The value, impact and role of nurses in rheumatology outpatient care: Critical review of the literature

Background: As rheumatology nurses make substantial contributions to intensive
management programmes following ‘treat to target’ principles of people with rheumatoid
arthritis (RA), there is a need to understand the impacts of their involvement. A
structured literature review was undertaken of qualitative studies, clinical trials and
observational studies to assess the impacts of rheumatology nurses on clinical outcomes
and the experiences of patients with RA and to examine the skills and training
of the nurses involved.
Method: A structured literature review was conducted to examine the value, impact
and professional role of nurses in RA management.
Results: The literature search identified 657 publications, and 20 of them were
included comprising: seven qualitative studies (242 patients), nine trials (a total of
2,440 patients) and four observational studies (1,234 patients). In clinical trials, nurses
achieved similar patient clinical outcomes to doctors, and nurses also enhanced
patients' satisfaction of received care and self-efficacy. In the qualitative studies
reviewed, the nurses increased patients' knowledge and promoted their self-management.
The observational studies studied examined found that nursing care led to
improved patients' global functioning. The nurses in the various studies had a wide
range of titles, experiences and training.
Discussion: Our structured literature review provides strong evidence that rheumatology
nurses are effective in delivering care for RA patients. However, their titles,
experience and training were highly variable.
Conclusion: There is a convincing case to maintain and extend the role of nurses
in managing RA, but further work is needed on standardisation of their titles and
training.