Journal of Neuroscience Nursing:
Clinical Practice Guidelines
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Nursing Management of the Patient With Multiple Sclerosis
Amy Perrin Ross, APN MSN CNRN MSCN (cochair); Suzanne Smeltzer, EdD RN MSCN FAAN (cochair); Megan Barrett, DNP ARNP MSCN; Cheryl Blaschuk, RN MSN FNP MSCN; Kathleen Costello, MS ANP-BC MSCN; Constance Easterling, MSN ARNP MSCN; Ann Gutierrez, MSN RN CRRN CBIS; June Halper, MSN APN-C FAAN MSCN; Patricia Kennedy, RN CNP MSCN; Mary Kitten, MSN RN CRRN MSCN; Paule Joseph, MSN FNP-BC RN CRRN BCLNC-C; Elizabeth McAndrews, MSN CRNP; Margie O’Leary, MSN RN MSCN; Brant J. Oliver, FNP-BC PMHNP-BC MSN MPH; Patricia Pagnotta, ARNP MSN CNRN MSCN; Dorothea Cassidy Pfohl, RN BSN MSCN; Yaritza Rosario, APN MSCN; Matthew R. Sorenson, PhD RN; Angela Stone Schmidt, PhD MNSc RNP RN; Alpa Uchil, MPH RN
ABSTRACT: Multiple sclerosis (MS) is a progressive, inflammatory, neurodegenerative demyelinating disease of the central nervous system. Approximately 2.5 million persons are living with a diagnosis of MS, which is the most common nontraumatic cause of neurologic disability in young adults. To promote optimal care of adult patients with this disease, a clinical practice guideline was developed jointly by the American Association of Neuroscience Nurses, the Association of Rehabilitation Nurses, and the International Organization of Multiple Sclerosis Nurses. The purpose of this guideline is to provide recommendations based on current evidence that will help registered nurses, advanced practice nurses, and institutions provide safe and effective care to the patient with a diagnosis of MS across the continuum of care. Included in the guideline are recommendations for nursing management of the MS patient related to assessment and diagnostic testing, medication management, symptom assessment, and management and patient/care-partner education.
In the United States, multiple sclerosis (MS) affects more than 400,000 people, and 12,000 new cases are diagnosed annually. Worldwide, approximately 2.5 million persons are living with the disease, and it is the most common nontraumatic cause of neurologic disability in young adults. Thus, it is an important patient population for the provision of evidence-based nursing care to optimize outcomes. There are four defined clinical types of MS: relapsing-remitting MS, primary-progressive MS, secondary-progressive MS, and progressive-relapsing MS. These types are described by relapses, remission, and chronic progression (increasing disability over time). Relapse can be followed by full or partial recovery. Disease severity varies considerably among people with MS, no matter the type ascribed to them. Nursing care of patients with MS and their families or care partners has evolved from a focus on interventions during periods of crisis to a focus on symptom management, wellness, prevention of disease worsening, and empowerment. The goal of this guideline is to offer evidence-based recommendations on nursing activities that have the potential to maximize outcomes for adults with MS. In the development of the guideline, a computerized search of Medline, Cochrane, and the Cumulative Index to Nursing and Allied Health Literature was performed using multiple sclerosis, symptom, disease management, nursing, and education as keywords. The search was restricted to works in English and adults. The reference lists of identified articles were also searched for additional, relevant references, including books, guidelines, and articles. Background information is provided on epidemiology, classification of MS, immunogenetics and pathogenesis, and natural history. A panel of nursing experts developed recommendations for practice based upon the quality of available supporting evidence. Recommendations for nursing management of the MS patient related to assessment and diagnostic testing, medication management related to disease modifying therapies, management of specific symptoms (e.g., pain, paresthesia, fatigue, etc), and patient/care-partner education are provided. Included in the guideline are resources for clinicians as well as patients and care partners. The complete guideline is available as Supplemental Digital Content, at http://links.lww.com/JNN/A5.