Dissemination and evaluation of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis: results of a multinational survey among nurses, rheumatologists and patients

Objectives: 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. Conclusion: 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.