“We focus on the important aspects from a patient’s perspective,” says Ms. Ruffing. “It is helpful to talk to fellows about how you put this information into a language that patients are able to understand.”
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Explore This IssueJuly 2020
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Dr. Bingham agrees and notes that is a driving force within the Johns Hopkins fellowship program. “Not all rheumatologists can access or have a nurse in their practice after completion of their training,” he says. “Learning the strategies and the ways nursing approaches a patient can actually be quite important in terms of integrating their own skills into the practice if they don’t have an RN.”
How to find assistive devices and how to properly fill out the forms needed to get payment assistance from pharmacy companies or qualify for disability are just a couple of the topics addressed by nurses in the fellowship program.
Ms. Ruffing and her colleagues teach three lectures a year. She is also available at any time for discussions with the fellows. The fellows are encouraged to observe interactions and patient-teaching discussions.
Fellows Say RNs Improve Their Experience
“The nurses as a resource absolutely improved learning, discussing hands-on topics that aren’t always found in a book or the clinic,” says Dana DiRenzo, MD, MHS, an instructor at Johns Hopkins and a recent fellow. “I had a patient who was on vacation call me because they had frozen their [adalimumab] and did not know what to do. I would never have known how to answer that question without the RN exposure.”
Paperwork is an important aspect of rheumatology practice that RNs can complete, but physicians still need to be exposed to.
“We touch on many day-to-day issues that RNs often do, but physicians are sometimes thrown into,” says Ms. Ruffing, “things like writing appeal letters when your patient is denied a needed medication or completing disability or long-term insurance forms, for example.”
Health Literacy Concerns
“One of the things I hope the fellows are taking away is how to recognize concerns around health literacy,” says Ms. Ruffing. “What I hope to impart is a recognition that the patients often don’t understand what is being said even after being told the same thing many times. It hasn’t been explained to them in terms they can understand.”
She points to the administration of methotrexate. It is given only once a week, which to many patients is counterintuitive—especially when they are to take multiple pills at one time.
“How you talk to a patient about that is going to make a difference,” says Ms. Ruffing. “You ask them what day they think is the best for them to take all six of these pills.” The idea that you’re supposed to take six pills on one day, not one pill a day six times a week needs to be explained clearly, and the patient needs to be able to reiterate that information to ensure understanding.
Nurses model patient education techniques, adding a new understanding of what the person in front of the doctors needs to know about their disease, medications, treatments and changes in regimen. And the fellows learn how best to communicate that information to patients.
The Health Literacy Act requires all materials for patient use be understandable to lay people with a less-than-college education. “Our nurses do a very good job of putting these kinds of communications in terms patients at all education levels understand,” says Dr. Bingham. “They are helpful in instructing our fellows on how to relay information in words the patient can understand more fully.”