Nurses Can Lead the Way in Research

Texas — Nursing-led research can help change outcomes for patients, communities, and the healthcare system, as was shown by several posters presented at recent research meetings, reported Linda Grinnell-Merrick, NP, of the University of Rochester Medical Center in Rochester, New York.

“Research is an important part of what we do,” said Grinnell-Merrick during the Rheumatology Nurses Society annual meeting (RNS).

“An example of this was several years ago on the dialysis unit — we had been using Betadine for catheter cleansing, and you had to wait for it to dry, until a nurse from the ICU said she didn’t think that was very efficient. So they did a study using rubbing alcohol, where you only have to wait 10 seconds, and it changed everything we did, not only for the unit but for the whole hospital,” said Grinnell-Merrick, who is president of the RNS.

To provide examples of other nurse-led research, she reviewed posters that were presented at the most recent meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR).

One ACR poster described a pilot program in which rheumatology clinic nurses helped educate newly diagnosed rheumatoid arthritis (RA) patients. Researchers from the University of Vermont explained that a successful treat-to-target approach in RA requires shared decision-making between patient and providers, but at the time of diagnosis, patients may not have sufficient knowledge or understanding of the disease to fully participate. So they developed a program that included a decision-making toolkit that was mailed to new patients, and a couple of weeks after the initial visit, they telephoned patients to offer disease education.

The program included 26 patients, most of whom were women and whose mean age was 54. The calls averaged 14.5 minutes, and patients reported that they overwhelmingly supported the call program. At the time of the report, 23 of the patients had been adherent to their follow-up visits.

“And in surveys, they also said they wanted to have more nurse telephone calls,” Grinnell-Merrick said.

A second ACR poster described the therapeutic protocols and adverse events among children receiving medications via infusions at the University of Alabama at Birmingham during the years 2012 to 2015.

It was a retrospective chart review that included 398 patients who had 7,585 infusions of medications including abatacept (Orencia), belimumab (Benlysta), cyclophosphamide, infliximab (Remicade), methylprednisolone, and rituximab (Rituxan) for diseases such as juvenile idiopathic arthritis, lupus, dermatomyositis, and inflammatory bowel disease.

The highest rate of adverse reactions was reported for rituximab (10%), which were mainly allergic, while the lowest rate was seen with infliximab (0.8%).

“The reactions they found were similar to what we seen in adult infusion centers — nausea, vomiting, cough, itching, some tightness in the throat,” Grinnell-Merrick noted.

The events were mostly mild and transient, and were managed by slowing the infusions and administering steroids, antihistamines, and analgesics.

“By looking at their adverse events, they were able to formulate better protocols for themselves, Grinnell-Merrick said.

One poster presented at EULAR looked at the role of the rheumatology specialist nurse in smoking detection and cessation among patients with chronic inflammatory disease in a hospital in Spain. Smoking is a predictor of poor response to treatment and poor prognosis overall.

The study included 22 patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. Smokers averaged 16 cigarettes per day, and mean duration of smoking was 27 years. One-quarter had high nicotine dependence.

“By talking to the patients and asking if there was anything they could do to help them quit smoking, the researchers found that almost all wanted to quit, and it didn’t really matter whether the nurses made a major effort to help,” Grinnell-Merrick said.”That can happen: you have a poster and then the conclusion may not be what you expected. This probably wasn’t the right intervention, but that’s okay,” she said.

A second poster at EULAR reported on a randomized trial in Hong Kong comparing the efficacy of nurse-led consultations and conventional rheumatologist-led care over a year among patients with stable RA.

Conventionally, RA patients are seen by rheumatologists every 3 to 6 months. However, the burden of RA disease has been increasing globally and programs in Western countries have shown that contributions by nurses can help alleviate this burden. To see if this also was the case in a Chinese setting, the researchers included 276 patients who were randomized to see a rheumatologist or a nurse every 3 to 4 months. The outcome was the percentage of patients who maintained low disease activity, or a Disease Activity Score in 28 joints of ≤3.2 at 12 months.

The percentages achieving this goal was 95.5% among patients seeing nurses and 90.5% of those seen by rheumatologists, with an adjusted treatment difference of 5% (95% CI 1.27-11.54), and noninferiority with a predefined margin of -10%.

“The nurses did just as well and even a little better,” Grinnell-Merrick commented.