Purpose of arthritis care rounds

The core purpose of arthritis nursing rounds is to open up the gap between "clinical guidelines-individual conditions-patient needs", while dynamically tracking changes in the condition, and implement nursing measures into the actual life of each patient, ultimately reducing the disability rate of arthritis and improving the patient's quality of life.

I have been working in the rheumatology department for almost 6 years, and I have seen many people think that nursing rounds are just a formality - the nurse goes around the beds, asks "Does it hurt today?" Last week, I followed the head nurse to examine the 67-year-old Aunt Zhang with rheumatoid arthritis in bed 12. Previously, the plan we gave according to the care path was to do 20 minutes of hand hot compresses and 15 minutes of finger grasping exercises every morning and evening. However, during the ward rounds, the aunt hesitated for a long time before saying that she had to send her grandson to elementary school before 7 o'clock in the morning. There was no time to do hot compresses. Sometimes she hurriedly touched the cold water, but her fingers were so stiff that she couldn't even hold chopsticks.

Here we can just talk about the two directions that have been controversial in the nursing circle: one group insists on strictly implementing standardized nursing paths to ensure that all patients receive homogeneous nursing services and avoid missing key operations due to nurses’ lack of personal experience.； The other group believes that there are too many individual differences in chronic diseases such as arthritis. Some patients are retired and have full time at home, while others are working overtime from 9 to 5. If a rigidly unified time requirement is imposed, patients will feel "I can't do it at all" and simply give up on the implementation. The current practice in our department is to take the essence of both sides. The core nursing requirements cannot be relaxed, but the time and form can be adjusted according to the patient's condition. Later, Aunt Zhang changed the hot compress to be done in the evening when she is doing homework with her grandson, and also changed the finger exercise to watching TV while pinching a decompression ball. When she came for a review last week, her finger grip strength had improved by almost 20%.

Another role that is easily overlooked is to detect early signs of deterioration that patients do not take seriously. Last month, I admitted a 32-year-old young man with ankylosing spondylitis, who works in Internet development. Every time I asked him if he felt uncomfortable as usual, he waved his hand and said, "It's just that my back hurts after sitting for a long time. It'll be fine if I take a break." The head nurse during the last ward round didn't ask the usual question. She stared at his neck for two seconds and asked, "Is it difficult to turn your head recently?" How long does it take to put on socks? ”, the young man was stunned, and said that in the past half month, his back had been as stiff as a stone after getting up, and it took 5 minutes to put on socks. He thought it was because of continuous overtime work, and did not think about the progress of the disease at all. We quickly adjusted the dose of NSAIDs and gave him a set of spinal stretching exercises that can be done at the workstation. During the review last week, most of the morning stiffness had been relieved. If it were two months later, he might have suffered irreversible damage that limited spinal mobility.

To talk about some very disturbing data, the 2023 survey results of the Rheumatology Branch of the Chinese Medical Association show that less than 30% of arthritis patients can insist on completing the standardized out-of-hospital care plan. Among them, 70% of the reasons for interruption are not the patient's lack of cooperation at all, but the complete conflict between the care plan and his daily habits - you give The uncle who has to stand and sell vegetables every day said that he should stand less and rest more, and the mother with gout who had just given birth told her not to drink meat soup to breastfeed. These requests all sounded right, but the patient simply couldn't do it. Ward rounds are the best communication window, and the plan can be adjusted to a level acceptable to both parties before these conflicts become factors that worsen the condition.

Oh, yes, there is still a hot discussion right now: Should family members be invited to attend ward rounds for arthritis? Some people object, saying that many elderly patients are afraid that their children will think they are troublesome, so they will say "It's okay, I'm fine" in front of their family members even though they are in severe pain, which will delay their condition. ； Some people also support it, saying that if family members know how to help patients recover and adjust their diet, the implementation rate of the nursing plan can increase by more than 40%. Our department now asks patients about their wishes first. If they are willing to let their family members listen, they can come in together. If they are not willing, they can ask their family members to wait outside for a few minutes. Don’t make a one-size-fits-all approach.

In fact, the longer I work, the more I realize that care for arthritis, a chronic disease that follows a person for a lifetime, is never something that can be solved in one or two missions. The purpose of ward rounds is not to check the "disease", but to check how the patient is doing, whether there are any unspeakable secrets caused by the disease, and whether the things we teach can be really used. To put it bluntly, it can save patients two pains, and allow them to buy groceries and cook normally, pick up their grandchildren from school, and go for a walk in the park. This is more practical than any lofty nursing indicators.