Understanding Function in RA: The Nurse's Role in Patient Evaluation

The intensive, individualized management algorithm incorporated into the “treat to target” approach to rheumatoid arthritis includes an expanded role for the rheumatology nurse. Recently added job responsibilities for nurses include in-depth patient evaluation, care coordination assistance, referral facilitation, and patient self-management education and support. However, there is a critical shortage of trained rheumatology nurses. Recently published recommendations for nurses in managing chronic inflammatory arthritis provide a clear framework for future role development, but determining the specifics for implementing them is challenging. Nurse-rheumatologist teams can have a positive influence on patients' knowledge, satisfaction, and pain and provide clinical outcomes as successful as those provided with usual rheumatologic care. Rheumatology nurses are well positioned to participate actively in the increasingly complex care management activities that are required. The current “treat to target” approach to rheumatoid arthritis (RA) incorporates an intensive, individualized management algorithm that includes an expanded role for the rheumatology nurse. In 2010, an international task force provided recommendations for achieving optimal treatment outcomes in RA based on the following 4 principles: (1) promoting shared decision making between the patient and the rheumatologist; (2) maximizing patients' quality of life through symptoms control, joint damage prevention, function normalization, and engagement in social activities; (3) halting inflammation; and (4) using disease activity measures to adjust treatment.1 Included in the disease activity measures are assessments of patients' joint swelling and pain and their degree of functional impairment. A major challenge is determining how these outcome data will be collected and by whom. This article, the fifth in a 5-part series designed to provide a practical approach to better understanding of function in RA as an essential component of treat to target management strategies, discusses the rheumatology nurse's potential role. The first article in this series (“Understanding Function in RA: An Update on ‘Treat to Target,'” The Journal of Musculoskeletal Medicine, February 2012, page 10) provided an overview. In the second article (“Understanding Function in RA: Importance and Measurement,” The Journal of Musculoskeletal Medicine, March 2012, page 41), we first presented a standardized vocabulary for describing function, based on the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF), and then applied it to an assessment tool frequently used in rheumatology, the Health Assessment Questionnaire (HAQ). The third article (“Understanding Function in RA: The Role of Impairments,” The Journal of Musculoskeletal Medicine, April 2012, page 78), described how impairments in body systems caused by RA can affect function and how patients can adapt their activities to cope with these impairments. In the fourth article (“Understanding Function in RA: Practical Evaluation in the Outpatient Setting,” The Journal of Musculoskeletal Medicine, May 2012, page 102), we discussed how functional assessment may be incorporated into clinical practice. This fifth article provides an overview of the nurse's role in the care of rheumatology patients, with a focus on RA.FIGURE 1