1. A Study to Explore the Influences Which Drive Clinical Decision Making Amongst Rheumatology Nurses. Domini Bryer MA Biologic Nurse Specialist in Rheumatology, Leeds

2. Introduction  Rationale for the study  Methodology chosen  Aims of the study  Literature review  Study group  Findings  Discussion  Conclusions and recommendations

3. Rationale for the study  Challenge of providing effective patient care  Constant change through government directives  Influence clinical and organisational effectiveness

4. Importance for Rheumatology  Clinical leaders/specialists awareness  Complex decisions/treatment plans  Long term effects  Quality service  Professional development of junior staff  230 Rheumatology departments (BSR 2001)  Lack of clinical research

5. Methodology chosen  Qualitative design  Semi-structured interviews  Ethics approval  Data Protection  Pilot study  Thematic content analysis

6. Aims of the Study  Enhance the clinical decision-making process  Improve clinical practice and expertise within the specialty  Facilitate a structured development programme  Improved patient care

7. Literature Search  Clinical decision-making  Intuition  Evidence based-practice  Experiential learning  Knowing the patient  Skilled knowledge  Rheumatology nursing

8. Study Group  Two Rheumatology Wards  Ward Managers identified suitable staff  Six D Grade S/N  At least six months experience in the speciality  No further formal training  Respondents consent

9.  Professional development  Patient focussed care  Working in a specialty  Rheumatology nursing Findings

10. Professional Development  Professional Development within the specialty  Working alongside senior colleagues  Consideration of wider issues relating to specialty  Increased knowledge base  Effective interventions  Reflective practice  Use of local guidelines and policies

11.  Specialist knowledge not transferable  Lack of interest from colleagues prevented further study  Lack of research in rheumatology nursing

12. Patient Focussed Care  Patient knowledge  Recognition of cues  Confidence in own decision making  Effective patient relationship  Patient stories to aid reflective practice  Intuition  Futility of chronic illness  Personal reservations about treatments

13. Working in a Specialty  Increased knowledge  Development of an inherent knowledge store  Networking  Creating independent thought  Multi-disciplinary approach  Ward environment

14. Rheumatology Nursing  Rheumatology nursing was “special”  Relationship building over time  Advocacy  Working with patients  Abundance of resources available  Specialist support structure

15.  Lack of awareness of RCN guidelines for practice  Patient cues rather than in depth knowledge of disease process used to inform decisions especially in emergency situations  Some need for standardisation and nursing protocol

16. Conclusions  Wide range of factors influences decision-making  Decision making reliant on professional development and clinical supervision within the specialty  Vast amount of resources available – not always accessed  Specialised experiential knowledge  Need for specialised competency framework

17. Recommendations  Develop link nurse role between CNS and ward staff  Development of care pathways/protocols for specific diseases  Competency framework  Computerised resources – resource room  Further study to establish what sources of information are being used and to what effect

18. Limitations of the study  Aim was to gain an insight into local practice  Only applicable to this group of nurses within an snapshot of time  Unreliable data  Triangulation method may have been more useful  Recommendations transferable to other Rheumatology areas?  Time and workload