administrative
  • Clinical assessments,

planning, implementations and evaluation

  • Disease management

– Investigations, imaging – prescribing or treatment changes – Joint injections

Supportive Service delivery and co-ordination

Informed by: Bech B, et al. Ann Rheum Dis 2020;79:61–68. http://dx.doi.org/10.1136/annrheumdis-2019-215458

  • Audits, service

improvement, research

  • Vision, planning, leading
  • Support learning
  • Developing guidelines

Governance and leadership

Clinical

slide-5
SLIDE 5

Setting Outpatient clinic, Home, e-Health or Remote consultation

Rheumatology Nursing

  • Addressing patients’

needs and/or concerns

  • Patient education and

training

  • Promoting or supporting

self-management

  • Psychosocial support to

the patient and/or family

  • Referral to physicians or

wider MDT

  • Communication and

coordinating patient care across different providers

  • Administrative
  • Clinical assessments,

planning, implementations and evaluation

  • Disease management

– Investigations, imaging – prescribing or treatment changes – Joint injections

Supportive Service delivery and co-ordination

Informed by: Bech B, et al. Ann Rheum Dis 2020;79:61–68. http://dx.doi.org/10.1136/annrheumdis-2019-215458

  • Audits, service

improvement, research

  • Vision, planning, leading
  • Support learning
  • Developing guidelines

Governance and leadership

Clinical

  • Different dimensions, experience, job

grade and associated skills level

  • Registered practitioner
  • Specialism specific practitioner
  • Advanced level practitioner
  • Consultant level practitioner
slide-6
SLIDE 6

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

slide-7
SLIDE 7

Need for training…

Informed by

EULAR survey of health professionals (2015)

Vliet Vlieland TPM, et al. (2016) RMD Open 2:e000337. http://dx.doi.org/10.1136/rmdopen-2016-000337

EULAR recommendations for generic core competences (2019)

Edelaar L, et al. Ann Rheum Dis. 2020;79(1):53-60. http://dx.doi.org/10.1136/annrheumdis-2019-215803

EULAR recommendations for the role of the nurse (2012, 2018)

Bech B, et al. Ann Rheum Dis 2020;79:61–68. http://dx.doi.org/10.1136/annrheumdis-2019-215458

UK Nationwide survey (2018)

British Society for Rheumatology (2019) Specialist nursing in rheumatology - State

  • f play report, London, BSR. https://www.rheumatology.org.uk/news-

policy/details/Specialist-nursing-in-rheumatology-the-State-of-Play

RCN Rheumatology Forum survey (2019)

RCN Rheumatology Nursing Workshop: London, RCN ARMA http://arma.uk.net/rcn-rheumatology-forum-workshop-2019/

  • Rheumatology - basic, advanced and extended

level of practice

  • Aetiology, pathophysiology, epidemiology,

clinical features and diagnostics of common RMDs

  • Disease management, pharmacologic and non-

pharmacologic interventions

  • Risk management and health promotion
  • Service evaluation and improvement
  • Leadership, financial awareness and business

planning

  • Succession planning, training and raise the

profile of rheumatology nursing

slide-8
SLIDE 8

Competences approach

22/06/2020 8

Competence

(defined by EULAR task force for generic competences)

A set of knowledge, skills and attitudes that concern the consistent and appropriate use of communication, knowledge, skills, clinical reasoning, emotions, values and reflection on practice, for the benefit of people with RMDs and the community

Edelaar et al (2020)

Edelaar L, Nikiphorou E, Fragoulis GE, et al 2019 EULAR recommendations for the generic core competences of health professionals in rheumatology. Ann Rheum Dis. 2020;79:53-60. (Generic) Chance-Larsen K, Backhouse MR, Collier R, et al. Developing a national musculoskeletal core capabilities framework for first point of contact practitioners, Rheumatol Adv Pract. 2019;3(2)rkz036. (Generic) Royal College of Nursing – A Competency Framework for Rheumatology Nurses (Mar 2020) (Nurse specific)

slide-9
SLIDE 9
  • 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

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

  • 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 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

EULAR generic competences

22/06/2020 9

Nurses Physiotherapists Occupational therapists

slide-10
SLIDE 10

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 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 terms) 9: HPRs should support people with RMDs in self-management of their condition. This 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

EULAR generic competences – cont.

22/06/2020 10

Nurses Physiotherapists Occupational therapists

slide-11
SLIDE 11

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

Defines:

  • Specific rheumatology nursing qualities and outcomes
  • 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

RCN Competency Framework

22/06/2020 11

Endorsed by Published: March 2020 For review: March 2023

slide-12
SLIDE 12

Harmonising needs and training

22/06/2020 12

Challenges – National variations in rheumatology nurses – different, legislation, funding – Role differences – may need specific training based on need – Condition management – based on area of specialism – Interventions – CBT, motivational interviewing, imaging, joint injections – Many pathways to rheumatology – organic in-house training – Funding (time) – scarce resources, staff shortages

slide-13
SLIDE 13

Opportunities – Person-centred approaches – Assessment, investigation and diagnosis – Service and professional development – MDT approach to training – learn from each other – Support from professional organisations

Harmonising needs and training

22/06/2020 13

Challenges – National variations in rheumatology nurses – Role differences – Condition management – Interventions – CBT, motivational interviewing – Many pathways to rheumatology – Funding (time)

slide-14
SLIDE 14

Opportunities – Person-centred approaches – Assessment, investigation and diagnosis – Service and professional development – MDT approach to training – learn from each other – Support from professional organisations

Harmonising needs and training

22/06/2020 14

Challenges – National variations in rheumatology nurses – Role differences – Condition management – Interventions – CBT, motivational interviewing – Many pathways to rheumatology – Funding (time)

EULAR offers online course for health professionals National professional organisations offer or endorse specific training Visionary leadership is required

slide-15
SLIDE 15

Any questions?

Email: mwidimi.ndosi@uwe.ac.uk Twitter: @ndosie

Thank you for listening

22/06/2020 15