Representation of dark skin tones in foundational nursing textbooks: An image analysis.

PURPOSE: This study aimed to analyze and quantify the representation of dark skin tones (DST) images/graphics across fifteen foundational and clinical nursing textbooks to understand the degree of portrayed diversity in current nursing texts. BACKGROUND: The United States (U.S.) population is becoming more ethnically and racially diverse. There is a scarcity of nursing literature, studies, and educational materials on the assessment and early recognition of common skin assessment in patients with dark skin tones (DST). The underrepresentation of people with DST images in didactic material suggests that omissions of these images in educational resources may introduce bias in health care provider education and practice. METHODS: Fifteen popular foundational and clinical nursing textbooks were selected and analyzed. All the photo images and drawn graphics in these textbooks were coded according to Fitzpatrick's skin phototype (FSP) scale, which categorizes skin tone as (a) "Light" or Fitzpatrick scale I or II, (b) "Medium" or Fitzpatrick scale III or IV, and (c) "Dark" or Fitzpatrick scale V or VI. The training was provided for data collectors before analysis to ascertain good inter-rater reliability (Cohen's kappa = 0.960 for light skin tone, Cohen's kappa = 0.899 for medium skin tone, and Cohen's kappa = 0.913 for dark skin tone). RESULTS: Analysis of 14,192 photo images and drawn graphics depicting skin tone was completed across 15 foundational and clinical nursing textbooks. 12.3 % of photo images and 2.4 % of drawn graphics depicted dark skin tones, compared to 60.9 % of photo images and 82.8 % of drawn graphics that displayed light skin tones in these textbooks. CONCLUSIONS: Nursing textbooks overrepresent light skin tones and underrepresent dark skin tones. While the approximate racial distribution of the U.S. population is 59.3 % non-Hispanic-White, 13.6 % Black/African American, and 26.6 % Person of Color, the images and graphics of skin tones represented 68 % light, 15 % medium, and 9.4 % dark. RELEVANCE TO CLINICAL PRACTICE: All healthcare providers are expected and required to deliver competent clinical care to an increasingly diverse population. For teaching-learning, more visual representations of DST and comparative images between what to expect in dark, medium, and light skin tones can help improve knowledge deficits and increase health equity.

Asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería: competencias y propuesta de contenidos / A course on care for people with skin lesions for the undergraduate nursing programme: competencies and proposed contents

El presente artículo pretende desarrollar una propuesta marco sobre una asignatura sobre el cuidado de las personas con lesiones cutáneas en el grado de enfermería. Esta ha sido realizada por consenso de expertos, profesores con experiencia en el cuidado de heridas y fue sometida a modificaciones en el marco del Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. Con ello se presenta una propuesta de competencias sobre el cuidado de las personas con lesiones cutáneas para la enfermera graduada, así como la propuesta curricular, con su estructura pedagógica basada en unidades didácticas y la propuesta de carga docente y ubicación de la asignatura de cuidados de las personas con lesiones cutáneas en el grado en enfermería. Finalmente se presentan documentos de apoyo al profesorado y estudiantado para la creación de la asignatura de cuidados de las personas con lesiones cutáneas para el grado en enfermería (AU)

This article aims to develop a framework proposal for a course on the care of people with skin lesions in the nursing degree. It has been developed by consensus of experts, professors with experience in wound care and was subject to modifications in the framework of the Segundo Encuentro Iberolatinoamericano de Facultades y Escuelas Universitarias con Programas Formativos en Heridas. This includes a proposal of competencies on the care of people with skin lesions for the graduate nurse, as well as the Curricular proposal, with its pedagogical structure based on didactic units and the proposed teaching load and location of the subject of care for people with skin lesions in the nursing degree. Finally, support documents are presented for the teaching staff and students for the creation of the subject of care of people with skin lesions for the degree in nursing (AU)

Avaliação e medidas de prevenção e tratamento da xerose cutânea em idosos: uma revisão integrativa / Evaluation and measures for prevention and treatment of skin xerosis in elderly: an integrating review / Evaluación y medidas de prevención y tratamiento de la xerosis cutánea en idosos: una revisión integrativa

Objetivo: Analisar a produção científica em enfermagem acerca dos cuidados para a avaliação, prevenção e tratamento da xerose cutânea em idosos. Método: Revisão integrativa realizada nas bases Literatura LatinoAmericana e do Caribe em Ciências da Saúde, Biblioteca Virtual Scientific Eletronic Library Online, PubMed Central e Cumulative Index to Nursing and Allied Health Literature, no período de agosto a dezembro de 2017. Resultados: Foram analisados 14 artigos dos quais emergiram três categorias: A hidratação oral e tópica para o cuidado do idoso com xerose cutânea; A utilização de instrumentos e o cuidado a xerose relacionada aos pés; e por fim Medidas de higiene e processos de escolha/indicação de produtos. Conclusão: Os cuidados de enfermagem devem estar voltados à educação para o autocuidado com ênfase na hidratação dos pés bem como na indicação e orientação acerca do uso de produtos com a finalidade de minimizar as complicações oriundas da xerose

Objective: To analyze the scientific production in nursing about the care for the evaluation, prevention and treatment of cutaneous xerosis in the elderly. Method: Integrative review carried out in the Latin American and Caribbean Literature on Health Sciences, Virtual Electronic Library Online, PubMed Central and Cumulative Index to Nursing and Allied Health Literature, from August to December 2017. Results: Analyzed 14 articles from which emerged three categories: Oral and topical hydration for the care of the elderly with cutaneous xerosis; The use of instruments and care for xerosis related to the feet; and finally Hygiene measures and product selection / indication processes. Conclusion: Nursing care should focus on education for self-care, with emphasis on hydration of the feet as well as indication and orientation about the use of products in order to minimize complications from xerosis

Objetivo: Analizar la producción científica en enfermería acerca de los cuidados para la evaluación, prevención y tratamiento de la xerosis cutánea en ancianos. Método: Revisión integrativa realizada en las bases Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Biblioteca Virtual Scientific Eletronic Library Online, PubMed Central y Cumulative Index to Nursing and Allied Health Literature, en el período de agosto a diciembre de 2017. Resultados: Fueron se analizaron 14 artículos de los cuales surgieron tres categorías: La hidratación oral y tópica para el cuidado del anciano con xerosis cutánea; La utilización de instrumentos y el cuidado de la xerosis relacionada a los pies; y por último Medidas de higiene y procesos de elección / indicación de productos. Conclusión: Los cuidados de enfermería deben estar orientados a la educación para el autocuidado con énfasis en la hidratación de los pies así como en la indicación y orientación acerca del uso de productos con la finalidad de minimizar las complicaciones oriundas de la xerosis

Teleconsulta como sistema de información en el cuidado de pacientes con deterioro de la integridad cutánea / Teleconsultation as an information system in the care of patients with cutaneous integrity deterioration

OBJETIVOS: Evaluar los beneficios de la teleconsulta frente a la consulta presencial convencional en pacientes con deterioro de la integridad cutánea. METODOLOGÍA: Estudio piloto de intervención controlado, aleatorizado, abierto. Sujetos de estudio: pacientes con deterioro de la integridad cutánea pertenecientes a los centros de salud urbanos. Se crearon dos grupos, uno sobre el que se realizó la intervención a través de la teleconsulta y otro grupo control donde la consulta y la valoración se hizo de forma presencial. Recogida de los datos mediante observación, entrevistas, cuestionarios y escalas validadas. RESULTADOS: Se realizaron un total de 31 consultas desde los centros de salud, 12 de las cuales fueron de forma presencial (38,7%) y 19 a través de la teleconsulta (61,3%). Las lesiones consultadas fueron en su mayoría de etiología venosa. Estos pacientes presentaban alteración de su calidad de vida. Se obtuvo una media de mejoría de 6 puntos en la escala PUSH en la modalidad presencial frente a 8 puntos en la teleconsulta, siendo menor el tiempo en que se consigue la epitelización de las lesiones en esta última. CONCLUSIONES: La teleconsulta se perfila como un nuevo sistema organizativo, una nueva manera de organizar y gestionar la provisión de los servicios sanitarios en beneficio de los pacientes, profesionales y sistema sanitario en general, estableciendo un canal de comunicación rápido, fluido, efectivo y eficiente que repercuta directamente en el paciente disminuyendo tiempos para la resolución de su problema de salud, evitando desplazamientos innecesarios y disminuyendo los costes

OBJECTIVES: To evaluate the benefits of teleconsultation compared to the conventional face-to-face consultation in patients with cutaneous integrity deterioration. METHODOLOGY: Pilot study of controlled, randomized, open intervention. Subjects of study: patients with deterioration of the cutaneous integrity belonging to the urban health centers. Two groups were created, one on which the intervention will be carried out through teleconsultation and another control group where the consultation and Assessment was done in person. Collection of data through observation, interviews, questionnaires and validated scales. RESULTS: A total of 31 consultations were carried out from the health centers, 12 of which were in person (38.7%) and 19 through teleconsultation (61.3%). The lesions consulted are mostly of venous origin. These patients present altered quality of life. A mean improvement of 6 points is obtained in the PUSH scale in the face-to-face modality versus 8 points in the teleconsultation, the time in which the epithelialization of the lesions in the latter is achieved. CONCLUSIONS: Teleconsultation is emerging as a new organizational system, a new way of organizing and managing the provision of health services for the benefit of patients, professionals and the health system in general. Establishing a fast, fluid, effective and efficient communication channel that has a direct impact on the patient, reducing time for the resolution of his health problem, avoiding unnecessary movements and reducing costs

Construction validation of an instrument for nursing care related to cutaneous xerosis.

OBJECTIVE: Describe the construct validation process of the instrument "Nursing care for the assessment, prevention and treatment of cutaneous xerosis in the elderly". METHOD: Methodological study carried out with 101 nurses in four hospitals in the great João Pessoa, between July and September 2018. Construct validation was performed through exploratory and confirmatory factor analysis, in addition to the consistency check by Cronbach's alpha. RESULTS: Through the factorial analysis, three factors of the instrument construct were defined: treatment performed for cutaneous xerosis, preventive care for cutaneous xerosis and skin evaluation, with a total explanation variance of 47.77%. In Bartlett's sphericity test, p <0.001 was obtained, and the general Cronbach's alpha was 0.811. CONCLUSION: The instrument proved to be valid and reliable, contributing to the training and practice of nurses as an integral part in the process of caring for the elderly.

Dermatological diseases, sexuality and intimate relationships: A qualitative meta-synthesis.

AIMS AND OBJECTIVES: To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases. BACKGROUND: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue. DESIGN: A systematic review and meta-synthesis of qualitative studies. METHODS: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes. RESULTS: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies. CONCLUSION: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included. RELEVANCE TO CLINICAL PRACTICE: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face.

Prevention and management of moisture-associated skin damage.

The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence-associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.

Promoting Skin Care for Older Adults.

Chronic conditions and age-related changes place older adults at increased risk for skin breakdown and damage to skin integrity, leading to poor outcomes that may impact quality of life. Although we cannot stop skin from aging, home care clinicians are in the best position to mitigate further skin problems and influence healthier outcomes for patients with skin issues. Home healthcare clinicians can improve skin health and well-being for older adults by incorporating simple but thorough systematic skin assessments at every visit. This includes identifying the patient's personal skin care practices and preferences. Home healthcare clinicians can intervene and address excessive moisture or extreme dryness of skin, use available resources for best practices in wound care, and educate about sun protection.

Recognising and managing age-related dermatoporosis and skin tears.

Dermatoporosis is a chronic skin fragility syndrome, caused by age and environmental factors. People with dermatoporosis have skin whose protective mechanical function is reduced and which has a decreased tolerance for friction and shearing forces. Skin tears are another clinical consequence of age-associated skin vulnerability and people with dermatoporosis are at increased risk of skin tears. Dermatoporosis may also delay the healing of skin tears, making it vital that healthcare professionals are aware of this condition. Skin tears have profound effects on the health and well-being of older people, and these kinds of injuries are being seen more frequently in clinical practice as the average age of the population increases. The treatment of skin tears in three older people with dermatoporosis is discussed and the clinical decisions made in each case.

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.

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.

Prevalence of neonate adhesive skin injuries in a Jordanian intensive care unit.

AIM: To determine the prevalence of adhesive skin injuries in neonates in a Jordanian neonatal intensive care unit (NICU) and to examine the characteristics of neonates with these injuries. METHOD: A cross-sectional period-prevalence study was conducted in a NICU in Irbid National University Hospital in Jordan. A total of 169 neonates were examined for skin injuries caused by adhesive equipment. RESULTS: The prevalence of skin injuries in this population was 26.6%. The injuries were located mostly on the face, arms, hands and chest, and were caused by endotracheal tubes, intravenous cannulae, fixation of nasogastric tubes and electrodes. Neonates with skin injuries were more likely to be preterm and underweight, to have respiratory problems and to have been connected to a mechanical ventilator. CONCLUSION: Adhesive skin injuries were found in more than one quarter of the neonates in this NICU and healthcare service providers should endeavour to minimise the occurrence of these injuries.

Nursing challenges caring for bone marrow transplantation patients with graft versus host disease.

Nursing care of blood and marrow transplantation (BMT) patients is complicated. Nursing considerations of BMT patients with GVHD require an additional set of skills and knowledge that include side effects, both expected and less common, assessment skills, treatment administration, both standard and novel, and acute or intensive care. Nursing care of BMT patients with skin GVHD will be determined by the degree of skin alteration with distinct decisions made about hygiene, both topical and systemic treatment, infection prevention, relief of discomfort, functional ability (ADL) and body image alteration. The nurse needs to have knowledge about assessment criteria for acute and chronic (NIH) assessment with special attention to skin (presence of rash, texture, mobility), joint mobility, mouth care, dressings, and skin care products. Nursing consideration of gastrointestinal GVHD includes importance of accurate intake and output, obtaining culture, fluid and electrolyte imbalance, nutrition, treatment, and skin care. Complication of GVHD treatment, namely effects of steroids require experts from many disciplines to provide comprehensive care. Caring and advocating for GVHD patients may include preparing for outcomes that are undesirable and impact the patient's quality of life and mortality. BMT survivorship programs are a major source of patient education about chronic GVHD for patients after treatment. Caring for BMT patients, especially those experiencing GVHD, takes a knowledgeable, committed, and caring team of healthcare providers. Workshops like this are vital in providing information and networking to keep providers around the region and globe engaged in this critical work.

Assessment, prevention and management of skin tears.

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

PURPOSE: The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. DESIGN: Descriptive study. SUBJECTS AND SETTING: Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. METHODS: Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. RESULTS: Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. CONCLUSION: WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.