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Patient education -
this includes information about the diagnosis, treatment required and how
to access care. Sometimes extra education opportunities are offered to
you. This can be as part of a group education programme or one to one
sessions to help you manage your condition. This can be really helpful
advising you how to rest your joints or deal with pain control.
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Medications: Advice
on medications, how you will be monitored on treatment and possible risks
and benefits of treatment. To give consent to treatment you must
understand the risks and benefits of treatment and then make an 'informed
or educated' decision about your treatment. [see also Treatments]
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Examination: The
nurse is usually qualified in examining your joints to assess how well
your disease is controlled. This assessment will include reviewing blood
tests and asking you questions about how you have been since last
attending clinic [see section on
Assessment and Monitoring]
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Screening and
assessment. Sometimes nurses will see you before you might need to come
into hospital for a specific treatment. Some of these treatments include
coming in for rest and rehabilitation, having a treatment that requires an
infusion (a medication that is given to you with a bag of fluid and tubing
that is administered by a needle into a vein). [see also
Assessment and Monitoring]
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Personal Issues:
Nurses are aware of all the other problems that might effect how you
manage your disease and cope with your life. They are skilled in talking
to you about problems that relate to your daily life and listening to your
needs. Sometimes people have problems with their personal relationships
because of their arthritis particularly when pain and movement of joints
are a problem. It is worth talking to your nurse about these problems as
they do have an understanding about these problems and practical advice
can be very helpful.
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Practical support:
The nurse can provide advice to support you with various problems. These
include, how to manage 'flares' of your arthritis and the best ways of
managing your pain, practical things around the house, and access to
additional support that will help you such as referring you to the
physiotherapist for information on exercises.
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Many nurses have what are called 'nurse led
clinics'. When you come to clinic you may be seen by a nurse, as long as
you are in agreement. The nurse can often write you a prescription or
alter the dose of medication you are receiving, request bloods tests and
x-rays and sometimes inject joints. They also have the support of doctors
should they require additional information or support.
In some hospitals it is not possible to see the consultant
rheumatologist every time and it may mean that you see another doctor
working with the consultant. Patient with chronic diseases like arthritis
have been found to appreciate the development of nurse led clinics. This
is maybe because there is an opportunity to get to know the nurse well and
as a result, the nurses has a better long term understanding about your
arthritis and how you manage and what medications you have been on.
In some circumstances having access to a nurse led clinic can sometimes
mean you won't have to wait quite as long to be seen when you have a
problem and need to be seen sooner than your planned appointment. These
clinics might be held in the hospital or the community or doctors surgery.
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Telephone Advice.
Most departments provide a telephone advice line service and this is
usually run by nurses. This is a valued service for individuals who have
arthritis that need long term treatment and have to be seen regularly in
hospital for their care. The advice line, particularly when you have just
been diagnosed with arthritis, can be very important and reassuring to
you. As you become more informed and learn to manage your disease, it will
become a reassuring 'safety net' that can be helpful to guide you when you
have a crisis that you cannot manage yourself. The advice line can also
provide direct access to the Nurse Specialist when the nurse, or the team,
need to keep in close contact about your treatment.
Some patient support groups also run helplines for people who don't need
to see the doctor or nurse at the hospital but might wish to have more
information. Telephone helplines are run by Arthritis Care (www.arthritiscare.org.uk)
and National Rheumatoid Arthritis Society (www.rheumatoid.org.uk).
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Inpatient care: You
may find that when you go into hospital the Nurse Specialist or one of the
team will be around supporting and advising other nurses about your care.
They sometimes oversee treatments or medications you receive as an
inpatient. You should ask the ward that you have been asked to attend if
there is a rheumatology specialist nurse/practitioner or a nurse who is
experienced in caring for patients with arthritis. The nurses on the ward
should be able to contact your specialist nurse to let them know you are
in hospital.
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Working as a member
of the rheumatology team. Nurses can usually refer you to other members of
the team to ensure you get the best care.
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The Specialist Practitioner:
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Sometime instead of a specialist nurse may be called a specialist nurse
practitioner you may also see someone called a 'specialist practitioner'
who is a physiotherapist of occupational therapist who have developed
specific expertise that used to be a traditional nursing role.
The Rheumatology Team
Rheumatology is a strong multi-disciplinary speciality. For some types of
arthritis that require regular assessment and treatment decisions
specialist teams either based in a hospital or in the community will
provide the full support you need using a team approach. The team will
meet regularly to discuss patients and their needs, refer patients to each
other where appropriate and share knowledge and expertise. All members of
the team recognise the value of educating individuals about their
arthritis. The teams also work at educating other healthcare
professionals.
In some areas you will notice that there are areas where all the team will
have some expertise, this overlap means that all the team are able to
identify problems and know when to ask another member of the team to take
over one particular aspect of care. As in other specialities members of
the team will have specific qualifications in their own field and then
will have developed additional specialist skills relevant to the care of
rheumatology patients.
Who are the members of the team?
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Consultant Rheumatologist
This is a fully trained doctor with specialist training in rheumatology.
Their role is to diagnose, manage and oversee medical treatment of
patients have a disease that requires care from the rheumatology
department. A large proportion of this work will be with inflammatory
joint diseases (Rheumatoid Arthritis, Psoriatic Arthritis) and other forms
of auto-immune diseases such as Lupus, Scleroderma and Mixed Connective
Tissue Disease. In fact there are over two hundred diseases that come
under the 'umbrella' of rheumatology. Many of the diseases mentioned can
be adequately managed by your own doctor.
General Practitioner with a Specialist Interest (GPwSI)
These are doctor who you might usually see in your health centre but have
a special interest and usually additional training in an area such as
rheumatology. They are not as highly qualified in the specialist area (for
example not as expert as the consultant for managing very complex care)
but have lots of expertise in not only the special needs of those with
arthritis but general medicine.
Physiotherapist
Physiotherapists are trained in the anatomy and physiology of the
musculoskeletal system (muscles and bones). Having examined the
musculoskeletal system they are able to identify problems or prescribe a
course treatment (although usually this does not include treatment with
tablets unless they have received additional training). Other advice and
treatments can include exercise programmes or walking aids. They will then
reassess you and review what benefits are achieved. Sometimes
physiotherapists may suggest a course of hydrotherapy. Hydrotherapy is the
use of very warm water to enable easier exercises that will strengthen the
muscles. Other types of treatment physiotherapists may prescribe are:
ultrasound, acupuncture and Transcutaneous electrical nerve stimulation
(TENS). There are many physiotherapists working in the community or
interface clinics.
Occupational therapist
The occupational therapist will have receive a broad training which
enables the therapist to identify problems associated with the
individual's problems in carrying out activities of daily life. This will
mean they can assess not only problems in the home environment but also
work and leisure activities. The therapist will work to improve each
individual's functional ability. The aim is to maintain a safe,
comfortable, independent environment. This can be achieved with the use of
aids to reduce the amount of strain to joints or improve comfort and
safety.
A large component of the occupational therapists' work will involve the
assessment of joint function and the need to protect or prevent further
damage to joints with the use of splints. Occupational therapists have
close links with other agencies that can help patients. These include;
social services departments, disability centres and vocational training
schemes.
They may work closely with the nurses to ensure that the social and
psychological consequences of your arthritis are cared for and maybe able
to advise you on relaxation techniques and pacing strategies to help you
cope with your arthritis. Occupational therapist may support or run
specialist patient education programmes for inflammatory arthritis.
The General Practitioner (local doctor) and practice nurse
The professionals that work at your local doctor's health centre are very
important part of the rheumatology team. Many hospitals care for
individuals using a 'shared' approach to care. Indeed many times you have
a problem the first person you will see will be your local doctor or
nurse. They need to be informed and supported in all aspects of your care
so good communication between hospital and your local health centre are
essential.
Orthotist
A piece of equipment called a 'prosthesis' is an aid designed to fit a
patient's individual body and improve function. This could be a knee
brace, corset or even especially made shoes.
Podiatry
Podiatrists are more advanced specialists in chiropody who have expertise
in managing foot problems related to illnesses. There are a number of
diseases that affect the feet (e.g. Diabetes). Pain on walking,
particularly the sensation of 'walking on pebbles' described by some
people with rheumatoid arthritis can be disabling. Podiatrists will often
assess the foot function and alignment to see the best way of relieving
the stresses and strains experienced often this will help your overall
ability to walk using your joints in the right way. The support of
podiatry can sometimes reduce foot deformities, improve pain control and
improve the normal position of the joints.
Pharmacist
There is often a pharmacist who is part of the team. Your hospital or
local pharmacist can provide useful information and support on the
medications you are prescribed. With an increasing in what are called
'over the counter products' (things you can buy yourself without
prescription) the help of the pharmacist in advising you what you can and
cannot take can be invaluable. Always check with your pharmacist if you
are buying 'over the counter products' and you are also prescribed
treatments by your doctor, the pharmacist will be able to tell you whether
the two treatments are safe to be taken together.
Other members of the team that may be available: |