Nursing Care in Dermatologic Oncology: a Qualitative Study.

Nurses in hospital dermatology departments must increasingly provide care for patients with skin cancer. Although the experience of oncology nurses in numerous specialties has been widely explored, no study has focused on the experience of nurses in dermatologic oncology. We aimed to explore how nurses experience their care for patients with skin cancer. This is an inductive, exploratory study employing semi-structured interviews and focus groups with nurses, followed by thematic analysis. The study included purposive sample of 14 nurses practicing in different sectors of this dermatology department. Data were collected via two focus groups of six nurses each and 14 individual, semi-structured interviews, both using a researcher-developed interview guide. Interviews were transcribed and analyzed with thematic analysis. The most illustrative quotes were translated into English. Nurses' experiences of providing care in dermatologic oncology are organized around two themes: (1) their practices for these patients and (2) their management of emotional distress as the major issue in care, especially at night. Our results show the predominant place of relationships with patients in nurses' practices and of their emotional distress due to their closeness to the patients. Specific and original aspects have also been demonstrated with practical implications to be drawn for nurses' supportive care role: the distress engendered by the specific and harrowing experience of nurses dealing with skin cancer, which can be both seen and smelled.

Compassionate leadership in district nursing: a case study of a complex wound.

This article encourages nurses to explore leadership in district nursing practice and community teams. The challenges faced by district nurses are discussed in relation to the current health policy agenda in Wales and the increasingly complex care demands being placed on district nursing services because of the aging population and the rise in numbers of individuals living longer with multiple long-term health conditions. The concept of compassionate leadership is presented and discussed using a case study approach. The article explores compassionate leadership in the context of caring for a patient with a complex malignant wound needing palliative care. A framework for practice is developed to illustrate compassionate leadership in action to meet the needs of both the team and of the nurses delivering person-centred care.

Understanding a sentinel lymph node biopsy service for patients with malignant melanoma.

Malignant melanoma cases represented the seventh most common cancer type in Northern Ireland between 2011 and 2015, and the incidence of melanoma cases is expected to rise. Sentinel lymph node biopsy (SLNB) is commonly offered to patients in the UK with malignant melanoma to help in staging their disease, but a commissioned SLNB service is not available in Northern Ireland. This article describes a Florence Nightingale Foundation Travel Scholarship to gain knowledge and experience with the aim of developing and implementing an effective and efficient SLNB service for patients with malignant melanoma in Northern Ireland. A 3-week visit was made to an eminent centre of excellence in skin oncology in the UK.

Professional caregivers' knowledge in dermatology : Improving knowledge and communication to dermatologists in geriatric facilities.

BACKGROUND: Research regarding effective collaboration and communication between professional caregivers and dermatologists and the need for further education and training for caregivers in the field of geriatric dermatology still remains relatively scarce. OBJECTIVE: To document the state of knowledge of professional caregivers in the field of geriatric dermatology and make recommendations for dermatological education and postgraduate training. METHODS: A questionnaire with open and closed questions was used to evaluate the level of knowledge and current need for information in geriatric dermatology. A total of 58 professional caregivers from several hospital departments, including geriatric wards and nursing homes participated in this study. Quantitative and qualitative data were generated and responses to open questions were categorized according to the most quoted contents. The study was approved by the Charité University in Berlin ethics committee. RESULTS: The study demonstrates that there is a lack of dermatological knowledge. Participants indicated a huge information need regarding skin tumors (77.2 %), prevention of skin diseases (50.0 %) and pruritus (41.4 %). According to the caregivers, communication problems with physicians arise in view of using standardized terms of skin diseases (22.9 %) and formulating unclear care records of skin diseases (20.8 %). CONCLUSION: Difficulties in communication between professional caregivers and physicians can influence patients' punctual and well-founded treatment; therefore, further education must be mediated vividly and practically. Moreover, training should focus on learning standardized terms and descriptions for optimizing the flow of information with physicians and written communication, such as care records.

Teaching Nursing Students about Skin Cancer Using a Skin Analyzer Machine.

Nurses are in an excellent position to perform skin assessments and teach the public about skin cancer prevention. Knowledgeable nurses can help reduce the incidence of skin cancer. Determining the best method to teach nursing students about skin cancer is thus important.

Diagnosis, treatment and management of epidermolysis bullosa.

Epidermis bullosa is a genetically inherited disease in which painful blistering of the skin or mucous membranes occurs after minor trauma. It is a lifelong problem. The diagnosis should be confirmed by a specialist, preferably at a specialist unit where a treatment plan and follow-up arrangements for professionals and families can be put in place. Nurses will be involved in frequent dressings of wounds, after extra analgesia, and may need to be alert to any need for further specialist referral, especially in the case of complications such as infection, deformities, gastrointestinal strictures and possible skin cancers. Genetic counselling should also be offered to families, especially when considering the possible risks to future pregnancies.

[The nurses involved in therapeutic innovation]. / Infirmière de recherche clinique en onco-dermatologie.

Clinical research nurses (CRNs) play an important role within the teams involved in the fight against cancer and in therapeutic innovation. In the dermatology department of the Gustave-Roussy Institute, patients treated for melanoma and taking part in clinical trials are supported along their care pathway by a CRN who, in addition to her clinical expertise, acts as a link between the different players concerned.

[Global management of melanoma in the palliative phase]. / Le mélanome en phase palliative, une prise en charge globale.

The priority of the care management of people with melanoma in the palliative stage is to treat symptoms causing discomfort and to provide psychological support. The commitment of caregivers is important, both on the professional as well as human level. A team in Lyon shares its practices.

[Using Shared Decision-Making on a Patient With Renal Cell Carcinoma and Subcutaneous Metastasis: A Care Experience].

When a patient aggressively receives treatment and looks forward to returning home, the prolonging of meaningful life is difficult, even with medical treatment. It is typically very challenging at this juncture for the members of the medical team to fully disclose to the patient the true extent of his / her condition and to recommend the withdrawal of life-support medical treatment. This article describes a nursing care experience with a renal cell carcinoma patient with subcutaneous metastasis. Her pain was induced by an edema and subcutaneous tumor in her lower limbs, which diminished the effectiveness of hemodialysis. During hospitalization, the mood of the patient shifted from looking forward to recovery to facing a rapidly worsening health status. Achieving a balance between fighting the disease and sustaining patient quality of life became increasingly difficult, and the patient began experiencing anxiety about dying. We use the belief of shared decision-making to guide the case in a discussion of her expectations during which primary medical care options and her choice to withdraw from hemodial-ysis treatment were explained. Essential oils, selected for appropriateness with her current disease stage, were used to stabilize her mood and relieve pain. In the end, we helped the patient to complete her pre-death preparations and to say goodbye to her children, parents, and siblings. As a result, the patient experienced a good death.

Comfort vs risk: a grounded theory about female adolescent behaviour in the sun.

AIMS AND OBJECTIVES: To generate a grounded theory about female adolescent behaviour in the sun. BACKGROUND: Nurses have key roles in health promotion and skin cancer prevention. Adolescents' resistance to sun safety messages and their vulnerability to sunburn are of concern internationally. Understanding why young women do as they do in the sun may enhance skin cancer prevention, but their behaviour has not been explained before in the UK. DESIGN: The study incorporated a qualitative grounded theory design using the approach of Glaser. METHODS: Qualitative data were gleaned from group and one-to-one, semi-structured interviews with 20 female participants aged 14-17, research memos and literature. Sampling was purposive and theoretical. Data collection, analysis and theory generation occurred concurrently. Data were analysed using the constant comparative method. Data collection ended when a substantive theory had been generated. RESULTS: Data analysis revealed five categories of findings: fitting in, being myself, being physically comfortable, slipping up and being comfortable (the core category). The theory generated around the core explains how young women direct their sun-related activities towards meeting their physical and psychosocial comfort needs. CONCLUSIONS: A contribution of this research is the grounded theory explaining the behaviour of young women in the sun. Further, the theory challenges assumptions that female adolescents necessarily take risks; it explains their sun-related activities in terms of comfort. The theory extends findings from other researchers' descriptive qualitative studies and also appears to apply to young people in countries other than the UK. RELEVANCE TO CLINICAL PRACTICE: Understanding the sun-related activity of young women in terms of physical and psychosocial comfort may help nurses to develop new approaches to skin cancer prevention. These could complement existing messages and humanise health promotion.

[Screening for melanoma, an advanced practice nurse consultation]. / Dépistage du mélanome, pratique collaborative d'une infirmière experte.

In the dermatology consultation, at Cochin hospital, Paris, a nurse cooperates with a dermatologist in order to insure the clinical follow-up for high-risk melanoma patients. To adopt this innovative public health approach, the nurse has received theoretical, clinical and educational knowledge.

Side effects in melanoma patients receiving adjuvant interferon alfa-2b therapy: a nurse's perspective.

PURPOSE: The aim of this review was to examine the toxicity profile of adjuvant interferon (IFN) alfa-2b in melanoma patients from a nursing perspective and to summarize practical information to guide the effective management of common IFN toxicities to improve patient comfort. METHODS: This is a narrative summary of both research and review articles identified by searching PubMed, National Cancer Institute, and American Cancer Society websites. It also assesses recognized guidelines on the management of adjuvant IFN toxicity relevant to nurses who are caring for patients receiving adjuvant IFN therapy. RESULTS: Adjuvant high-dose IFN alfa-2b (HDI) as compared with observation significantly prolongs relapse-free survival in patients with melanoma at high risk for recurrence after surgical resection; however, treatment compliance and patient quality of life can be compromised by its toxicity profile. HDI toxicities affect a number of organ systems and the majority of patients will experience some side effects. Common toxicities such as flu-like symptoms, fatigue, anorexia, neuropsychiatric symptoms, and laboratory abnormalities are discussed, along with both pharmacological and nonpharmacological management strategies. CONCLUSIONS: The considerable side effects of HDI can be managed using established strategies. Oncology nurses play a significant role in the management of patients with melanoma receiving adjuvant HDI, and their prompt recognition of side effects, together with an understanding of effective pharmacological and nonpharmacological interventions, will improve patient comfort; this has the potential to positively influence treatment adherence and completion of the recommended treatment course.

Skin cancer: causes and groups at risk.

This second in a two-part series focuses on the causes and risk factors of skin cancer, highlighting risk factors among the general population as well as in high-risk groups. Part 1, published last week, outlined the main types of skin cancer and the treatment options available for each type; this article stresses the importance of early identification and patient education to prevent skin cancer.

Malignant melanoma.

"Melanoma has become a major public health problem worldwide and its incidence in individuals of European origin continues to rise. Melanoma is the third most common cancer in Australia (in men and women); the fifth in the United States (in men and women); and the 12th in men and the sixth in women in the United Kingdom" (J. G. Thompson, R. A. Scolyer, & R. F. Kefford, 2009, p. 362). The American Cancer Society estimated that about 68,720 new melanomas were diagnosed in the United States during 2009, resulting in about 8,650 deaths. The purpose of this article is to explain the pathophysiologic components of malignant melanoma.

Unit cost of Mohs and Dermasurgery Unit.

BACKGROUND: Appropriate pricing for medical services of not-for-profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. OBJECTIVE: The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas-MD Anderson Cancer Center, Houston, TX from the healthcare provider's perspective. METHODS: MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients' statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. RESULTS: The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow-up visit, consultation, Mohs and non-Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. CONCLUSIONS: Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU.

Dermatology and the community nurse: actinic (solar) keratosis.

Community nurses are in daily contact with patients and, in the course of their day's work, have every opportunity of recognizing those patients who are more vulnerable to the sun's rays, and noticing actual sun damage and actinic keratoses. They are then able to check other sun-exposed areas such as the face, ears, scalp, back and limbs to discover any other lesions or more serious problems of basal cell carcinoma, squamous cell carcinoma or malignant melanoma the would require referral, sometimes urgently, to a dermatologist for full assessment and treatment. In any case, sound advice about further protection from the sun, both for themselves and their families may help to reduce the likelihood of further problems.