Nursing Challenges in the Care of People with Multiple Sclerosis: Results from an International Needs Assessment

Background: Given the unpredictable and debilitating nature of multiple sclerosis (MS), providers caring for people with MS are faced with several challenges related to treatment, monitoring, and management of the disease. Nurses play a pivotal role in the care of people with MS; however, few studies have investigated nurses' perceived needs in clinical practice. An international needs assessment was conducted in six countries to obtain a better understanding of the perceived knowledge, skill, and confidence gaps of providers involved in the care of people with MS, including nurses, neurologists, radiologists, and pharmacists.

Objectives: To highlight the specific challenges for nurses in relation to their role in the treatment, monitoring, and management of people with MS.

Methods: A mixed-methods framework was utilized combining qualitative (semi-structured interviews) and quantitative (online surveys) data. Qualitative data were analyzed using thematic coding analysis and quantitative data were analyzed using frequencies, and analyses of variance/Tahmane’s T2 post-hoc tests were used to identify differences by country. Qualitative and quantitative findings were triangulated to strengthen the trustworthiness of the findings.

Results: The total sample included 146 actively practicing nurses from Germany (n=22), Spain (n=22), France (n=24), United Kingdom (n=22), Italy (n=22), and United States (n=34). The majority of nurses had a caseload of greater than 150 MS patients/year (42%). Seven practice gaps were identified, including: monitoring patient status and response to treatment, managing issues related to quality of life, and patient-provider communication. Nurses reported that their knowledge of new therapies (65%) and emerging monitoring methods (61%) as 'could be improved/not acceptable'. Nurses also reported that their skill in detecting treatment side effects could be improved (51%). The majority of nurses (62%) reported lack of skill in engaging patients in shared decision-making. Furthermore, nurses reported lack of confidence in discussions with their patients, with significant differences between countries. 

Conclusions: The challenges identified in this study were common to all countries, with some nuances. These findings could be used to inform educational interventions for nurses, targeting not only knowledge change, but also skills to effectively and confidently manage and communicate with their patients and improve clinical efficiency.