Domini Bryer MA Biologic Nurse Specialist in Rheumatology, Leeds

1. A Study to Explore the Influences Which Drive Clinical Decision Making Amongst Rheumatology Nurses. Domini Bryer MA Biologic Nurse Specialist in Rheumatology, Leeds

2. Rationale for the study Methodology chosen Aims of the study Literature review Study group Findings Discussion Conclusions and recommendations Introduction

3. Rationale for the study • Challenge of providing effective patient care • Constant change through government directives • Influence clinical and organisational effectiveness

4. Importance for Rheumatology • Clinical leaders/specialists awareness • Complex decisions/treatment plans • Long term effects • Quality service • Professional development of junior staff • 230 Rheumatology departments (BSR 2001) • Lack of clinical research

5. Methodology chosen • Qualitative design • Semi-structured interviews • Ethics approval • Data Protection • Pilot study • Thematic content analysis

6. Enhance the clinical decision-making process Improve clinical practice and expertise within the specialty Facilitate a structured development programme Improved patient care Aims of the Study

7. Literature Search • Clinical decision-making • Intuition • Evidence based-practice • Experiential learning • Knowing the patient • Skilled knowledge • Rheumatology nursing

8. Study Group • Two Rheumatology Wards • Ward Managers identified suitable staff • Six D Grade S/N • At least six months experience in the speciality • No further formal training • Respondents consent

9. Findings • Professional development • Patient focussed care • Working in a specialty • Rheumatology nursing

10. Professional Development • Professional Development within the specialty • Working alongside senior colleagues • Consideration of wider issues relating to specialty • Increased knowledge base • Effective interventions • Reflective practice • Use of local guidelines and policies

11. Specialist knowledge not transferable • Lack of interest from colleagues prevented further study • Lack of research in rheumatology nursing

12. Patient Focussed Care • Patient knowledge • Recognition of cues • Confidence in own decision making • Effective patient relationship • Patient stories to aid reflective practice • Intuition • Futility of chronic illness • Personal reservations about treatments

13. Working in a Specialty • Increased knowledge • Development of an inherent knowledge store • Networking • Creating independent thought • Multi-disciplinary approach • Ward environment

14. Rheumatology Nursing • Rheumatology nursing was “special” • Relationship building over time • Advocacy • Working with patients • Abundance of resources available • Specialist support structure

15. Lack of awareness of RCN guidelines for practice • Patient cues rather than in depth knowledge of disease process used to inform decisions especially in emergency situations • Some need for standardisation and nursing protocol

16. Conclusions • Wide range of factors influences decision-making • Decision making reliant on professional development and clinical supervision within the specialty • Vast amount of resources available – not always accessed • Specialised experiential knowledge • Need for specialised competency framework

17. Recommendations • Develop link nurse role between CNS and ward staff • Development of care pathways/protocols for specific diseases • Competency framework • Computerised resources – resource room • Further study to establish what sources of information are being used and to what effect

18. Limitations of the study • Aim was to gain an insight into local practice • Only applicable to this group of nurses within an snapshot of time • Unreliable data • Triangulation method may have been more useful • Recommendations transferable to other Rheumatology areas? • Time and workload