Search

In 2002 the authors were successful in bidding for an Innovations in Healthcare Travel Award donated through the British Journal of Nursing, in association with J&J Medical. With this grant they were able to travel to the USA and study health care in Boston Massachusetts. The trip was not without problems, both in arranging and subsequently visiting the area. However, both authors have learnt from the experience and have returned with lessons that can be implemented in their healthcare setting. The following is a personal account of that trip and the lessons learnt.

Background: Skin conditions can result in many complex emotional and social problems. Psychological factors have long been associated with the onset, maintenance and exacerbation of many cutaneous disorders., Conclusion: This article is based on experience gained from contact with patients while on clinical placement at a specialist dermatology unit. It aims to assist nurses to understand the diverse ways in which stressors, coping strategies, acceptance, adaptation and compliance affect skin conditions. It will stimulate the reader to think about the psychological effect of skin conditions on everyday life and explore the advantages of specialised dermatology care in addressing the emotional problems of patients with such conditions.

The principles of dermatologic examination focus on visual recognition, diagnosis, and treating the presenting skin problem. Psychologic dysfunction may not be immediately obvious.

Given the central role that topical medications play in treating skin disease, nurses must understand the delivery systems of topical preparations to make the most informed decisions for their patients and provide adequate patient education to ensure the best clinical outcomes.

Cutaneous manifestations occurring in patients with end stage renal disease (ESRD) can indicate systemic problems that have significant morbidity and mortality risks. Skin changes are sometimes a consequence of the disease that caused the renal failure or may be an ESRD manifestation. Pruritus is the most prevalent ESRD cutaneous complaint, but its pathogenesis is not understood. The pathophysiology, presentation, and nursing implications of perforating dermatosis, metastatic calcification, polytetraflouroethylene graft infection, and lichen planus are discussed with corresponding case reports.

I am sure many other nurses working in this field have similar experiences and feel their achievements are not always recognized and valued. To go home at the end of a working day knowing that you have provided good-quality individualized care to all your patients is extremely satisfying, and I am sure is not always achievable on many general wards. Is it not time that dermatology was given some acknowledgement?

The research question was whether there exists a relationship between quality of nursing diagnoses in nursing documentations and patient's satisfaction with nursing diagnoses. The hypotheses stated that a positive relationship between nursing diagnosis and patient satisfaction exists; high quality of nursing diagnoses in the nursing documentation goes along with high patient satisfaction with nursing diagnoses. The sample consisted of 57 patients, their nursing documentations and nurses of three dermatological units of a university hospital in Switzerland. Nursing diagnosis was analysed from two points of view: the professional nursing focus and patients' focus. For this purpose, two measurement instruments have been developed. Three subconcepts of quality of nursing diagnoses and patient satisfaction were derived: interaction/personal dimension, patient participation and knowledge of nurses. Content validity of both instruments was established and the reliability coefficents of both instruments were rather high (.91 and .95). To test assessment objectivity, twelve raters analysed three nursing documentations. The tree Kappas were significant at a 5% level. The hypothesis was analysed by a correlational design. The main findings showed a significant relationship between quality of nursing diagnoses in documentations and patient satisfaction (tau = .18, p < or = .03). The evaluation of nursing diagnoses indicated effective communication between nurses and patients and that nurses assessed patients' situations appropriately. Patients satisfaction with nursing diagnoses was rather high. One of three subscales in both instruments yielded a significant correlation. The statistically significant, but low relationship suggests the need for further study.

Obesity is one of the nation's most serious health problems. When individuals are overweight, they are at risk for disease, medical complications, and death. Patients are considered morbidly obese or bariatric when their weight far exceeds recommended guidelines. Excess weight in these individuals increases morbidity and mortality, and causes numerous care challenges. Nurses caring for bariatric clients should recognize the need to use specialized assessment and management strategies to prevent poor patient outcomes.

Adaptation to life with a stoma depends to a large extent on the health of the peristomal skin. This area of skin can become damaged in various ways, and the resulting discomfort or pain can make the use of a stoma appliance difficult. Problems such as these can be one of the major factors facing a community nurse in her/his care of the stoma patient. If the community nurse is able to recognize and correct these problems, this will enable the patient to carry on with a normal and productive life. Failure to correct stoma-related problems can have significant negative effects on patients' psychosocial well-being. This article discusses the causes and management of the commonest stoma-related skin problems.

Ensuring that handicapped persons are not denied goods and services, including health care, because of their disability is the essence of The Americans With Disabilities Act. Nurses can help assure that patients with hearing impairments receive proper, quality care in their dermatology practices.

Community nurses are ideally place to fully utilize nurse prescribing to improve the accessibility to emollient therapy for any patient with dry skin, regardless of cause. Skin diseases affect 23% of the general population and patients accessing care in the primary setting contribute to 15-20% of general practice appointments.

Background: There is a lack of good data about patient satisfaction with teledermatology and about its potential interaction with quality-of-life factors., Objectives: To assess the association between perceived skin-related quality of life and patient satisfaction with a nurse-led teledermatology service., Methods: In a mobile nurse-led teledermatology clinic located in four inner city general practices in Manchester, the teledermatology service used digital cameras to capture and store images of skin conditions for remote diagnosis by dermatologists. One hundred and twenty-three adult patients, non-urgent dermatology referrals from primary care, completed the Dermatology Life Quality Index (DLQI) and a 15-item patient satisfaction questionnaire., Results: In common with other studies of patient satisfaction, subjects reported highly favourable views of 'hotel' aspects of the service (93%) and found it 'convenient' (86%). However, 40% of patients would have preferred to have had a conventional face-to-face consultation with a dermatologist, and 17% felt unable to speak freely about their condition. Patient satisfaction with the service was related to quality of life. Patients reporting lower quality of life as measured by the DLQI were more likely to prefer a face-to-face encounter with a dermatologist (r = 0.216, P < 0.05), and to evince anxiety about being photographed (r = 0.223, P < 0.05)., Conclusions: Patient acceptance and satisfaction with telemedicine services is complicated by patients' subjective health status. Telehealthcare providers need to recognize that patients with poor quality of life may want and benefit from face-to-face interaction with expert clinicians.

Skin diseases affect 20-30% of the population at any one time, seriously interfering with activities in 10%. Skin conditions are, by their vary nature, visible. As a result, those with a skin condition receive the same reaction from society as anyone who looks 'different'. They can be subjected to stares, whispered comments, antagonism, insult or exclusion from normal social activity. Those with a skin condition have the needs of all other patients, but in addition, the impact upon their lives of a skin condition, its treatment and the ways in which others perceive them, makes their situation unique. Many nurses however will have little or no experience of patients with skin conditions. They need therefore to be aware of the wide-ranging effects skin disease can have on the individual and their family. It is important that nurses understand the basic principles of skin disease and care, but are also aware of their limitations, seeking further advice as necessary. This article will guide the nurse in assessing patients with a skin condition.

The Minimum Data Set is designed to be the assessment instrument used in all long-term-care facilities receiving federal funds for Medicare and Medicaid. However, Section M: Skin Condition is one of the most challenging sections to complete when trying to match the Minimum Data Set documentation with the true clinical picture. If wounds are not adequately assessed and documented, outcomes of care cannot be evaluated, and treatment and prevention plans will be inadequate. This may result in less than optimal outcomes and possible lawsuits for inadequate care against both the caregiver and facility. The purpose of this article is to provide examples of medical record documentation necessary to support the Minimum Data Set assessment.

For the nursing profession, the practice of minor surgery means the recovery of an activity which possesses a long historical tradition in our profession and an experience for nurses to provide a specific service in health care. The incorporation of minor surgery as one of the services offered by Primary Outpatient Clinic Care is taking place slowly but surely, especially in light of the advantages it provides. For several years now, some health professionals, nurses and doctors belonging to the Andalucian Health Services, have been actively working on the development and implementation of Minor Surgery Programs inside the Health Clinics of our community. One of our lines of work has been the development of protocols for the treatment of the most habitual lesions by means of minor surgery. Among these are cutaneous cysts whose protocol we present in this article.

Paraneoplastic syndromes are caused by hormones or other substances produced by cancer cells and may be the first sign of cancer. A wide range of paraneoplastic syndromes, including endocrine, neurologic, and cutaneous disorders, occurs in patients with cancer. More than 30 cutaneous paraneoplastic syndromes have been identified; this article reviews some of the more common syndromes--acanthosis nigricans, Paget's Disease, acquired ichthyosis, telangiectasia, hypertrichosis lanuginosa acquisita, erythroderma, Bazex's Syndrome, and necrotizing migratory erythema. When these syndromes are diagnosed during the course of a malignancy, professional caregivers may misinterpret them as indicative of metastatic disease or other disorders and patients may be misdiagnosed and not receive optimal treatment. Paraneoplastic syndromes also compromise quality of life by often causing skin impairment and discomfort. Therefore, nurses must be aware of the signs and symptoms of these cutaneous disorders and know how to care for patients with paraneoplastic syndromes.

Skin disease is highly prevalent, particularly in the developing world. This can result in skin failure which in turn may have a major social and economic impact on individuals and communities (Finlay & Ryan 1996). The significant lack of dermatologists worldwide, most of whom are based in hospitals, means that expertise in skin care cannot always be delivered to those who need it. This paper advances the argument that a care delivery model is needed which provides skin care focused at a primary care level throughout the nursing service, drawing on specialists who are often based in the secondary health care facilities. This can only be achieved through adopting a strategic approach which identifies the training needs of such professionals, harnesses the appropriate expertise, shares good practice, and operates in close conjunction with dermatologists. This paper outlines how this vision can be put into operation, by outlining the strategic international development work being undertaken by nurses and the efforts to promote inter-professional collaboration.

Appearance is one of the most powerful factors influencing social interactions with others. What patients with disfigurements experience from society on a daily basis is a very real stigma. Cosmetic rehabilitation is a system of cosmetic techniques devised for patients to use to assist themselves to cope constructively with the psychological and physical trauma of their disfigurements.

The skin serves many purposes, acting as a barrier to infection, protecting internal organs, contributing to temperature regulation, storing insulating fats, excreting electrolytes and water, and providing tactile sensory input. This article focuses on a review of normal skin structure and function and selected neonatal skin disorders. The disorders reviewed are Staphylococcal scalded skin syndrome, epidermolysis bullosa, and the ichthyoses. The basis for each skin disorder is presented. Nursing management and skin care are incorporated into the review of each selected disorder.

Awareness of pregnancy-related skin changes can facilitate improved care of women during pregnancy by identifying those skin changes that require further evaluation. Women experience significant endocrine and metabolic changes during pregnancy that can cause both physiologic and pathologic alterations in the skin, nails, and hair. This review discusses the physiologic changes and pruritic dermatoses that are specifically associated with pregnancy. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided.

A study carried out in an NHS trust showed that its dermatology nurses could safely undertake nurse prescribing. To be effective a formal system of nurse prescribing is required. This involves the compilation of a formulary for the nurse prescribers and the development of relevant treatment protocols. The introduction of nurse prescribing in a day-care unit led to improvements in the dermatology services available to the local population.

Dermatologists, who have assets far in excess of most of the people of the world, have the opportunity to contribute globally to the forces of social progress. This article addresses the dermatologic needs of the developing world and discusses how the needs of these areas, including rural areas in the United States, should be addressed.

The skin care of disabled elders living in nursing homes and adult congregate, subacute, and home health settings requires special effort and consideration. Practitioners who regularly assist elders in these situations may be unfamiliar with dermatology problems related to chronic disability. As the U.S. population ages, skin care in the elderly and disabled will continue to be a challenge. However, if the diseases and problems can be addressed in a knowledgeable and problem-oriented manner, treatment can be maximized.

Many cutaneous diseases which afflict Caucasians also occur in Blacks. However, some of these diseases may occur more commonly in African-Americans or present in an "atypical" or different manner. It is important to be aware of these variations in presentation to properly diagnose and manage these diseases. There is also a subset of skin diseases which are unique to Black patients about which the clinician should be knowledgeable. Finally, because so many skin diseases can affect the pigmentary system, causing hypopigmentation or hyperpigmentation, the social and psychological impact of cutaneous disease at times may be more devastating in African-Americans.

People with chronic wounds or skin conditions often face not only physiological challenges, but also emotional ones as well. Measuring these emotional challenges and more broadly, the emotional challenges of having a skin defect, was the focus of this instrument development study.

In a questionnaire to community nurses treating dermatological patients, 14 out of 69 (20%) either treated children or gave advice to parents regarding childhood eczema, 35 (51%) treated adult eczema, 11 (16%) treated psoriasis, 55 (80%) treated leg ulcers, and 30 (43%) treated other dermatological problems. Specific questions regarding confidence to treat or educate were analysed in relation to the tasks being performed. All but 15% (8/55) treating leg ulcers were confident about their ability to apply four-layer bandaging. However, 8 out of 11 (72%) respondents treating psoriasis were not confident about their ability to treat scalp scaling, 11 out of 14 (79%) of those treating childhood eczema were not confident about applying body suiting, and 26 out of 36 (72%) of those treating eczema (any age), were not confident about ability to recognize infection as a cause or complication of dermatoses. The favoured educational modalities were visits to the local dermatology department (60/69, 87%), availability of a dermatology Nurse Practitioner or Liaison Nurse, or access to a hospital nurse-run dermatology clinic (both 44/69, 63%), or attendance at courses (36/69, 52%). Community nurses have an important role in treating and educating patients who may not require or be able to attend hospitals for treatment; they will achieve this best by provision of relevant locally based education, with allocation of adequate study time.