Barriers to and facilitators of rheumatology nurses in their support of patients to use a self-management program: A qualitative study

Abstract

Background: ‘Challenge Your Arthritis’ is a peer-guided program to enhance patients’ self-management in coping with their rheumatic disease. Although rheumatology nurses are seen as important suppliers of the program, only a few patients are referred to this program by them. Moreover, a limited number of patients participate in it. To date, nurses’ perspectives on the program have remained underexposed. Insight into the barriers to and facilitators of rheumatology nurses in their support of patients to use the program is needed. Aim: To investigate the barriers to and facilitators of rheumatology nurses in daily care practice with respect to their support of patients to use the self-management program ‘Challenge Your Arthritis’, in order to provide information that may be used to optimize its implementation. Methods: A qualitative generic descriptive design was chosen, using semi-structured interviews with Dutch rheumatology nurses. Theoretical thematic analysis with constant comparison was applied, using a deductive approach in which analysis was directed by the concepts of theoretical frameworks. Results: Data collected from fourteen participants yielded fourteen barriers and twelve facilitators, within sixteen subthemes at six overarching levels: professional, innovation, patient, social context, organizational context and external context. Conclusion and recommendations: Regarding the identified barriers to and facilitators of rheumatology nurses, it was found that whereas rheumatology nurses reported facilitators on the levels of professional, innovation and social context, they indicated many barriers on the levels of professional and organizational context. For ‘Challenge Your Arthritis’ to be more widely supported by nurses, barriers should be overcome. Notably the lack of work structure and of resources, time, knowledge and skills, and an undue attitude of care. It is recommended to explore the use of a tool to guide the work structure and of a multifaceted training for nurses.