The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.

AIMS AND OBJECTIVES: To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. METHODS: A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. RESULTS: Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. CONCLUSION: A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. RELEVANCE TO CLINICAL PRACTICE: Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

Utilización del ácido hialurónico solo y en combinación con sulfadiazina argéntica en un caso de colagenosis perforante reactiva / Use of hyaluronic acid alone and combined with argentic sulphadiazine in reactive perforating collagenosis. A case report

La dermatosis conocida como colagenosis perforante reactiva (CPR) es una lesión que se caracteriza por la eliminación transepidérmica del colágeno. Existen dos formas de presentación: la heredada y la adquirida. La forma adquirida se presenta en la edad adulta, principalmente en diabéticos con insuficiencia renal crónica. El ácido hialurónico es un glucosaminoglucano de alto peso molecular que se sintetiza en el sistema vacuolar de los fibroblastos y otras células, como son los queratinocitos, con ayuda de los factores de crecimiento y en otras citocinas. La sulfadiazina argéntica es un fármaco tópico de acción antiinfecciosa que se utiliza para prevenir y tratar las infecciones en heridas y quemaduras de grado II y III. Su acción se realiza sobre bacterias y hongos (AU)

The dermatosis known since reactive perforating collagenosis (RPC) is an injury that is characterized by the transepidermal elimination of the collagen. Two forms of presentation exist: the inherited one and the acquired one. The acquired form appears in the adult age, principally in diabetics with renal chronic insufficiency. The hyaluronic acid is a glycosaminoglycan of high place molecular weight that is synthesized in the system vacuolar of the fibroblasts and other cells, since they are the keratinocytes, with help of the factors of growth and in other cytokines. The argentic sulphadiazine is a hackneyed medicament of antiinfectious action that is in use for anticipating and treating the infections in wounds and burns of degree the II and IIIrd. His action realizes it on bacteria and fungi (AU)

Developing a nurse-led integrated 'red legs' service.

This project was developed to set up a nurse-led service based on the needs of patients diagnosed with 'red legs'. These patients are often wrongly admitted into hospital for treatment of cellulitis. Representatives from the specialties involved in caring for those individuals with red legs were invited to participate with patients to create a stakeholder group whose purpose was to develop integrated care pathways focused on referral criteria, diagnostics and treatment to inform a new nurse-led service. There was a commitment to utilising a number of facilitation techniques and practice-development methods in the progression of the project with the support of the Foundation of Nursing Studies. Much of the prescribed care can be carried out by the patients at home and only 25% patients have required a follow-up appointment within the new service. The service has now been fully commissioned and a secondment opportunity has been developed to lead the new service. Significant savings have been demonstrated and regular revision of the integrated care pathways with all groups, including the patients, will take place.

Using a soft-silicone dressing to treat moist desquamation.

Skin reactions are a common side effect of radiotherapy. Radiotherapy damages basal cells and skin reactions occur when the basal layer is unable to produce enough new cells to compensate for the loss of damaged cells at the skin's surface. Skin reactions progress from erythema, through dry desquamation to moist desquamation. As yet, there are no nationally recognised guidelines for the management of radiotherapy-induced skin reactions. As a result, there is widespread variation in practice throughout the UK. Hydrocolloid and hydrogel dressings have been used to treat moist desquamation. However, this article describes the successful clinical experience with an alternative dressing, Mepilex Lite®. The clinical evidence presented also raises the question of whether Mepilex Lite can be used prophylactically as an alternative to aqueous cream on grade 1 (erythema) reactions. Further evidence on this indication for Mepilex Lite will be published in a BJN supplement in November 2014.

[Nursing care management in dermatological patient on phototherapy narrow band UVB]. / Gestión y cuidados de enfermería al paciente dermatológico en tratamiento con fototerapia con rayos ultravioleta B de banda estrecha.

Phototherapy with narrow band ultraviolet B is a treatment used in some dermatology units, and is the first choice in some dermatological diseases due to being comfortable and cheap. The aim of this paper is to describe the management and nursing care by grouping more specific diagnoses, following NANDA-NIC/NOC taxonomy, such as the methodology from application, technique, material, and personnel to space-related aspects, with the aim of avoiding the clinical variability and the possible associated risks for the patients, and for the nurses who administer the treatment. The continuity of the same nurse in the follow-up sessions stimulates the relationship between medical personnel and patients, key points for loyalty and therapeutic adherence. This paper examines a consensus procedure with the Dermatology Unit Team and accredited by the Hospital Quality Unit.

Gestión y cuidados de enfermería al paciente dermatológico en tratamiento con fototerapia con rayos ultravioleta B de banda estrecha / Nursing care management in dermatological patient on phototherapy narrow band UVB

La fototerapia con rayos ultravioleta B de banda estrecha es un tratamiento utilizado en algunos servicios de dermatología, siendo de primera elección para algunas dermatosis porque resulta cómodo y económico. El objetivo de este artículo es describir la gestión y cuidados de enfermería agrupando aquellos diagnósticos más específicos según taxonomía NANDA-NIC/NOC, la metodología desde la aplicación, técnica, utillaje y los aspectos relativos al espacio, material, personal, con el fin de evitar la variabilidad clínica y los posibles riesgos tanto para pacientes como para la enfermería que los administra; la continuidad en las sesiones por la misma enfermera favorece la relación de ayuda, clave para la fidelización y la adherencia terapéutica. Este artículo sintetiza un procedimiento consensuado con el equipo del Servicio de Dermatología de la unidad y acreditado por la Unidad de Calidad del Hospital (AU)

Phototherapy with narrow band ultraviolet B is a treatment used in some dermatology units, and is the first choice in some dermatological diseases due to being comfortable and cheap. The aim of this paper is to describe the management and nursing care by grouping more specific diagnoses, following NANDA-NIC/NOC taxonomy, such as the methodology from application, technique, material, and personnel to space-related aspects, with the aim of avoiding the clinical variability and the possible associated risks for the patients, and for the nurses who administer the treatment. The continuity of the same nurse in the follow-up sessions stimulates the relationship between medical personnel and patients, key points for loyalty and therapeutic adherence. This paper examines a consensus procedure with the Dermatology Unit Team and accredited by the Hospital Quality Unit (AU)

Diagnosis, treatment and management of pruritus.

Pruritus is a ubiquitous symptom with a wide range of presentations, often causing considerable distress for many individuals and resulting in reduced quality of life. In recent years there has been renewed interest and increased research activity in this previously neglected field. Although there is still much to be learnt about the mechanisms of pruritus, appropriate nursing interventions can be pivotal to the success of treatment. This article focuses primarily on the diagnosis, treatment and management of pruritus resulting from common dermatological causes. Key aspects of effective management of pruritus include individualized management and holistic assessment. The words 'pruritus' and 'itch' are used synonymously in this article.

[Skin care and skin protection in preterm babies]. / Hautpflege und Hautschutz beim unreifen Frühgeborenen. Eine systematische Literaturübersicht.

UNLABELLED: The skin of preterm infants is anatomically and physiologically premature. This quality of the skin as well as the need for intensive monitoring and treatment/care represent additional stress factors for the integrity of the babies' skin. The babies have an increased vulnerability and risk of skin injuries. Therefore, during the first two to three weeks of life observation of the premature skin is of utmost importance. Ritualistic activities have to be questioned. This is particularly true for infants who are born before 28 weeks of pregnancy. This systematic literature review investigates the effectiveness of nursing interventions in the skin care and protection of the premature infants born earlier than the 32nd week of pregnancy. A systematic literature-search in different databases addressed the following topics: Skin-assessment, selection and use of adhesives, skin care with emollients, and body cleaning (wash interval). Despite certain methodological problems with some of the studies included in this review the following results can be formulated: Based on altered infant behaviour and the skin's continuously high population of germs the interval of bathing should be enhanced to four days. During the first two to four weeks of life the application of sun flower oil is recommended. It has a disinfecting effect and is relatively cheap. Potential preventive or protective dressings of the skin are recommended. Similarly both the utilisation of a valid skin assessment instrument and of preventive measures are inevitable. CONCLUSION: Evidence-based knowledge of the needs and care of premature skin could reduce complications during the neonatal phase and therefore health care costs. The implementation of a standardised, evidence-based skin care guideline could raise the health professionals' awareness in of skin care needs in this vulnerable patient group.

Nurse prescriber-patient consultations: a case study in dermatology.

AIM: This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. BACKGROUND: Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. METHOD: A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. FINDINGS: Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. CONCLUSION: Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas.

Skin problems in people with obesity.

AIM: To establish the level and type of skin problems in people with obesity and the extent to which they sought advice on their problem. METHOD: A self-report survey was carried out in a specialist nutrition clinic in Scotland during 2001. A convenience sample of 100 patients was selected. RESULTS: A majority (n = 75, 75 per cent) of respondents had some type of skin problem. The main problems identified were itchiness and dry skin. The sites for skin problems varied although groin, limbs and beneath the breasts were the most prevalent areas. The two main causes of perceived skin problems were perspiration and friction. Forty four (59 per cent) had seen a doctor about their skin problem, but few (n = 12, 16 per cent) had consulted other healthcare professionals and some (25 per cent) had not sought any advice. CONCLUSION: There is a considerable level of skin problems in this patient group, which has not previously been reported or identified as a significant potential co-morbidity. Therefore, nurses and other healthcare professionals should incorporate some form of skin assessment into any assessment of patients with obesity. Further research is needed to determine the specificity and degree of skin problems in those who are diagnosed as obese and the impact it has on their life and their weight management.

The value of in-patient dermatology: a survey of in-patients in Scotland and Northern England.

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.

Self-care activating support: therapeutic touch and chronic skin disease.

As the body's largest organ, the skin functions as the most important human communication organ, possessing communicative aspects of caring and healing of self and others. The program "Self-Care Activating Support" for psoriasis and other chronic skin disease is presented as an instrument for promoting health by dermatology nurses.