MS Nursing: A Global Success Story

Linda Morgante, RN,MSN,MSCN, CRRNDirector of Clinical ServicesMaimonides MS Care Center

Brooklyn, NY

Multiple Sclerosis results in...

• Physical and functional changes• Emotional and social consequences• Changes in self-image and sexuality• Financial loss and vocational instability• Societal stigma & environmental

challenges• Uncertainty

The World of Multiple Sclerosis

EpisodicCare

SupportiveManagement

Diagnoseand

“adios”

PalliativeMeasures

Symptomatic Intervention

MRIand

“goodbye”

DiseaseModification

ClinicalTrialsAdvanced

Technology

Wellspringof

Hope

Evolution in MS Treatment

A New Vision of Multiple Sclerosis

During the past decade, a greater understanding of multiple sclerosis has emerged

New therapies have modified the disease course and changed the vision of the disease

What has emerged is a philosophy embracing action (early intervention), hope (I can

do something about it), and empowerment

A New Philosophy of MS Care

• Acute, symptomatic, sustained, and rehabilitative care remain the mainstays of care

• A wellness approach incorporates other systems of care (primary services, preventive measures, a focus on education)

• The MS Team may be found in MS Centers, in private practices, and in “Centers without Walls”

The MS Team

• Neurologists, physiatrists, specialists, PMDs

• Nurses, NPs, Medical Assistants, PAs• Rehabilitation Specialists (PT, OT, SLP)• Counselors (social workers, psychologists,

neuropsychologists, voc rehab, clergy)• Patient Advocates/Case Managers• THE PATIENT AND FAMILY/PARTNERS

The MS Nurse

The Multiple Sclerosis Nurse has emerged as a pivotal player in the MS team

S/he frequently is involved in many aspects of care either directly or

indirectly

The Many Hats Worn By MS Nurses

• Care provider• Educator• Facilitator• Counselor• Case manager• Advocate• Researcher

Evolution of MSNursing Care

AcuteCare

AdvancedPractice

PrimaryCare

SpecialistCare

Rehab.Care

InternationalOrganizationof MS Nurses

MS Research

HomeCare

Long-Term Care

MS Center Care

Nursing Care in Multiple Sclerosis Requires...

Creativity

Caring

Empathy

Hope

Lots of Stamina

What is an MS Nurse

• A competent expert who collaborates with those affected by MS and shares knowledge, strength, and hope. He/she empowers people to cope, and inspires a spirit of optimism about living with this lifelong illness.

MS Nursing Philosophy

• Nurses care for people with MS throughout the spectrum of the illness, and respond with expert knowledge, skills, empathy, and hope. Nurses empower people by facilitating treatments, managing symptoms, promoting maximal function, and supporting a wellness-focused quality of life.

Mission of the IOMSN

• The IOMSN was established to ensure that a specialized branch of nursing in MS will continue to grow, and flourish. The organization hopes to establish standards of nursing care in MS, support MS nursing research, educate the health care community about MS, and disseminate this knowledge throughout the world.

Mission of the IOMSN

•The ultimate goal of the IOMSN is to improve the lives of all those persons affected by MS through the provision of appropriate healthcare services.

From the bylaws of the IOMSN

IOMSN

• The International Organization of MS Nurses was founded in 1997 in Calgary, Alberta, Canada.

• The organization welcomes individual and affiliate members.

• To date, there are over 700 members from around the globe.

Benefits of IOMSN membership

• Access to current information regarding best practices in MS nursing

• Education materials for health care professionals and patients

• Internet access for professional information and e-mail correspondence to nurse experts

• Mentorship

Benefits of membership (cont)

• Scholarships which are available for research, educational opportunities, and attendance at conferences

• Opportunities for international networking and joint meetings

• Newsletter• Speaker training

Credentialing

• In 2001, an international board was established to develop and define the domains of MS nursing.

• An exam to credential MS nurses was developed to capture the global commonalties within the field.

MS Nursing Domains

• Clinical Practice• Advocacy• Education • Research

Clinical Practice

• The care and nurturing nurses provide for the physical, emotional, social, and spiritual dimensions of the patient and family

• The tasks that we do every day: injection trainings, infusions, bladder care, bowel care, etc.

Clinical Practice

• Establish a partnership• Perform a comprehensive assessment• Formulate a collaborative treatment plan• Initiate and facilitate a treatment

regimen • Monitor outcomes• Sustain therapeutic alliances

Education

• Increasing patient’s and family’s understanding of MS and how it affects each person

• Informing patients about treatment strategies and the need for self-responsibility

• Providing information about programs, services, and relevant resources

Education (cont)

• Teaching and improving self-care skills (ie: self-injection, nutrition, fatigue and spasticity management)

• Encouraging patients to maintain an active, wellness-oriented lifestyle

• Fostering productivity• Encouraging informed decisions

Advocacy

• Increasing access to services, programs, and entitlements

• Networking with community agencies and legislators

• Facilitating public awareness of the needs in MS

• Assisting patients with complex entitlements

Nursing Research

• Many questions come from clinical practice and require validation. Some of the areas MS nurses have studied include:

• Adherence to injectable therapies: Self-efficacy

• The Lived Experience: Relapsing/remitting MS

• Women’s Issues: osteoporosis

The exam

• There are 150 questions• Designed for a nurse who has worked in

MS for 2 years• The majority of questions are related

to clinical practice• Can get 41 questions wrong, and still

pass

Certification

• There are more than 300 certified MS nurses (MSCN) in world!!

Future Directions of Care in Multiple Sclerosis

• Long-term options (housing, day programs)

• Increased focus on MS in the neurologic community

• Comprehensive care programs• Managed care centers• Improved access to rehabilitation

programs• Networks of care (CMSC, RIMS, IOMSN)

Future Directions For MS Nursing

• Continue global educational efforts (IOMSN)• Implement creative nursing measures to

insure patient’s health and promote healing• Validate what we do through nursing

research• Continue to credential MS nurses• Take care of ourselves, and one another