Ward-based care and referral to the multidisciplinary team

Musculoskeletal problems are common, affecting up to one in five people. People with musculoskeletal problems are frequently admitted to hospital and it is important for nurses working in hospital ambulatory care, emergency care, and on wards to understand the nature of musculoskeletal conditions in order to provide high-quality care. Patients may present with an acute medical or surgical illness, trauma, or bone disease (e.g. osteoporosis, degenerative arthritis, or inflammatory arthritis). A range of drugs treatments are given to improve symptoms of pain and stiffness. Drugs for inflammatory arthritis are given to modify the immune system, such as methotrexate or biologics (e.g. tumour necrosis factor inhibitors). Patients can be very disabled by their musculoskeletal condition and they have specific care needs. Safety during hospitalization and on discharge is important and key aspects are covered in this chapter.

Symptom control: Using pharmacological and non-pharmacological methods

This chapter examines how to assess and manage the common symptoms of musculoskeletal conditions including pain, depression, and fatigue. As the most prevalent symptom is pain, the assessment and support of patients with pain are discussed in depth including the significance of identifying both serious causes of pain and psychosocial influences on pain. Pharmacological and non-pharmacological approaches to the management of all three symptoms are included. The roles of education, exercise, pacing of activities, relaxation, and access to specialist input are discussed. The chapter outlines how the nurse can provide practical support and advice to enable the patient to manage the impact of their symptoms as well as managing self-limiting conditions such as a soft tissue injury.

Connective tissue diseases

This chapter covers the connective tissue diseases including systemic lupus erythematosus, Sjögren’s syndrome, scleroderma, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (including granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), eosinophilic granulomatosis with polyangiitis (formerly known as Churg–Strauss syndrome), and microscopic polyangiitis), polyarteritis nodosa, and Behçet’s disease. For each example of a connective tissue disease it provides an overview of the condition and classification criteria, alongside the prognosis. Techniques and tricks for diagnosis, clinical features, assessment tools, and treatment are all covered. Key points of nursing care are described, including the nurse’s role in treatment with thalidomide and cyclophosphamide, and any particular organs that can be affected is detailed.

Inflammatory joint diseases

Inflammatory joint diseases are conditions that have an underlying inflammatory component that may be driven by a faulty autoimmune response by the body, often resulting in the body’s tissues being attacked by the body’s own immune responses. This chapter covers a range of inflammatory joint diseases, which both target specific joints and/or surrounding tissues and have a genetic predisposition. For each condition, it covers methods of diagnosis, clinical features, methods of assessment and treatment, management, and frequently asked questions when presented with a patient experiencing the condition.

Elective orthopaedic surgery

This chapter on orthopaedic surgery reviews the specialist nursing management of patients undergoing (elective) orthopaedic surgery during the preoperative, perioperative, and postoperative phases of treatment. In particular, the management of pain during a surgical episode of care and the potential postoperative complications including deep vein thrombosis, pulmonary embolism, infection, and the prevention of pressure ulcers are detailed. A review of the most common orthopaedic procedures including surgery to the spine, hip, knee, wrist, hand, elbow, and shoulder is also given, with details on the specific nursing management, rehabilitation, and patient education pertinent to each procedure. This chapter is written for qualified nursing staff.

Nurse-led clinics

For patients with long-term conditions, the role of the nurse specialist is key to continuity of care. This chapter outlines issues that nurse specialists need to be aware of in demonstrating their value. Nurse-led care and the competencies required for nurse specialist roles are outlined and provide a framework for nurses new to the role to consider. Working as a nurse specialist often has a level of autonomy that ward nurses do not have and therefore it is vital that nurses working in these roles should be able to clearly articulate the components of their role, define the clinical effectiveness of the nurse-led clinic activities, and demonstrate the benefits to the individual, the organization they work for, and the wider society. This chapter succinctly outlines these key points.

Patient’s perspective

This chapter is written by a patient with a long-term musculoskeletal condition but who also happens to be the chief executive of a patient organization. The patient’s perspective on their disease, their experience of the healthcare journey, and their ability to access to key information are important components that healthcare professionals need to be mindful of. This chapter describes the needs of the patient in practical terms, and offers tips to guide the patient during their outpatient appointments. The nurse specialist role is highlighted as one that is highly valued and the cornerstone for many patients with a long-term condition. The challenges patients face are described, along with advice to services on how to build care that is receptive to patients’ comments but importantly also offers opportunities that can empower the patient . Equally, this chapter offers some great links and information on some excellent resources for nurses and patients to access.

Holistic and patient-centred care

This chapter examines important components of providing a holistic and patient-centred approach to care including motivational interviewing and goal setting. Only by exploring the patient’s view from a physical, psychological, spiritual, and social perspective can meaningful care be provided. Definitions of holistic and patient centred care are given together with guidance on what nurses need to consider when undertaking a nurse consultation. The value of such an approach is outlined in the context of legal responsibilities, documentation, and consent. Considerations on how to aid patients in becoming educated about their conditions, the social and psychological impact of the condition, interpreting evidence, and making an informed decision are also discussed. The role of the nurse in offering education and support to the patient and their family with the key aim of encouraging active participation in their own care results in more positive outcomes. The chapter also offers information and support offered by the voluntary sectors.

Osteoporosis

This chapter defines osteoporosis and its clinical features. The factors influencing bone mass and bone loss are described as well as contributing factors to the development of osteoporosis including hormonal, dietary, hereditary, and activity undertaken as well as the secondary causes seen in drug or disease-related issues. Diagnosis and how dual-energy X-ray absorptiometry scans are used and interpreted are briefly outlined. A key point that is discussed is osteoporosis in premenopausal women and in men, including causes and management. Vertebral and hip fractures result in a significant burden to the individual and to society. Avoiding these fractures is an important factor for all health professionals to consider so this chapter offers some useful information about managing older people at greater risk of such fractures as well as lifestyle points and how to offer appropriate education and support to all those at risk. In the final sections, assessment tools are described, the role of the nurse in the care of patients with osteoporosis is outlined, and frequently asked questions are covered.

Assessment tools and outcome measures

The use of tools to measure important components of the patient’s disease, functional ability, psychological issues, or self-efficacy are now considered an integral part of healthcare. Such tools must be well researched and demonstrate that they are valid and reliable. This chapter first gives an overview of assessment and outcome tools, followed by considerations in selecting the right tool for the job. A section then follows on validity. In addition, various tools used in musculoskeletal care are described briefly including examples of tools measuring clinical indicators, domain- and disease-specific measures, and tools measuring psychological aspects, as well as pointers to selecting the right tool.