Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK.
J Clin Nurs. 2021 Jan;30(1-2):145-160. doi: 10.1111/jocn.15531. Epub 2020 Oct 30.
Management of rheumatoid arthritis has changed dramatically over the last decade and is characterised by early start of intensive treatment and tight monitoring of disease activity until remission. The role of nurse-led care at early stage of disease is not well understood.
To develop an understanding of rheumatology nurse-led care from the perspective of patients with early rheumatoid arthritis.
A systematic review of qualitative studies, reported in line with PRISMA checklist. In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Studies were included if they: included adults with rheumatoid arthritis; were qualitative studies with data on patients' perspectives of nurse-led care; and published in peer-reviewed journals, in English, between 2010-2019. Due to few studies in early rheumatoid arthritis, inclusion was extended to adults with established rheumatoid arthritis. Two reviewers screened abstracts and full texts. Joanna Briggs Institute Critical Appraisal Tool was used for quality assessment. Thematic synthesis was conducted according to the framework of Thomas and Harden (2008).
The search identified 1034 records. After screening and assessing for eligibility, eight qualitative studies were included in the review (133 patients). Three themes were identified from the synthesis. Nurse-led care was seen to provide professional expertise in planning and delivery of care. A person-centred approach was used combined with good communication skills, thus creating a positive therapeutic environment. Nurse-led care was described as providing a sense of empowerment and psychological support.
Patients with rheumatoid arthritis are supportive of nurse-led care. They value its professionalism and person-centred approach which provide a sense of security and confidence.
The findings outline ingredients of nurse-led care that are important to patients. These can inform nurses' professional development plans, service improvement and the competence framework for rheumatology nursing.
在过去的十年中，类风湿关节炎的治疗发生了巨大变化，其特点是早期开始强化治疗，并密切监测疾病活动直至缓解。在疾病的早期阶段，护士主导的护理作用尚未得到充分理解。
从早期类风湿关节炎患者的角度了解风湿病护士主导的护理。
对符合 PRISMA 清单的定性研究进行系统评价。2019 年 3 月，检索了以下数据库：MEDLINE、EMBASE、CINAHL、PsycINFO 和 OpenGrey。如果研究符合以下标准，则将其纳入：纳入患有类风湿关节炎的成年人；是定性研究，有关于患者对护士主导护理看法的数据；并在同行评审期刊上发表，发表时间在 2010-2019 年之间。由于早期类风湿关节炎的研究较少，因此将纳入范围扩大到患有已确诊类风湿关节炎的成年人。两位审查员筛选了摘要和全文。使用 Joanna Briggs Institute 批判性评估工具进行质量评估。根据托马斯和哈顿（2008 年）的框架进行主题综合。
搜索共确定了 1034 条记录。经过筛选和资格评估，有 8 项定性研究被纳入综述（133 名患者）。综合分析确定了 3 个主题。护士主导的护理被认为在规划和提供护理方面提供了专业知识。采用以人为本的方法，结合良好的沟通技巧，从而营造了积极的治疗环境。护士主导的护理被描述为提供赋权感和心理支持。
类风湿关节炎患者支持护士主导的护理。他们重视其专业性和以人为本的方法，这为他们提供了安全感和信心。
研究结果概述了对患者重要的护士主导护理的要素。这些要素可以为护士的专业发展计划、服务改进和风湿病护理的能力框架提供信息。
