Nurse-led care for people with early rheumatoid arthritis: Interview study with thematic analysis

Aims: To develop an understanding of what comprises nurse-led care in early rheumatoid arthritis from the perspective of rheumatology nurse specialists in England.Design: Qualitative study.MethodsSemi-structured telephone interviews with rheumatology nurse specialists in England were conducted in Summer 2020. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Reporting follows the appropriate elements of consolidated criteria for reporting qualitative research.Methods: Semi-structured telephone interviews with rheumatology nurse specialists in England were conducted in Summer 2020. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. Reporting follows the appropriate elements of consolidated criteria for reporting qualitative research.Results: Sixteen nurses were recruited and interviews lasted 30-60 min. Four themes with 14 subthemes were identified.A specialist service delivered by experienced rheumatology nurses Specialist care is provided by experienced nurse specialists with a high degree of autonomy in the rheumatology multidisciplinary team context.Addressing patients' complex care needs: Care is evidence-based and aims to start treatment, keep in treatment, educate and support. Access to psychology expertise is needed.Care with compassion using person-centred, holistic and empathetic approaches: Nurses create patient relationships and a positive therapeutic environment. Nurse-led telephone advice lines are essential for treatment adjustment, patient support and empowerment.Continued evaluation and development of the service: Consultations are reviewed, and patients are asked for feedback. The COVID-19 pandemic caused disruption, but changes streamlined procedures and improved documentation and communication.Conclusion: Nurse-led care in early rheumatoid arthritis is a specialist service delivered with compassion, addressing complex care needs and using person-centred approaches. This study identifies key aspects of care in early disease from the nurse perspective.