Nurse Led Clinics
A nurse-led clinic is often an important aspect of patient care. These clinics are often out-patient based and managed usually by the clinical nurse specialist or nurse practitioner. The clinic may run alongside a clinic with a doctor present. Nurse-led clinics have assumed quite distinct roles and may vary from centre to centre. Working beyond scope of job role may require additional qualification and or assessment for example to review and order investigations, take a history, complete physical examination, perform joint injections and prescribe medications. Guidance should be sought.
New patient / new treatment clinics
These are aimed at patients and families commencing or changing treatments, with an opportunity to explore and address baseline knowledge and understanding, obtain consent as appropriate (e.g., Home Care) and to provide written information. Any baseline investigations or tests may also be performed including blood tests and chest x-ray. Injection techniques can be assessed and queries or concerns can be addressed. Families should also be aware of how to seek advice if they are concerned or their child is unwell.
These aim to ensure regular monitoring of disease and treatment. This is particularly important for patients receiving immunosuppressive or immuno-modulatory treatments including methotrexate and biological therapies. Disease activity can be assessed by history taking, joint examination (using pGALS) and blood profiles. Blood pressure and urine assessment may be needed. Joint injections may also be performed if required, sometimes using inhaled nitrous oxide. Issues relating to coping and functional impairment may also require support from the physical / occupational therapist(s).
Annual review clinics
These allow a review of disease status and disease control, growth and development, assessment of knowledge and understanding and prepare the young person for transitional care.
In many centres clinics are structured according to disease diagnosis and / or age. Good practice encourages clinics to accommodate young people from the age of 11 years. The transition clinic prepares young people and families to move into the ‘teen’ clinic which will move the focus from the parent to the young person taking ownership and responsibility for management of their condition and treatment. In a dedicated transitional care clinic all aspects of care can be addressed.
Offering patients the opportunity to participate in clinical research is vital to further improvements in clinical care and outcomes. Nurses are a key point of contact for families, providing education and support for research to improve patient care. They work across all paediatric specialities and help with the recruitment and delivery of research in the clinical context and within routine clinical practice. Research in paediatric rheumatology is active in the UK and involves clinical trials, Registries and cohort studies.