Is patient education helpful in providing care for patients with rheumatoid arthritis? A qualitative study involving
French nurses
Estelle Fall, PhD,1,2 Nadia Chakroun, PhD,1,2 Nathalie Dalle, PhD3 and Marie Izaute, PhD1,2
1
Department of Psychology, Clermont University, 2Social and COgnitive Psychology LAboratory (LAPSCO), UMR 6024,
CNRS, and 3Clinical Investigation Center, University Hospital Center, Clermont-Ferrand, France
Abstract
This French study explored nurses’ involvement in patient education for patients with rheumatoid arthritis.
The study design was qualitative. Semistructured interviews were conducted with 16 hospital nurses. Data analysis was performed according to Giorgi’s descriptive phenomenological method, and supported by specific qualitative analysis software (Sphinx). The results showed the important role of hospital nurses in rheumatoid arthritis care. Patient education is a core part of nurses’ work, allowing them to give patients information and emotional support. The interviewees displayed skills in helping patients learn to care for themselves. However, patient education mostly concerned patients who are already committed to their health care. Non-adherent patients warrant special attention; their acceptance of their disease, perceptions about disease and treatment, motivation, and autonomy should be specifically addressed. French nurses could benefit from more training, and could be aided by psychologists. Ambulatory services could also be developed for patient education in France, based on examples from other countries.
Key words
France, nurse, patient education, phenomenological approach, rheumatoid arthritis.
INTRODUCTION
New biologics have led to considerable progress in the treatment of chronic autoimmune diseases. However, nonadherence is a major barrier to improving health and reducing the suffering of patients with chronic diseases.
Adherence is defined as “the extent to which patients’ behavior matches agreed recommendations from the prescriber”, which sees patients as autonomous actors in their own care
(Horne et al., 2006, p. 12). In rheumatoid arthritis (RA), new biologics are able to treat symptoms efficiently, provided that patients adhere to the prescribed treatment regime.
However, as reported by current literature, and also as described by health professionals (Blum et al., 2011), the extent of non-adherence continues to be a major concern.
Patient education (PE) was recently put in place by French health systems to overcome the problem of non-adherence and to improve the lives of patients suffering from chronic diseases. The term refers to measures taken by health professionals to inform patients, improve their healthcare behavior, and help them cope with their disease (Zabrisson &
Correspondence address: Nadia Chakroun, UMR 6024, CNRS, Social and COgnitive
Psychology LAboratory (LAPSCO), 34 Avenue Carnot, Clermont-Ferrand 63037,
France. Email: nadia.chakroun@univ-bpclermont.fr
Received 2 March 2012; revision received 14 December 2012; accepted 30 December
2012.
Hägglund, 2010). Among health professionals, nurses play an important role in RA care. This report seeks to understand how, through PE, nurses can help patients adhere adequately to their treatment and lead a better life with RA.
Literature review
RA is a chronic disease affecting less than 1% of the French population (Guillemin et al., 2005). It causes painful joints, swelling, morning stiffness, and tiredness. These symptoms impact greatly on patients’ quality of life (Elliot, 2008), resulting in functional disability (Conaghan et al., 1999) and emotional distress (Dickens & Creed, 2001). Clinical studies have shown that medical care improves RA symptoms
(Hirano et al., 1994), providing that patients stick to their treatment. However non-adherence is considerable in RA
(Elliot, 2008), even with
