Patient education can be described as a set of planned, organised activities providing information to service users. Patient education aims to improve patient behaviours while optimising the health status of the individual to achieve positive long-term outcomes (Lovisi Neto et al, 2009). Patient education in chronic disease is particularly important as people must learn coping and adaptation mechanisms to deal with the progressive nature of certain conditions and the effects of long-term treatments (Ndosi and Adebajo, 2015; Senara et al, 2019).
Rheumatoid arthritis (RA) and the group of diseases known as the spondyloarthropathies (SpAs)—primarily psoriatic arthritis (PsA) and ankylosing spondylitis (AS)—are the most commonly found autoimmune conditions in the rheumatology clinic. Each are systemically driven diseases that can result in joint destruction, long-term disability, and premature mortality (Gabriel, 2008; Aletaha et al, 2010; Haroon et al, 2013; Hegarty et al, 2021). There are no curative treatments for these forms of arthritis and, as a result, some patients cycle through a number of treatment regimens. In addition, those who have refractory disease may develop joint destruction and disability at an early stage regardless of any treatments. This can be difficult for some patients to comprehend, especially at a time when they are at their most vulnerable during flares of their disease.
Patients who experience high levels of pain and fatigue because of their arthritis are at greater risk of developing depression, which can occur at any time during the disease course. It has been reported that, in the UK, up to 30% of RA patients will develop depression within 5 years of diagnosis (Jacob et al, 2017). Those with depressive tendencies tend not to seek help because of the stigma attached to mental illness (Machin et al, 2017). A patient's level of autonomy and insight into their disease also plays a crucial role in their psychological wellbeing (Ryan and McGuire, 2016).
To develop autonomy and assume responsibility for self-care, patients must first learn coping and adaptation mechanisms and take ownership of their condition, which is not possible without an adequate knowledge base (Kääriäinen et al, 2011). Patients' motivation to engage in positive health behaviours and educational initiatives can also be dependent on their knowledge base. According to Wilkinson (1997), the act of gaining new knowledge and engagement in problem-solving-based education is inherently motivating. Nurses can build on current patient understanding and provide new knowledge and promote an environment where patients are motivated to change.
Motivational interviewing can be helpful for rheumatology patients to encourage behavioural change (Palmer and El Miedany, 2018). It provides patients with the opportunity for self-assessment, focuses on self-reflection, allows patients to identify their own needs (Mulimba and Byron-Daniel, 2014) and should be an integral component of any educational intervention.
Having a rheumatology-specific, patient-centred education programme gives patients the knowledge base they require to develop an understanding of their individual disease and enhances motivation to change negative behaviours by providing an insight into disease pathology, prognosis and treatment plans. Arthritis-based patient education programmes should also offer patients guidance and support to navigate the complexities of their disease from a functional perspective. According to Neame et al (2005), the patient education needs of RA patients are sizeable but generally underestimated in everyday practice. For this reason, patient education initiatives for people who experience any form of inflammatory arthritis must be a vital component of standard nursing care, and should be a planned interactive process that empowers patients to self-manage their disease, and should always be tailored to the individual's needs (Zangi et al, 2015; Ndosi et al, 2016).
Patient self-management education, if effective, should prove beneficial to patient-reported outcomes (Palmer and El Miedany, 2012). Patient-reported outcome measures (PROMs) are a set of questionnaires designed to help patients report on their condition, including arthritis, on such topics as quality of life, work, disability and sexual dysfunction. PROMs are completed by the patient from the patient's perspective. El Miedany et al (2012) reported their success in incorporating PROMs and self-management into their patient-based fitness educational programme, resulting in a significant reduction of disease activity scores. Improvements were also observed in patient adherence to drug treatments. In their combined group, 89.1% of patients were adherent to their medication compared with 64.4% in their control group (P<0.01).
Background
Current practice in Irish rheumatology units is that either a clinical nurse specialist (CNS) or an advanced nurse practitioner (ANP) delivers patient education to patients in a multitude of formats, including verbal information, written documentation, videos, and directed guidance toward patient support services if further information is sought. These interactions often occur in busy rheumatology outpatient clinics. The COVID-19 pandemic has challenged the way healthcare providers deliver care to rheumatology patients. Virtual consultations and video-led education have become feasible alternatives to face-to-face clinic reviews during pandemic restrictions (Elhassan et al, 2020).
The educational needs of patients can be assessed on an individual basis during either virtual reviews or face-to-face contacts. Relevant information can be given, allowing the patient to ask questions and seek clarity about new information. PROMs can assist in identifying individual patient needs from the patient's perspective. Providing a platform to allow patients to report and document their feelings demonstrates the value of their opinions in the treatment plan and, according to El Miedany and Palmer (2008), improves medication adherence. If not performed correctly in collaboration with an objective tool of disease assessment, such as a tender joint count, this process can become routine for staff and baseline education can become standardised over time.
However RA, PsA and AS patient profiles are not standardised and differ from each other in a multitude of ways, such as disease pathophysiology, disease trajectory, and response to medications. The educational needs of patients diagnosed with the same disease can vary depending on what joints or tissues are affected. For example, patients diagnosed with PsA may have up to six different symptom domains (Coates et al, 2016), which can develop at different time points in the course of the disease.
The nature of an inflammatory joint disease is such that patients experience periods of high disease activity, known as flares. During disease flares, patients can experience extreme pain, joint swelling, stiffness, and fatigue, which impacts dramatically on their normal activities of everyday life. Their information needs during these times are usually concerned with symptom control and medication information. On the other hand, when their disease is quiescent, patients tend to seek information about lifestyle behaviours such as smoking cessation or dietary and exercise advice. Age and social circumstances also influence the educational needs of patients. For example, those who are planning a family have different information needs compared with those who are planning for their retirement. Therefore the education needs of patients change during each stage of their disease and throughout their lifetime.
In the Irish rheumatology setting the CNS service is a limited resource due to a number of factors. Doody and Bailey (2011) suggested that, in 2011, the CNS role in Ireland was in danger of becoming task-oriented, with policy makers insisting services show value for money while delivering the highest quality care. Subsequently, CNSs reported limitations in practice where clinical responsibilities took precedence over other aspects of the role, such as research and education. Time constraints were seen as a limitation to providing a holistic service. This was especially true in rheumatology centres where there were insufficient CNS staff to deliver all aspects of a CNS service. According to the Irish Rheumatology Nursing Forum (2014), the ratio of CNSs to service catchment area is less than 0.5 whole time equivalents per 135 000 inhabitants. Best practice recommendations from the National Clinical Care Programme (Health Service Executive, 2018) suggest an appropriate CNS-to-rheumatologist ratio of 1:1, or 1 whole time equivalent CNS per 100 000 inhabitants. Due to COVID-19 redeployments, many CNS services have been reduced and/or limited to delivering essential clinical care only.
In the researchers' outpatient department (OPD) setting, at the time of the study, two CNSs were in full-time employment. Since then, an advanced nurse practitioner post was sought and filled. Despite having three rheumatology specialists on site, due to the volume of attendees, not every patient who attends the clinic can access rheumatology nursing personnel on the day of their appointment. Patients must therefore also rely on other members of the multidisciplinary team (MDT), such as doctors or physiotherapists, as their source of information. In the rheumatology outpatient clinic, the MDT are tasked with seeing the maximum number of patients in the minimum amount of time to optimise resources. Clinicians in this environment may not have the flexibility to address the educational needs of each individual patient. In addition, although individualised patient education interventions are more effective, they can be more costly, making routine use in clinical practice unsustainable (Hill, 1997).
In the rheumatology clinic, patients often request to see the CNSs specifically to discuss ‘personal issues’ that they perceive to be too mundane to raise during the clinic consultation with a doctor or physiotherapist. These types of queries are not urgent in nature but are wholly relevant to the patient's personal self-care and independence. Queries on topics concerning stress management in everyday life, non-pharmacological pain management techniques, and general dietary advice reflect, to a certain degree, the unscheduled CNS interactions with patients in the OPD setting. If a CNS is unavailable at the clinic to deal with these personal queries, most patients will contact the service via the telephone helpline at a later date. However, a proportion of patients will decide not to make contact with the service and seek answers from other sources that may not be reliable or trustworthy; a valuable educational opportunity is then lost.
It is clear that alternative strategies are required to proactively address these issues. Nurses need to provide alternative means of sharing accurate, up-to-date information to meet the educational needs of patients at a time, and in a manner, that suits the patient, while maximising available resources. It has been documented that clinicians who adopt a more patient-centred approach to patient education inspire confidence and trust while also motivating patients to become empowered (Fiscella et al, 2004; Deakin et al, 2006; Anderson and Funnell, 2010). Improved patient-centered education initiatives can boost patient motivation and confidence levels. A robust education initiative will instil a desire for new knowledge. Improved levels of knowledge and service satisfaction can improve PROMs and increase patients' self-management abilities.
Many articles have been published detailing the importance of patient-centred communication (Suarez-Almazor, 2004; Epstein et al, 2005; Hashim, 2017) and have shown that video and digital education can play an important role in optimising resources in the healthcare setting (Penick Brock and Smith, 2007; Tuong et al, 2014; Correnti et al, 2017), particularly in the field of rheumatology (Kataria and Ravindran, 2018). The potential benefits of information technology to deliver patient education clearly and accurately cannot be underestimated. Tailored educational health videos can be used as a way of delivering information in a timely, concise manner, and in an entertaining format which, after the initial filming, require very few resources from health professionals.
The study
Aim
The aim of this study was to examine the effect of a rheumatology video-based patient education initiative on patient demand for access to the CNSs in the OPD setting.
Design
This study used a quasi-experimental, non-equivalent groups design to examine the differences between two groups of participants: patients with exposure and those with no exposure to the educational video.
Method
Funding was acquired for the video production of 10 health education messages. Topics were chosen from previously published studies that provided details of the educational needs of RA patients. These included general arthritis information, disease and flare management, medications, pain management and diet (Neame et al, 2005; Brown et al, 2006; Connelly et al, 2019). Other topics chosen for production deemed relevant by the CNSs from a health promotion perspective were: the importance of exercise, stress management, and safety while travelling. Video topics were allocated to individual rheumatology MDT members based on their role or special interest within the MDT, for example the topic ‘importance of exercise’ was allocated to a physiotherapist, ‘dietary advice’ was given to the dietitian and so on. Each would then write a script. The CNSs wrote scripts on ‘managing a flare up’ and ‘travel advice’. All scripts were reviewed externally by a clinical psychologist to ensure that the terminology and language used were patient friendly. A rheumatology patient was recruited to take part in a recorded, semi-structured interview, telling their own personal journey of RA as part of the video catalogue. This was intended to help viewers relate to the information provided on a personal level (Haigh and Hardy, 2011; Yu et al, 2011). The videos consisted of each member of the team talking directly to camera for approximately 2 minutes on their topic. The videos were assembled into a short film format and played on a loop in the rheumatology outpatient suite for patients to view prior to their consultation. Following this, the patient education videos were uploaded to the rheumatology section on the hospital website. This offered participants the opportunity to watch the videos on their mobile device while in the OPD setting.
Participants
A convenience sample of 240 patients attending the rheumatology OPD in a model 4 tertiary referral hospital in Ireland, was selected over a 2-year period—120 patients without video exposure, of which 7.5% were new attendees, and 120 patients with video exposure, of which 7.7% were new attendees.
The non-exposed participants were recruited while the educational videos were in production (December 2015 to December 2016). A CNS attended the clinics every week and approached every patient after check-in for participation. Consent was obtained from those who agreed and they were given the questionnaire to complete after their consultation. The video was then displayed at the clinic and recruitment began in January 2017 for the video-exposed group using the same sampling technique and questionnaire. The CNS was available during the full clinic to discuss any queries participants may have had about the questionnaire and to collect completed questionnaires at the end.
Data collection
A tick-box questionnaire was developed by the researchers based on the study aims, patient issues reported to the CNSs, and the self-reported educational needs of individual patients. The questionnaire was designed in three sections (Table 1). The first section sought information on time spent in the waiting room, with the doctor, and on the patient's diagnosis. The second section focused on personal issues and health status. This section comprised tick-box questions and two open-ended questions, which enabled the patient to give reasons for not discussing personal issues.
Table 1. Breakdown of questionnaire and categories of information
| Section | Categories of information | Question topics |
|---|---|---|
| Section 1 | Type of visitDiagnosis and length of time spent in the waiting room and with the doctor during the consultation |
|
| Section 2 | Interaction with doctor, if information was sought by the patient from the doctor during the consultationHealth status—if they had a recent flare of their disease and did they report it |
|
| Section 3 | Breakdown of educational needs, including disease and treatment aspects of conditionPreferred waiting-room activityDo patients want/need to see the clinical nurse specialist (CNS) at clinic |
|
The third section focused on the patient's educational needs, desire to speak to the CNSs and preferred waiting-room activity, including a tick-box question asking if the video was beneficial. A copy of the full questionnaire can be found with the online version of this article. The questionnaire was piloted on 10 patients with no video exposure to assess ease of administration and seek patient input. No issues were raised by patients during the pilot stage and all participants were able to complete the questionnaire within 10 minutes.
Ethical considerations
Ethical approval for the study was sought and granted from the hospital's Academic Research and Ethics Committee in 2015. The consent form was re-examined in June 2019 to ensure explicit consent was obtained in compliance with the Health Research Regulations (Health Research Board, 2018), with guidance set out by the Irish Department of Health (2018). An information leaflet was also produced in line with the Research and Ethics Committee's protocol to ensure informed consent, detailing the background of the study, data collection and storage, and the maintenance of confidentiality. The questionnaire asked for patients' initials and date of birth. This was deemed necessary to allow the CNSs to contact any individual in the event that they divulged information requiring a medical response, such as problems taking medication or serious mental health issues. Nothing of this nature was found. Once checked by the CNSs, the questionnaires were anonymised and sent for analysis.
Data analysis
Data analysis was conducted by staff at the Centre for Policy Studies in the hospital's partnered university. Data were divided into two groups for comparison: non-exposure and exposure. Response rates were 100% (n=120) in the non-exposure group and 86% in the exposure group (n=104); 16 questionnaires were returned blank or incomplete. Descriptive statistics were used to evaluate waiting times and categories of chronic condition. Group differences with categorical data were analysed using chi-square tests with Yates' correction, and the sole continuous variable, doctor time, with a t test. All analysis was performed using IBM SPSS 26.
Results
Need for CNS review
The number of patients who requested access to the CNSs at clinic was six times higher in the non-exposed group (25%), compared with the exposed group (5%) (χ2=15.7, P=0.00007) (Table 2).
Table 2. Preferred waiting-room activity
| Non-exposed | Exposed | |||
|---|---|---|---|---|
| Number | % | Number | % | |
| Read a book | 28 | 23% | 17 | 16% |
| 12 | 10% | 3 | 3% | |
| Read information brochures | 20 | 17% | 46 | 44% |
| Read newspaper | 34 | 28% | 21 | 20% |
| Watch video on phone | 9 | 8% | 21 | 20% |
| Watch TV | 28 | 23% | 36 | 35% |
| Listen to music on phone | 4 | 3% | 0 | 0% |
| Seek specialist nurse | 30 | 25% | 5 | 5% |
Note: Patients could choose more than one activity
Need to discuss personal information
Substantially more patients in the control group wanted to discuss personal problems compared with the exposed group (χ2=8.99, P=0.003).
Waiting times and conditions
There were no appreciable differences between groups in terms of waiting times (non-exposed group: 40 minutes, exposed group: 46 minutes, mean exposure: 43 minutes. Time spent with the doctor also showed no significant difference (16.7 minutes and 15.9 minutes respectively). Length of time attending the service was comparable for both groups (6.5 and 7.6 years). Patients who reported a diagnosis of inflammatory arthritis, RA, PsA, AS and SpA made up a significant proportion of both groups (non-exposed group: 71% and exposed group: 80%) (Table 3).
Table 3. Summary of diagnosis per group
| Non-exposed | Exposed | |||
|---|---|---|---|---|
| Number | % | Number | % | |
| Inflammatory arthritis | 21 | 18% | 18 | 17% |
| Rheumatoid arthritis | 39 | 33% | 42 | 40% |
| Psoriatic arthritis | 7 | 6% | 15 | 14% |
| Ankylosing spondylitis | 13 | 11% | 7 | 7% |
| Spondyloarthritis | 3 | 3% | 2 | 2% |
| Fibromyalgia | 1 | 1% | 5 | 5% |
| Lupus | 5 | 4% | 2 | 2% |
| Systemic sclerosis | 0 | 0% | 0 | 0% |
| Osteoarthritis | 13 | 11% | 3 | 3% |
| Osteoporosis | 5 | 4% | 0 | 0% |
| Gout | 2 | 2% | 1 | 1% |
| Other | 25 | 21% | 19 | 18% |
Note: Some patients had more than one condition
More patients in the non-exposed group (14%) compared with the exposed group (4%) thought that the time in the waiting room was beneficial for relaxation before going into their consultation (χ2=5.82, P=0.015). Twenty-one per cent of the non-exposed group thought the time spent in the waiting room was wasted compared with 39% of the exposed group. (χ2=8.39, P=0.004). Participants who were shown the video were more likely to watch it on their mobile device via the hospital webpage than watch it on the TV screen in the OPD (n=21).
Knowledge requirements
Both groups displayed an approximately equal interest in learning more about their diseases (81% and 82% respectively). The control group wanted more dietary advice (non-exposed group: 43% and exposed group: 21%) (χ2=10.6, P=0.001) and information about exercise regimens (non-exposed group: 33% and exposed group: 18%) (χ2=5.16, P=0.023). Those who had exposure to the educational video were more than twice as likely to want to read information brochures than the control (non-exposure: 17% and exposure: 44%) (χ2=19.06, P=0.000013) (Table 2).
Bias
There was homogeneity between groups in terms of time spent in the waiting room, time with the doctor and length of years attending the service. Diagnostic similarities were also evident (Table 3) in both non-exposure and exposure groups. Both groups were comparable at baseline, which strengthens the study's internal validity.
Every patient attending the selected clinics was approached to mitigate selection bias. The presence of a CNS at the clinic was a potential confounder which, due to the Hawthorne effect, could result in reporting bias from the participants. To minimise this, patients were informed that the CNS would not be involved in data analysis and questionnaire results would be anonymised. The use of a convenience sample might have introduced some undetected bias.
Discussion
This study demonstrates how a video-based patient education initiative saved CNS time and resources in the researchers' rheumatology OPD. All types of inflammatory arthritis have a substantial effect on patients' lives. If patients are educated with the correct information, it enables them to be better able to cope and adapt to their disease. The educational needs of both groups were considerable, 81% of non-exposed and 82% of video-exposed participants expressed an interest in learning more about their disease. These findings are in agreement with other studies on the educational needs of RA patients (Neame et al, 2005; Meesters et al, 2009).
Many patients seek medical information online before their consultation at the OPD, using the internet as a diagnostic tool (Diaz et al, 2002; Hay et al, 2008). Arthritis information on the internet is often financially driven and websites are targeted for product or service promotion (Kim et al, 2004) potentially providing biased and misleading information to patients (Suarez-Almazor et al, 2001; Akerkar and Bichile, 2004). This supports the concept of a structured, needs-based, patient-centred education approach for rheumatology units and is echoed in the European League Against Rheumatism (EULAR) recommendations for patient education (Zangi et al, 2015). By providing accurate information in a tailored patient education programme, rheumatology nurses can develop a platform where patients can access accurate information.
It is envisaged by the EULAR Taskforce on Patient Education that, due to the growing reliance on digital information, face-to-face meetings will be replaced by online patient education programmes in the future (Zangi et al, 2015). This is particularly pertinent during the current COVID-19 pandemic, where routine care is often conducted virtually. CNSs will need to adapt service delivery to accommodate virtual reviews to ensure future sustainability of services. Video patient-education initiatives should not replace current methods of face-to-face nurse consultations entirely or access to CNS telephone helplines. Such programmes can be incorporated into an established education initiative to complement and expand current practice, thereby improving the quality of patient care.
According to Ryan et al (2006), the CNS is a pivotal member of the team, providing individualised patient education while offering psychological support. Rheumatology CNSs possess the skills and ability to effectively deliver individualised patient education. Patients often prefer to speak to the rheumatology nurse rather than other MDT members (Brown et al, 2006) as they are perceived to be more adept at providing emotional support and coping strategies (Mäkeläinen et al, 2009). This study also explored the effect of the video on the patients' need to discuss personal information at the clinic. Patient-centred communication during the interaction is linked with higher levels of patients' self-efficacy (Finney Rutten et al, 2016). In the present study, 30% of patients without video exposure reported a need to discuss personal issues, compared with 12.5% who had seen the video. This implies participants with video exposure may have had some of their personal issues answered by the video content prior to their consultation. Providing patients with relevant information before their OPD consultation could streamline the patient–clinician interaction and potentially reduce the consultation time, improving patient flow through the department.
When exposed to the videos, participants reported different waiting-room activity preferences. More of those in the non-exposed group thought it was important to relax. Those who were shown the patient education video felt that time spent in the waiting room before its introduction had been wasted. Many of those who were shown the video chose to watch it on their mobile device in the clinic, demonstrating engagement in the initiative. Once exposed to the video, patients were twice as likely to read information brochures than their counterparts in the control group.
This research has shown that when patients are provided with information relevant to their educational needs, they become more engaged with learning and seek more knowledge. Similar findings were reported in the literature by Kjeken et al (2006). They suggest that rheumatology patients' desire for additional knowledge could be due to the unpredictable nature of arthritis, leading to new challenges for patients. Coupled with rapidly advancing pharmacological treatments, this results in patients needing constant access to up-to-date information. According to Mäkeläinen et al (2009), nurses play a crucial role in educating patients, providing up-to-date information, enabling independence and promoting confidence to motivate and encourage self-management. Providing patients with a platform to access this education at home or on-the-go allows them to learn at their own pace, in their own time.
Study limitations
The questionnaire designed for this study was not tested for content validity or reliability. Using a tool that was not tested for validity or reliability potentially hinders the external validity and generalisability of results. A search of the literature demonstrated numerous health service satisfaction surveys that demonstrate both reliability and validity, including the Patient Satisfaction Questionnaire Short-form (PSQ-18) (Marshall and Hays, 1994), the Post Hospitalization Behavior Questionnaire (PHBQ) (Weaver et al, 1993) and the Clinician & Group Survey (CG-CAHPS) (Agency for Healthcare Research and Quality, 2021); however, such surveys were not rheumatology specific. Similarly, the Educational Needs Assessment Tool (ENAT) was identified, which assesses patients' self-reported educational needs (Ndosi et al, 2011; Sierakowska et al, 2015) and is validated for use in the rheumatological setting. However, this was not sufficient to generate the data required to answer the research question.
It was the opinion of the researchers that this video-based intervention was individualised to the patients' educational needs and designed for one specific rheumatology unit alone, so that any positive effects of the intervention could be site specific. Replication of this study in other centres may not yield the same patient education needs. However, it offers CNSs a guide to initiating a similar programme for use in other sites that want to engage with video-based education.
The logistical constraints of the waiting-room set-up limited the study to the use of a convenience sample as it was not possible to segregate patients. However, the fact that the two groups were sampled consecutively, and over a long period of time (one year per group), suggests that any negative effects may be unimportant. There are no obvious confounders apparent to cause patients presenting in one year to be markedly different to those in the following year.
The mean time of exposure to the educational film was 43 minutes; some patients may have had only 5 to 10 minutes of uninterrupted viewing time. It is reasonable to assume, however, that if every patient had full access to the video in its entirety the results would have been at least replicated, and in all probability more pronounced. Barriers to viewing the video included patient positioning in the waiting room and background noise.
Future research
Future studies exploring patients' overall satisfaction with the clinic visit, having watched the patient education video, would be useful for analysing patient-reported experience and outcome measures for future service planning. Evaluation of the patient education programme would need to be undertaken to ensure the content remains valid over time.
Using a needs assessment questionnaire such as the ENAT, while incorporating PROMs prior to the initiation of future patient education programmes, might be beneficial. This would allow patients to identify their educational needs pre-intervention, and in order of priority.
A link to each video was uploaded to a dashboard on the rheumatology section of the hospital website. The dashboard was redesigned to provide patients with a platform to access each video at home or on-the-go and included sections relating to rheumatology MDT members, medication information leaflets, and links to support services. Investigation into the benefit of online access to the full video at home prior to the OPD consultation could be explored, using a control group with no video exposure and examining patient satisfaction during their visit.
It would be of benefit to investigate the effects of video-based patient education on both resource use and patient experience using a fully validated instrument and with a fully randomised sample across different participating hospitals. Such a study could include an economic evaluation of the intervention, thus providing a comprehensive picture of the impact of targeted education.
Conclusion
This study demonstrated that patients exposed to video-based patient education in a rheumatology OPD are 6 times less likely to require CNS review. Video-based patient education allows information sharing by the CNS with a large target audience without needing to be present at clinic. This has profound implications for CNS service planning and results drawn from this study can be applicable across different disciplines, especially considering the current pandemic, which has necessitated a transition to video and virtual-based interactions. It also offers a new approach to patient education in the clinical setting, delivering information in a timely, reproducible and cost-efficient manner.
The study also shows that video-based information in this setting promotes new learning opportunities and prompts patients to seek out written educational material, lessening the burden on the hospital service as a source of information.
KEY POINTS
- Patient demand for access to rheumatology clinical nurse specialists (CNSs) at outpatient clinics is growing. Due to increasing caseload numbers and commitments to inpatient and COVID-19 virtual review clinics, rheumatology CNSs may not be able to see every patient who requests specialist nurse review on the day of their in-person clinic appointment
- In this study, information that patients require from the CNS have common themes that are related to their disease or medication, including information about dietary advice, exercise regimens and sharps disposal
- The rheumatology CNS explored alternative ways to provide up-to-date, accurate information to meet patients' educational needs on a wider scale so the information is accessible to patients without depending on face-to-face CNS reviews
- In this study, high-quality rheumatology tailored educational videos on view in the rheumatology outpatient department provided patients with information sufficient to meet their educational needs, freeing up valuable CNS time and resources
- Video-based information in this setting promoted new learning opportunities and prompted patients to seek out written educational material, lessening the burden on the rheumatology CNS service as a source of information
CPD reflective questions
- How can nurses be facilitated to develop online video educational material as an essential component of a patient education programme in chronic disease management?
- Why is it important to maximise clinical resources in the specialist nursing service?
- How can nurses evaluate the quality of video-based patient education, in the outpatient department or at home, and its effect on patients' level of knowledge and understanding?
Appendix 1. Rheumatology outpatient department patient education initiative: patient questionnaire