Intensive care unit nurses' perceptions of debriefing after critical incidents: A qualitative descriptive study.

BACKGROUND: Intensive care unit (ICU) nurses are exposed to critical incidents daily at their workplace, which may have long-term physical and psychological impacts. Despite the growing evidence supporting clinical debriefing in health care to prevent these impacts, a scarcity of literature exists to support its use in the adult intensive care setting. OBJECTIVES: The objective of this study was to explore nurses' perceptions of clinical debriefing after critical incidents in an adult ICU. METHODS: A qualitative descriptive design was utilised. Thematic analysis of data from individual semistructured interviews with six ICU nurses was undertaken. FINDINGS: In this study, two themes were identified. Firstly, participants valued hot debriefing after critical incidents for the key reasons of having an opportunity to reflect on and learn from a critical incident and reduce normalisation of stressful situations. Secondly, when logistical factors such as communication, timing, and location were not considered, the attendance at debriefings was negatively influenced. Participants identified that ICU nurses commonly prioritised patient tasks over attending a debrief; therefore, teamwork and flexibility with logistics was crucial. CONCLUSIONS: Hot debriefing, of a short duration and close to the time of the event, was valued and played an important role in staff wellbeing and self-care, contributing to preventing self-blame and normalisation of stressful situations. A clearer definition of the term along with greater recognition of types of events that could be considered critical incidents is required for staff support after critical incidents in the complex intensive care setting.

Pre-Registration Nursing Students' Perceptions of Digital Health Technology on the Future of Nursing: A Qualitative Exploratory Study.

BACKGROUND: Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce. PURPOSE: To explore preregistration students' perceptions of digital health technology impact on their role as nurses. METHODS: Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration. RESULTS: Themes included fear of the unknown and who am I? Nursing in a digital world. Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career. CONCLUSIONS: Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing.

A Novel Antimicrobial Hydrogel for the Management of Periodontal Diseases.

OBJECTIVES: This study aimed to synthesise a drug-delivery system based on a porous polymer hydrogel, with antimicrobial properties against Porphyromonas gingivalis and potential to be used in tissue regeneration. MATERIAL AND METHODS: 2-Hydroxyethyl methacrylate monomers were polymerised using thermal and photoactivation in the presence of silver nitrate (AgNO3) and/or chlorhexidine digluconate. Poly-2-hydroxyethyl methacrylate (pHEMA) hydrogels containing silver nanoparticles (AgNPs) and/or 0.12% chlorhexidine (CHX) were produced and characterised using cryo-SEM and confocal microscopy. Hydrogel degradation and leaching of AgNP were tested for 1.5 months. The antimicrobial properties were tested against P. gingivalis using broth culture system and disk diffusion tests. RESULTS: Our methodology manufactured porous polymeric hydrogels doped with AgNPs and CHX. Hydrogels showed a successful delivery of CHX and sustainable release of AgNPs in a steady hydrogel degradation rate determined based on the weight loss of samples. Hydrogels with AgNPs or CHX had a significant antimicrobial effect against P. gingivalis, with CHX-hydrogels exhibiting a stronger effect than AgNP-hydrogels in the short-term assessment. AgNP-CHX hydrogels showed a compounded antimicrobial effect, whereas control hydrogels containing neither AgNPs nor CHX had no influence on bacterial growth (P < .05). CONCLUSIONS: The dual-cured pHEMA hydrogel loaded with antimicrobial agents proved to be an efficient drug-delivery system against periodontopathogens, with the potential to be used as a scaffold for tissue regeneration.

Dental students' knowledge of and attitudes towards prescribing medication in Western Australia.

INTRODUCTION: Dentists can prescribe medications for prophylactic and therapeutic purposes. In Australia, dental graduates can autonomously practise within the scope of their qualifications without needing to undertake an internship post-graduation. Although previous research has identified knowledge gaps amongst dental students in Australia on pharmacology and pharmacotherapeutic knowledge, there has been no published research that qualitatively highlights dental students' knowledge of medication prescribing in Australia. This study aimed to undertake a qualitative analysis of Western Australian dental students' attitudes towards and knowledge of medication prescribing. METHODS: This qualitative case study design employed semi-structured interviews as means of collecting data. It utilised a purposive sampling in penultimate and final year dental students at the University of Western Australia. RESULTS: Twenty dental students participated in the study. Five key themes were identified in the data: current and previous education, application when delivering pharmacology and pharmacotherapeutics, teaching to ensure patient-centred care, supervision and referral to relevant resources. Participants agreed that having previous knowledge in the area provides students with confidence regarding medication prescribing. Furthermore, students in this study valued having guidance when prescribing medications. CONCLUSIONS: This study highlights the complexity of medication prescribing for dental students. It also highlights their experience with the current pharmacology and pharmacotherapeutics curriculum. All students interviewed valued application-based teaching, making it specific to dentistry. If curriculum were to be redeveloped, considering their perceptions may be a valuable tool.

The impact of the intensive care unit family liaison nurse role on communication during the COVID-19 pandemic: A qualitative descriptive study of healthcare professionals' perspectives.

BACKGROUND: The COVID-19 pandemic has deeply impacted patient and family communication and patient- and family-centred care in the intensive care unit (ICU). A new role-the ICU Family Liaison Nurse (FLN)-was introduced in an Australian metropolitan hospital ICU to facilitate communication between patient and family and ICU healthcare professionals, although there is limited knowledge about the impact of this from the ICU healthcare professionals' perspectives. OBJECTIVE: The aim of this study was to explore the impact of the ICU FLN role on communication with patients and their family during the COVID-19 pandemic, from the ICU healthcare professionals' perspectives. METHODS: A qualitative descriptive study was conducted. Seven participants including ICU FLNs, ICU doctors, nurses, and social workers who worked with the ICU FLNs were interviewed. Thematic analysis was used to analyse the data. RESULTS: Two main themes related to the ICU FLN role were identified. First, the COVID-19 pandemic posed challenges to patient and family communication, but it also created opportunities to improve patient and family communication. Second, the ICU FLN role brought beneficial impacts to the ICU healthcare professionals' workflow and work experience, as well as patient and family communication. The ICU FLN role has potential benefits that extend beyond the pandemic. CONCLUSION: We found that during the COVID-19 pandemic, the ICU FLN role was acceptable, beneficial, and appreciated from the ICU healthcare professionals' perspectives. Further research should continue the evaluation of the ICU FLN role during and post the pandemic.

Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol.

OBJECTIVE: This review will evaluate the experiences of health care professionals in the intensive care unit when families participate in clinician handovers. INTRODUCTION: Families of patients admitted to the intensive care unit report stress and anxiety. Family participation in multidisciplinary rounds in the intensive care unit may improve patient and family outcomes. However, health care professionals have different attitudes toward family participation. Furthermore, there is limited understanding of the barriers, facilitators, and other outcomes of family participation in clinician handovers for the patient, family, and health care professionals. INCLUSION CRITERIA: The review will consider studies involving health care professionals (eg, nurses, physicians, allied health professionals) and any type of family participation, from bedside presence to participation in decision-making. Clinician handovers may be multidisciplinary ward rounds or nursing handovers. Settings may be the adult, pediatric, or neonatal intensive care unit in rural or metropolitan regions in any country. Studies in other clinical contexts will be excluded. METHODS: Databases to be searched include CINAHL, MEDLINE, Scopus, PsycINFO, Embase, Emcare, Web of Science, and ProQuest Central. The search will be limited to articles written in English from 2000 to the present. Two independent reviewers will screen titles and abstracts, assess the full text of selected citations for inclusion, and assess methodological quality. A data extraction tool will be used, and findings will be assigned a level of credibility. Meta-aggregation will be used to synthesize findings. Disagreements between reviewers will be discussed to reach consensus; a third reviewer will be consulted if necessary. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020223011.

Pre-registration nursing students' perceptions of their baseline digital literacy and what it means for education: A prospective COHORT survey study.

BACKGROUND: To build complex digital skills and capability required by digitally-driven work environments, we must first understand nursing students' baseline digital literacy if educators are to develop a fit for purpose curriculum underpinned by digital health technologies. OBJECTIVE: To determine first-year pre-registration nursing students' perceived baseline digital literacy before their first clinical placement. DESIGN: Prospective cohort study. SETTINGS: Two universities in Australia in 2020. PARTICIPANTS: Students enrolled in pre-registration nursing programs at Bachelor's and Master's level. METHODS: Participants (N = 205) completed an online 27-item survey composed of a Likert-type scale, forced-choice items, and open-ended questions. Data were analyzed with descriptive statistics. RESULTS: Participants engaged with digital technology early in life, with 49.75% students using some form of digital technology before ten years of age. Students reported the highest daily use of technology to search the internet for information (92%), online social networking (68.3%) and watching videos (67%). Most students expressed the least confidence in identifying different types of portable storage devices (24.1% Master's students; 41.7% Bachelor's students), describing the advantages of a digital camera (39.3% Master's students; 48.3% Bachelor's students), and totaling numbers in spreadsheets (22.8% Masters students; 48.3% Bachelor's students). No statistical differences were observed between the two universities or the two cohorts in terms of perceived confidence in using technology and software applications to support their learning. Interestingly, 24.7% of participants expressed high confidence in using electronic medical records without prior training, which may reflect positive attitude towards engaging with unknown digital technologies. CONCLUSIONS: Nursing students are frequent internet and social media users. However, despite positive attitudes to digital technology and widespread presence of digital technology in students' lives, deficits in students' confidence in using digital technology and software required for learning persist. Targeted digital literacy education interventions are needed as part of foundational nursing studies to improve nursing students' baseline digital literacy before commencing clinical placement. These should be scaffolded across the program to ensure an effective transition to nursing practice in evolving digitally-driven healthcare environments.

Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review.

OBJECTIVE: The COVID-19 pandemic has seen a rapid adoption of telehealth consultations, potentially creating new barriers to healthcare access for racial/ethnic minorities. This systematic review explored the use of telehealth consultations for people from racial/ethnic minority populations in relation to health outcomes, access to care, implementation facilitators and barriers, and satisfaction with care. MATERIALS AND METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute Manual for Evidence Synthesis. Five major databases were searched to identify relevant studies. Screening, full-text review, quality appraisal, and data extraction were all completed independently and in duplicate. A convergent integrated approach to data synthesis was applied with findings reported narratively. RESULTS: A total of 28 studies met the inclusion criteria. Telehealth-delivered interventions were mostly effective for the treatment/management of physical and mental health conditions including depression, diabetes, and hypertension. In several studies, telehealth improved access to care by providing financial and time benefits to patients. Technological difficulties were the main barriers to effective telehealth consultation, although overall satisfaction with telehealth-delivered care was high. DISCUSSION: Telehealth-delivered care for racial/ethnic minorities offers promise across a range of conditions and outcomes, particularly when delivered in the patient's preferred language. However, telehealth may be problematic for some due to cost and limited digital and health literacy. CONCLUSION: The development and implementation of guidelines, policies, and practices in relation to telehealth consultations for racial/ethnic minorities should consider the barriers and facilitators identified in this review to ensure existing health disparities are not exacerbated.

Families' control preference for participation in patient care in adult intensive care.

OBJECTIVE: Understand families' preferences and observed participation in patient care in an adult ICU. RESEARCH METHODOLOGY: The mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients. SETTING: Two public hospital intensive care units in Australia. MAIN OUTCOME MEASURES: 1) Families' preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit. RESULTS: Almost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%). CONCLUSION: Differences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.

Families' perspectives of participation in patient care in an adult intensive care unit: A qualitative study.

BACKGROUND: When a relative is admitted to the intensive care unit (ICU), stress, anxiety, and failure to cope may place families, and the patient, at risk for adverse psychological outcomes. Family participation in patient care may improve patient and family outcomes. However, to date, little is known about how families perceive and participate in patient care in ICU, and there is limited research to guide clinicians about supporting family participation in this context. OBJECTIVE: To describe family perspectives of participation in patient care in adult ICU. METHODS: Using a qualitative design, observation and interview data were collected from a convenience sample of 30 family members in the ICU at two metropolitan hospitals in Melbourne, Australia. An independent third party was used to recruit potential participants. Naturalistic observations and semi-structured interviews explored families' actions and perceptions of participation. Data were integrated and subject to thematic analyses. FINDINGS: The major theme Families as part of the healthcare team reflected family perspectives of their own significant contribution to supporting their relative's recovery while they were in ICU. Families' perception of their participation in patient care was characterised by three sub-themes: 1) Motivators for family participation; 2) Family roles during recovery; and 3) Influences on family participation. Families' perceived reassurance and companionship as important contributions to patient care. CONCLUSION: Families perceived their contribution to the patient's psychosocial and emotional well-being to be one of the most important aspects of participation. Nevertheless, their role in the healthcare team was influenced by several motivational factors. Results of this study can inform further research to test the effectiveness of clinical practice and educational interventions aligned with family preferences to promote participation and enhance patient and family-centered care in ICU.

Searching for meaning: A grounded theory of family resilience in adult ICU.

AIM: To explore families' experiences of their interactions in an Australian adult intensive care unit (ICU) to develop a grounded theory that can be used by critical care nurses to improve patient- and family-centred care (PFCC). BACKGROUND: Families in ICU play an important role in the patient's recovery and outcomes. However, families are at risk of significant psychological morbidity due to their experiences in ICU. Although many ICU patients can make their own decisions, a large proportion are unconscious or chemically sedated and unable to contribute to decisions about their care, leaving the decision-making role to the family. Therefore, the families' psychosocial and emotional well-being must be supported by implementing evidence-based interventions that align with a PFCC approach. This study describes the findings of a grounded theory of family resilience in ICU, of which the core category is Regaining control. The focus of this paper is on the major category: Searching for meaning. METHODS: We adopted a constructivist grounded theory method. Twenty-five adult family members (n = 25) of 21 patients admitted unexpectedly to an ICU in metropolitan Australia were recruited. In-depth interviews were used to collect the data, and the analytical processes of constructivist grounded theory underpinned the development of a core category and related subcategories. RESULTS: When adult family members experience the unexpected admission of a relative to ICU, they move towards a state of being beyond emotional adversity and regaining control when facilitated to search for meaning in their situation. When families were able to make sense of their situation and find a purpose by contributing to their relative's recovery, it encouraged them to cope and be resilient. CONCLUSIONS: Our findings can be used to promote PFCC in ICU, which considers a collaborative approach to meet the patient's needs while providing emotional and psychosocial support to their families.

The Impact of Social Support Networks on Family Resilience in an Australian Intensive Care Unit: A Constructivist Grounded Theory.

PURPOSE: This article discusses the findings of a grounded theory of family resilience in an Australian intensive care unit (ICU) with a specific focus on families' experiences of their interactions with other members within their own family, and the families of other patients in the ICU. DESIGN: A constructivist grounded theory methodology was adopted. Data were collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia. FINDINGS: The core category regaining control represents the families' journey toward resilience when in ICU. The major categories represent facilitators for, and barriers to, regaining control. One of the main facilitators is drawing strength, and it explains the manner with which families receive social support from their own and other family members to help them cope. CONCLUSIONS: This study offers a framework to improve patient- and family-centered care in the ICU by facilitating families' ability to manage their situation more effectively. Social support offered by family members facilitates the families' ability to regain control. An ICU family resilience theoretical framework, situated within the context of the Australian healthcare system, adds to what is currently known about the families' experiences in the ICU. CLINICAL RELEVANCE: The relationships that develop between families in the ICU may provide a source of social support; however, not all families welcome interactions with other ICU families, and it may cause further emotional distress. Further research is warranted to determine whether families suffer a secondary stress reaction from incidental interactions with other patients' families in the ICU. Furthermore, when family members pull together and offer social support to each other, they are better able to regain control. This process contributes to an ICU family resilience framework.

Barriers to families' regaining control in ICU: Disconnectedness.

BACKGROUND: The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. AIMS: The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. DESIGN AND METHODS: A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. FINDINGS: A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. CONCLUSION: Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to support patient- and family-centred care interventions in the ICU.

Barriers to regaining control within a constructivist grounded theory of family resilience in ICU: Living with uncertainty.

AIMS AND OBJECTIVES: To discuss families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit. BACKGROUND: The overwhelming emotions associated with the unexpected admission of a relative to an intensive care unit are often due to the uncertainty surrounding the condition of their critically ill relative. There is limited in-depth understanding of the nature of uncertainty experienced by families in intensive care, and interventions perceived by families to minimise their uncertainty are not well documented. Furthermore, the interrelationships between factors, such as staff-family interactions and the intensive care unit environment, and its influence on families' uncertainty particularly in the context of the Australian healthcare system, are not well delineated. DESIGN: A grounded theory methodology was adopted for the study. METHODS: Data were collected between 2009-2013, using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit in Australia. RESULTS: This paper describes the families experiences of heightened emotional vulnerability and uncertainty when a relative is admitted unexpectedly to the intensive care unit. Families uncertainty is directly influenced by their emotional state, the foreign environment and perceptions of being 'kept in the dark', as well as the interrelationships between these factors. CONCLUSION: Staff are offered an improved understanding of the barriers to families' ability to regain control, guided by a grounded theory of family resilience in the intensive care unit. RELEVANCE TO CLINICAL PRACTICE: The findings reveal in-depth understanding of families' uncertainty in intensive care. It suggests that intensive care unit staff need to focus clinical interventions on reducing factors that heighten their uncertainty, while optimising strategies that help alleviate it. Families are facilitated to move beyond feelings of helplessness and loss of control, and cope better with their situation.

Use of Intraoperative Indocyanine Green Videoangiography to Guide Cutaneous Angiosarcoma Excision.

Complete excision of cutaneous angiosarcoma, which is a rare, vascular, and aggressive tumor, is challenging. Its multifocal nature and propensity for lateral spread make the gross assessment of surgical margins difficult. Neither the use of frozen section analysis nor Mohs surgery consistently improves the probability of margin-free excision. Recent studies have advocated the use of indocyanine green to evaluate the vascular system perioperatively. We describe the intraoperative use of indocyanine green to help define the excision margin of a locally extensive scalp angiosarcoma in an elderly man.

Families' experiences of their interactions with staff in an Australian intensive care unit (ICU): a qualitative study.

OBJECTIVE: Nursing is characterised as a profession that provides holistic, person-centred care. Due to the condition of the critically ill, a family-centred care model is more applicable in this context. Furthermore, families are at risk of emotional and psychological distress, as a result of the admission of their relative to intensive care. The families' experiences of their interactions in intensive care have the potential to enhance or minimise this risk. This paper presents a subset of findings from a broader study exploring families of critically ill patients' experiences of their interactions with staff, their environment, the patient and other families, when their relative is admitted to an Australian intensive care unit. By developing an understanding of their experience, nurses are able to implement interventions to minimise the families' distress, while providing more holistic, person- and family-centred care. RESEARCH DESIGN: The study was a qualitative enquiry that adopted the grounded theory approach for data collection and analysis. In-depth interviews with family members occurred between 2009 and 2011, allowing the thoughts on interactions experienced by those families, to be explored. Data were analysed thematically. Twelve family members of 11 patients participated in this study. SETTING: This study was undertaken in a mixed intensive care unit of a large metropolitan hospital in Australia. FINDINGS: Interactions experienced by families of the critically ill primarily revolved around seeking information and becoming informed. Further examination of the interviews suggested that staff interacted in supportive ways due to their communication and interpersonal skills. However, families also experienced unsupportive interactions as a result of poor communication. CONCLUSION: Facilitating communication and interacting in supportive ways should help alleviate the anxiety and distress experienced by families of the critically ill in the intensive care unit.

Curriculum learning designs: teaching health assessment skills for advanced nursing practitioners through sustainable flexible learning.

BACKGROUND: Innovative curriculum designs are vital for effective learning in contemporary nursing education where traditional modes of delivery are not adequate to meet the learning needs of postgraduate students. This instance of postgraduate teaching in a distributed learning environment offered the opportunity to design a flexible learning model for teaching advanced clinical skills. AIM: To present a sustainable model for flexible learning that enables specialist nurses to gain postgraduate qualifications without on-campus class attendance by teaching and assessing clinical health care skills in an authentic workplace setting. METHODS: An action research methodology was used to gather evidence and report on the process of curriculum development of a core unit, Comprehensive Health Assessment (CHA), within 13 different postgraduate speciality courses. Qualitative data was collected from 27 teaching academics, 21 clinical specialist staff, and 7 hospital managers via interviews, focus groups and journal reflections. Evaluations from the initial iteration of CHA from 36 students were obtained. Data was analyzed to develop and evaluate the curriculum design of CHA. RESULTS: The key factors indicated by participants in the curriculum design process were coordination and structuring of teaching and assessment; integration of content development; working with technologies, balancing specialities and core knowledge; and managing induction and expectations. CONCLUSIONS: A set of recommendations emerged as a result of the action research process. These included: a constructive alignment approach to curriculum design; the production of a facilitator's guide that specifies expectations and unit information for academic and clinical education staff; an agreed template for content authors; and the inclusion of synchronous communication for real-time online tutoring. The highlight of the project was that it built curriculum design capabilities of clinicians and students which can sustain this alternative model of online learning.

One-stage Integra reconstruction in head and neck defects.

BACKGROUND: Integra dermal regeneration template - a two-stage, tissue-engineered, artificial skin - was introduced in the UK in May 1996. There were no restrictions on clinical application and a series of applications in reconstructive surgery were undertaken. One case involved a Caucasian lady with a nose tip basal cell carcinoma (BCC) who had a single-stage reconstruction. The 6-year follow-up was remarkable as it showed a scarless repair. OBJECTIVE: We undertook a clinical evaluation to explore the outcome of one-stage Integra reconstruction in a selected series of Chinese patients. METHODS: Ten patients (five male and five female; age range: 54-86 years) with complicated or atypical cutaneous lesions involving the head and neck were treated in an outpatient setting. RESULTS: Pathology revealed eight BCCs, one squamous cell carcinoma (SCC) and one seborrhoeic keratosis. Healing took place either by wound contraction alone or in conjunction with re-epithelialisation. All wounds were fully healed within 6 weeks. Follow-up ranged from 18 to 30 months, and there has been no recurrence of the malignant lesions. CONCLUSION: In selected cases, one-stage reconstruction using Integra can reduce operating time with no delay for frozen section, flap raising or graft harvesting. More immediate postoperative care is needed, but the long-term aesthetic results are uniformly acceptable.