Rheumatology is a complex and all encompassing field of health care that requires health professionals to consider all aspects of the individual when engaging in a therapeutic relationship. When I entered this field I was as green as a Granny Smith apple, I knew nothing about the practice. I have no shame when I admit that I researched the term and the common disease process before I went for my first interview. My nursing education did not include any formal training in this area. I had no idea at that point that I was walking into an opportunity that would provide me such expansive growth, knowledge and the fortunate ability to deeply connect with thousands of patients.
It was a dynamic fit for me right from the start. I realized very quickly that nursing and rheumatology made a great pair. It was the first focused practice of medicine that ignited my passion and created an excitement that catapulted me on an exhilarating journey. I had found a home where I could continue to expand my practice of nursing and in turn utilize all the medical knowledge that I was gaining to improve the lives of many. It was in this space I learned to be a clinician, and found ways of incorporating nursing theory on the front lines with exceptional success.
I began my journey in rheumatology with the foundational understanding that the most critical elements to creating a true health partnership with patients was to first observe and then listen to the individual. These two key elements cannot be overstated and are essential for creating the foundational blocks of a health partnership. These simple actions provide the most valuable information about the health status of each individual and the critical first step to forming authentic connections. For what investigational result written on a page, what study or value could provide such sensitive information into the complex entity of each unique human being? There is no tool more powerful than seeing and hearing the person in front of you and it is imperative when connecting with patients with rheumatic disease.
In rheumatology there are often more questions to be found over answers. The practice of rheumatology aims to identify and distinguish between degenerative, inflammatory and autoimmune diseases in patients who present with a wide-ranged of symptoms that are challenging to categorize, such as pain, fatigue, weakness or some type of disability. Often an individual will have had symptoms or findings that cannot be explained by another medical diagnosis and they end up in the hands of the health professional working in rheumatology. There is often a puzzle to be solved that requires thoughtful, intelligent and committed practice to achieve the objective. For most people they have an idea that rheumatology means dealing with patients who have arthritis, and although this is one aspect I assure you that there is so much more.
The real challenge comes once the disease or cause has been identified and the patient partnership and education begins. This is where the partnership of rheumatology and nursing make a perfect combination. Picture in your mind a 32 year old healthy and active mother of two young children. She was just told she has highly seropositive rheumatoid arthritis, and she is at an increased risk of erosive joint destruction along with other potentially serious/critical systemic complications. If you have no idea what any of that means then you are feeling her experience in that moment. This disease, the risks and the unknown have suddenly become a major factor in her identity. She has only seconds to let it all sink in before she is advised that it is necessary to initiate systemic treatment immediately because there would be a good chance of gaining control of the disease. This is followed quickly by her being asked a serious of questions; Are your vaccinations up to date, have you had testing for tuberculosis, are you planning on having any other children, are you interested in being involved in a research trial?
This patient has about ten minutes to process this, answer all the questions and learn about the disease and the medications. It is intimidating and scary. The only thing that she is actually thinking about is the fact that she went to her doctor because she had a couple of painful and swollen fingers. She is now rationalizing in her mind about the fact that she probably just irritated them when unpacking all those boxes after her move. She doubts this diagnosis and feels she does not need to take medication. She answers the questions being asked though, without truly even hearing them. Her mind is racing and she is trying to recall the name of the disease and the medication that was just mentioned.
The point of creating this picture is to identify that it is in this moment where the essence of the partnership is established, and the potential for a successful health plan is formed. It may seem simple when broken down like this. However I forgot to add in all the background noise influencing the situation. I failed to tell you that the patient’s phone rang three times during the appointment, her young daughter was growing bored and was jumping on and off the seat beside her, eager to leave the exam room. The health practitioner although invested and engaged with the patient was also training a new staff member and was focused on showing him how to appropriately capture the data in the electronic medical record (EMR). If that wasn’t enough to distract everyone, I will throw in the fact that the appointment was well over an hour delayed, it was almost 2pm and the last time anyone in that room had ate was at breakfast. This is a real life scenario. This is the experience on the frontlines in busy, high demand clinics.
Although some of the details were changed slightly this was a direct experience from my practice of nursing. Fortunately it did not include all of those distractions, I work very hard to protect the sacred space of the patient interaction. I have always felt this is a critical nursing role. Together we were able to create a safe space that provided me the opportunity to sense her fear and worry. It took only feeling connection for her to openly reveal all of the emotions and influences she was experience with the situation. Together we were able to identify what she needed to understand and accept her new diagnosis. This is the foundation for the best possible outcomes for all patients. It would not have been possible without identifying that key moment where it was necessary to step away from the checklist and take a minute to connect.
For me rheumatology has been an amazing space where I have been able to actively learn everyday, speak the language of a specialized field, identify trends in patients with certain disease processes and most important commit to the critical role of nursing in this field. Rheumatology has been an endless sea to swim in with abundant possibilities and I have not remotely found any sign of its shore. Most importantly for me, has been identifying the dynamic role of utilizing nursing theory to create authentic connections with patients to enhance and improve the outcomes of people dealing with rheumatic disease.
There is so much to be done.