Self-determination of patients with rheumatoid arthritis: model development during action research.

The purpose of this article is to describe the content and the development of the model to promote self-determination of patients with rheumatoid arthritis from a point of view of patients and nurses. For the patients the data were gathered using semistructured interviews and for the nurses through three focus groups in the initial and evaluation phases. The data were analysed by themes using qualitative content analysis. The model consisted of the concept of self-determination, impediments to and preconditions for self-determination, promoting and focusing on consequences. Patient's activity was a new view of the concept. Impediments to self-determination were linked to limitations and preconditions to patients' freedom to express themselves. Support developed an important factor promoting self-determination. The results indicate a clear need for various types of supportive nursing care to promote self-participation in patient care.

Self-evaluation and peer review--an example of action research in promoting self-determination of patients with rheumatoid arthritis.

AIMS AND OBJECTIVES: The aim of this paper was to describe the areas that have been performed well and the areas in need of further development of rheumatoid arthritis patients. BACKGROUND: Nurses' self-evaluation and peer review are important methods for ascertaining the changes and success in the development of nursing practice. To date, there has been minimal research regarding the use of those evaluation methods in nursing practice. DESIGN: The findings of self-evaluation and peer review of nurses are described in a participatory action research study aimed at promotion of self-determination for patients with rheumatoid arthritis. METHODS: In self-evaluation, the collection of data was accomplished using a self-evaluation instrument with the permanent nursing staff (n = 18), then analysed through quantitative methods. For peer review, the data were gathered through focus groups (n = 21) using a tool similar to the one used for self-evaluation. The participants included many of the same nurses as in self-evaluation. The data were analysed using qualitative content analysis. RESULTS: Well-performed areas in nursing of rheumatoid arthritis patients were found to be promoting patient participation, supporting self-determination, performing patient-centred nursing and raising patient self-respect. The areas in need of development were connected to the nursing staff themselves: increasing collaboration of nursing staff, decreasing authoritarianism in nursing care and developing nursing practice with colleagues. CONCLUSIONS: Self-evaluation and peer review are complementary and support one another, especially since nurses were found to be more critical in their self-evaluations than in peer review. RELEVANCE TO CLINICAL PRACTICE: Both evaluation tools proved to be useful methods in the evaluation phase of the action research process as a means of professional development. Also assisting in the development of clinical nursing practice.

The nurse's role in addressing unmet treatment and management needs of patients with rheumatoid arthritis: Delphi-based recommendations.

PURPOSE: Evaluate nurse's role in management of patients with rheumatoid arthritis (RA). METHODS: Modified Delphi with two rounds of questionnaires, followed by in-person meeting. International group of 12 nurses experienced with RA patients receiving biologic therapy. FINDINGS: Nurses often spend more time with patients than doctors do. Nurse is in unique position to explore patient needs; educate about treatment, administration, product storage, and self-injection technique; determine readiness for and understanding of treatment; monitor safety and progress; and coordinate care within multidisciplinary setting. CONCLUSIONS: Nurse's role is complex and vitally important to optimal RA patient care. Additional nurse involvement may address unmet needs. IMPLICATIONS FOR NURSING PRACTICE: Rheumatology nurses can address unmet patient needs by expanding current roles and by adopting additional functions.

The Nurse's Role in Addressing Unmet Treatment and Management Needs of Patients With Rheumatoid Arthritis: Delphi-Based Recommendations.

PURPOSE: Evaluate nurse's role in management of patients with rheumatoid arthritis (RA). METHODS: Modified Delphi with two rounds of questionnaires, followed by in-person meeting. International group of 12 nurses experienced with RA patients receiving biologic therapy. FINDINGS: Nurses often spend more time with patients than doctors do. Nurse is in unique position to explore patient needs; educate about treatment, administration, product storage, and self-injection technique; determine readiness for and understanding of treatment; monitor safety and progress; and coordinate care within multidisciplinary setting. CONCLUSIONS: Nurse's role is complex and vitally important to optimal RA patient care. Additional nurse involvement may address unmet needs. IMPLICATIONS FOR NURSING PRACTICE: Rheumatology nurses can address unmet patient needs by expanding current roles and by adopting additional functions.

Ethical issues in participatory action research.

The purpose of this article is to describe the ethical issues arising out of participatory action research (PAR), on the basis of both an empirical study and the research literature, and to discuss how to deal with these issues. The data consist of the experiences and results of three phases of PAR relating to orthopaedic patients with rheumatoid arthritis (RA) and the analysis of 20 articles on the ethics of action research. As a result, the following ethical issues and the ways to treat them were discussed: informed consent, confidentiality and anonymity, protecting an individual from harm, the role of the researcher, the location of 'power' in PAR, and the ownership of the research. The flexibility of PAR in use and its main features are also related to the decisions made and actions taken in response to ethical issues. It is particularly important in PAR to proceed according to the participants, and to involve them from the beginning of the process, in order to insure the equal balance of power between participants and researcher.