title: Dissemination and evaluation of the European League Against Rheumatism recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients.
abstract: OBJECTIVE
  The aims of this study were to disseminate, assess agreement with, assess the application of and identify potential barriers for implementation of the European League Against Rheumatism (EULAR) recommendations for the role of nurses in the management of chronic inflammatory arthritis (CIA) using a survey of nurses, rheumatologists and patients.
  
  
  METHODS
  A Web-based survey was distributed across Europe and the USA using snowball sampling. Levels of agreement and application were assessed using a 0-10 rating scale (0 = none, 10 = full agreement/application). Reasons for disagreement and potential barriers to application of each recommendation were sought. Regional differences with respect to agreement and application were explored.
  
  
  RESULTS
  In total, 967 nurses, 548 rheumatologists and 2034 patients from 23 countries participated in the survey. Median level of agreement was high in all three groups, ranging from 8 to 10 per recommendation. Median level of application was substantially lower, ranging from 0 to 8 per recommendation. Agreement and application were lowest in Eastern and Central Europe. The most commonly reported reasons for incomplete agreement were too many other responsibilities (nurses), doubts about knowledge of the nurse (rheumatologists) and fear of losing contact with the rheumatologist (patients). The most commonly reported barriers to the application were time constraints and unavailability of service. Rheumatologists responses suggested that nurses had insufficient knowledge to provide the recommended care.
  
  
  CONCLUSIONS
  The EULAR recommendations for the role of nurses in the management of CIA have been disseminated among nurses, rheumatologists and patients across Europe and the USA. Agreement with these recommendations is high, but application is lower and differed across regions.
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.Department of Patient and Care, Division of Rheumatology, Department of Internal Med
authors.forename: Yvonne
authors.initials: Y
authors.lastname: van Eijk-Hustings
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Mwidimi
authors.initials: M
authors.lastname: Ndosi
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Beate
authors.initials: B
authors.lastname: Buss
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Françoise
authors.initials: F
authors.lastname: Fayet
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Antonella
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Carine
authors.initials: C
authors.lastname: Savel
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Marieke
authors.initials: M
authors.lastname: Scholte-Voshaar
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Jenny
authors.initials: J
authors.lastname: de la Torre-Aboki
authors.affiliation: Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.Department of Patient and Care, Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands, Academic and Clinical Unit for Musculoskeletal Nursing (ACUMeN), Section of Clinical Biomechanics and Physical Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK, Charité Universitätsmedizin, Department Rheumatology, Berlin, Germany, Service de Rhumatologie 4e HE, Hôpital Gabriel Montpied, Clermont-Ferrand, France, Clinica Reumatologica, Università Politecnica delle Marche, Ospedale C. Urbani, Jesi (An), Italy, Staffordshire and Stoke on Trent NHS Partnership Trust, Rheumatology Centre, Stoke on Trent, UK, Tools, Foundation for Patient Empowerment, Bussum, The Netherlands and Department of Rheumatology, Alicante General and University Hospital, Alicante, Spain.
authors.forename: Astrid
authors.initials: A
authors.lastname: van Tubergen
mesh_terms: D000328:Adult; D001168:Arthritis / Q000451:nursing*; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D057240:Patient Preference; D012219:Rheumatology
keywords: guideline; inflammatory arthritis; nurses; rheumatology nursing