An exploration of the clinical practice of Rheumatology specialist nurses undertaking consultations with patients starting Methotrexate
Notice bibliographique
Résumé
Background \nRheumatology nursing roles have evolved over the last 25 years to include educating patients prior to commencing drugs such as Methotrexate in consultations. The expansion of their role has not been supplemented by specific training in order to prepare them for this undertaking. Thus, this study was developed to explore how Rheumatology Specialist nurses gained knowledge about consulting with patients on Methotrexate, how they delivered information to patients, and to identify elements of their consultation for further \ndevelopment. \n \nMethods \nThis was a mixed-methods practice based study undertaken in three phases. Training, confidence and knowledge were explored with a questionnaire, which constituted Phase I. Phase II explored the lived experiences of the nurses with semi-structured interviews. Phase III explored the interaction between the nurses and patients during a consultation which was video-recorded and analysed using qualitative and quantitative approaches, with the interaction scored against items in the Calgary Cambridge consultation model. \n \nFindings \nThe results of the survey (n=97) and the semi-structured interviews findings (n=6) revealed significant variability in training received by Rheumatology Specialist nurses. Confidence took three to 12 months to develop and was related to experience, knowledge and training, with nurses expressing a clear desire for more training. Written information was used by all participants during consultations, usually in the form of the Methotrexate information booklet, which had some benefits, including allowing the nurses to structure their consultations, ensuring that all of the information in the booklet was given to patients. However, it also had the disadvantage of becoming the nurses’ agenda which dominated the consultation, leading to overloading the patients with information and restricting discussion and questions from the patients. Analysis of consultation videos (n=10) supported these findings, demonstrating that whilst all of the important information from the booklet was given, there was a lack of involvement during the consultation of the patient agenda such as ideas, concerns and expectations, with little checking by the nurses to ensure the patients understood the information given. The effect of limited time was apparent. Cues from patients were often ignored or missed which may have been as a result of perceived time pressures or lack of confidence in dealing with questions. The comparison of the nurses’ consultations with the Calgary Cambridge consultation model showed variations in the nurses’ scores. It also raised new observations such as in those consultations which scored higher, the nurses used more illustrative and fewer batonic gestures, whilst the patient did the opposite. \n \nConclusions \nWhilst Rheumatology Specialist nurses are clearly doing many things well, the education of patients starting drugs such as Methotrexate could be improved by training aimed at improving consultation techniques with the adoption of a modified Calgary Cambridge model consultation technique. Such an approach would benefit from further research to identify whether it results in improving patients’ involvement in the consultation process. The findings from this thesis have led directly to the development of “Top Tips”, published online by Versus Arthritis, to guide nurses during their consultations when giving information to patients about Methotrexate. Further work will include writing a handbook that aims to give nurses more knowledge about how to conduct a consultation with patients based on the Calgary Cambridge consultation model.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».