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.

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.

[Global management of melanoma in the palliative phase]

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.

[Screening for melanoma, an advanced practice nurse consultation]

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.

Nurses lead the way for "safe in the sun" play!

Skin cancer prevention is of great importance as it is the most common type of cancer in the United States. Much skin damage occurs early in life. Adolescents are a vulnerable population, as they strive to fit in with their peers, and they neglect sun safety habits. Since a substantial portion of adolescents' time is spent at school, school nurses are in an ideal position to develop and lead a sun safety action plan, using guidelines from the Centers for Disease Control and Prevention and evidence-based sun safety internet resources. It is hoped that incorporating a culture of skin health promotion and disease prevention among teens will lead to improved health outcomes in the future.

Skin cancer: increasing awareness and screening in primary care

Skin cancer screening (SCS) promotes early detection and improves treatment. Primary care providers are strategically positioned to provide screenings, yet the frequency is low. Strategies to improve SCS include increasing skin cancer awareness, targeting high-risk patient populations, and advocating for primary care providers to conduct screenings.

Use of personalized decision analysis in decision making for Palliative vs. surgical management of the oldest-old patients with localized skin cancer in a culturally sensitive environment: a case study of a 96-year-old male Taiwanese patient

Clinical management of older cancer patients is challenging, especially for those in the oldest-old age group. In the Chinese culture, the preference toward noninvasive care for patients in this age group may create a difficult situation for clinicians when the cancer is potentially curable. Palliative care may not always be the obvious choice, especially if patients suffer from quality-of-life impairment because of symptoms related to progression of the untreated cancer. Balancing between higher rates of toxicities and potential gains in quality of life from anticancer therapies among the oldest old presents a real challenge in clinical practice. Decision analysis is an analytical tool that has a long history of successful application in clinical decision making. In this case study of a 96-year-old male with localized skin cancer, we demonstrate that personalized decision analysis can be a helpful tool to assist decision making in the clinical management of cancer patients in the oldest-old age group, especially in situations in which the evidence-based literature provides little guidance. This was achieved by providing information to help the key decision makers to better understand the risk-benefit trade offs and make an informed decision. We found that the option of surgical management was associated with higher expected quality-adjusted life years (0.894) than best supportive care (0.853). Based on this finding and various scenarios explored in sensitivity analyses, the family members recommended surgery for the patient. The patient recovered well from surgery and there is no evidence of recurrence to date.

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.

Romidepsin: a new drug for the treatment of cutaneous T-cell lymphoma

Patients with cutaneous T-cell lymphoma (CTCL) have a rare, disfiguring, and life-threatening subtype of non-Hodgkin lymphoma primarily localized to the skin. Their immune systems are altered and their skin is compromised. In addition, they are highly prone to infections-the most common cause of death in patients with this disease. Patients presenting with early-stage disease involvement typically are treated with topical therapies; patients with advanced-stage and recurrent disease require systemic treatment. Specialized knowledge is required by oncology healthcare providers to manage the wide array of symptoms experienced by these patients as a part of the natural course of this disease. A new drug, romidepsin, approved by the U.S. Food and Drug Administration, is indicated in the treatment of relapsed CTCL. The authors discuss use of romidepsin in the context of CTCL and the information needed to safely administer romidepsin and manage its side effects.

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.

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.

Introduction to skin cancer nursing

The incidence of skin cancer continues to increase annually and it is the most common cancer in the UK with over 100,000 cases each year. The treatment of skin cancer can involve many different disciplines including dermatology, plastic surgery, oncology, radiotherapy, ENT and maxillofacial and involves both adult and paediatric services in primary and secondary care. This article considers the many duties of a skin cancer clinical nurse specialist, and the increasing pressure such nurses are under. The skin cancer nurse specialist must liaise and work with the many different departments, and will be involved in the care of the patient with skin cancer from diagnosis throughout the pathway to discharge or death.

Management of skin conditions in the older population 2

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.

Cutaneous T-cell lymphoma: overview and nursing perspectives

Cutaneous T-cell lymphoma (CTCL) is an uncommon and complex malignancy of the immune system with a wide range of clinical presentations primarily involving the skin. An extensive menu of skin-directed and/or systemic treatment options exists. Best practices in management involve multidisciplinary collaboration. Nursing care for patients who have CTCL is a critical component in the successful management of the disease and requires special attention to the patient's physical, emotional, and spiritual needs. Nurses can make a significant impact by being accessible, offering emotional support, demonstrating advocacy, and providing ongoing education for the patient and family.

Skin Self-Examination in Patients at High Risk for Melanoma: A Pilot Study

PURPOSE/OBJECTIVES

To compare the effect of providing high-risk patients with standard brochures versus personalized photo books as part of a comprehensive nursing intervention on knowledge, awareness, and confidence with skin self-examination (SSE) performance, as well as compliance in performing SSE.

DESIGN

Randomized intervention design.

SETTING

The Lawrence E. Rockefeller Ambulatory Outpatient Cancer Center at Memorial Sloan-Kettering Cancer Center in New York, NY.

SAMPLE

100 patients at high risk for melanoma.

METHODS

Patients completed a baseline questionnaire before their initial photographs were taken and at the end of a nurse-teaching intervention at the clinic.

MAIN RESEARCH VARIABLES

Skin cancer knowledge, awareness, and self-confidence in SSE.

FINDINGS

A two-way analysis of variance with repeated measures was performed to examine differences within and among groups in relation to knowledge, awareness, and confidence. The group-time interaction was not significant. In group A (nursing intervention with photo book), 10% of the patients at baseline reported performing SSE three or more times during the prior four months. Mean knowledge scores, awareness, and confidence scores all increased. In group B (nurse-teaching intervention using brochures only, without a photo book), 20% reported practicing SSE three or more times during the prior four months. Mean knowledge, awareness, and confidence scores increased.

CONCLUSIONS

The main difficulty that patients experience with self-detection of melanoma is their limited recall of skin appearance; therefore, photographic records may be the most effective aid for detecting changes at longer intervals. The use of a photo book may help to diminish that difficulty.

IMPLICATIONS FOR NURSING

This study supports the fact that education can increase knowledge, awareness, and confidence regarding SSE, which is consistent with the findings of other investigators. Therefore, nurses should incorporate teaching patients how to perform SSE into their practice and recognize that personal involvement in health care has become a dominant theme in the cancer education literature in recent years. With this new emphasis, important self-care activities, such as testicular self-examination, breast self-examination, and now SSE, are being stressed because early detection has shown favorable effects in improving the prognosis of cancer.

Psychological consequences of malignant melanoma: patients' experiences and preferences

This article reports on the findings of a literature review exploring the psychological impact of malignant melanoma on patients, from diagnosis to follow up. It examines the preferences expressed by patients with regard to ongoing support from nurses in this field, and draws attention to some implications for practice. A small but significant body of literature provides information on the psychological stress experienced by patients with melanoma, and on their coping strategies. Preferences are expressed on the way that information is given at diagnosis and the support offered by the healthcare team during diagnosis and at later consultations. These preferences and experiences have implications for nurses working in cancer care in general, and skin cancer in particular.

Topical photodynamic therapy: an introduction for nurses

Non-melanoma skin cancers are the most common cancers in the UK. Although an estimated 50000 cases were registered in 1999 across England and Wales, there is likely to be significant under-reporting of cases. However, the cancer registries do not include pre-cancerous lesions of the skin and therefore the number treated will greatly outnumber the cancers (National Institute for Health and Clinical Excellence, 2006). Topical photodynamic therapy (PDT) is one of several effective treatments for pre-malignant and malignant non-pigmented skin cancers. The treatment is non-invasive and can be administered by nurses in a clinical setting. PDT is a two-step process involving the application of a light-activated substance followed by exposure to light to activate this substance. The treatment results in the elimination of tumour cells while leaving the healthy skin unharmed. This article provides an introduction to PDT for nurses who may in the future be involved in setting up a PDT service within their practice area.

Cutaneous T-cell lymphoma

OBJECTIVE

To review recent information on the epidemiology, etiology, clinical presentation, staging, treatment approaches, and nursing management of CTCL.

DATA SOURCES

Research and review articles and textbooks.

CONCLUSION

Identifying the etiology and finding a cure for cutaneous T-cell lymphoma is promising as our knowledge and understanding of the T-cell biology evolves, creating more options for innovative therapies or treatment modalities.

IMPLICATIONS FOR NURSING PRACTICE

It is essential for the oncology nurse to understand the disease process, treatment modalities, and side effect profiles to provide astute nursing assessment, establishment of treatment goals, management of cutaneous symptoms, treatment of side effects, and pain control while preventing infection and providing psychological/social support throughout the course of the disease.

Psychosocial Mediators of a Nurse Intervention to Increase Skin Self-examination in Patients at High Risk for Melanoma

This prospective study examines psychosocial mediators of an efficacious skin self-examination (SSE) intervention that includes provision of a whole-body digital photography book depicting the entire skin surface. Individuals (n = 100) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were randomized to receive a photobook immediately (n = 49) or 4 months after intervention delivery (n = 51). Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory, melanoma worry, and SSE anxiety drawn from Self-Regulation Theory, and skin cancer knowledge, and skin awareness. Only self-efficacy was a significant mediator, accounting for 8% of the total effect of photobook enhancement on SSE adherence at 4 months.

Managing bleeding malignant skin lesions

Malignant skin lesions can bleed as a result of the tumour itself or after the application of inappropriate dressings. Vivien McMurray discusses some of the measures that can be taken to control light bleeding, together with other methods that should be considered when profuse bleeding occurs.

The development of the nurse biopsy role

Research shows that nurse surgery posts strengthen continuity of care and allow collaboration with other health professionals to ensure patients receive appropriate and timely care. The consistent and integrated approach provided with the nurse biopsy role fills gaps in service provision and avoids duplication of services. Skin cancer is the most common cancer in the UK and at Queen's Medical Centre in Nottingham they see approximately 160 suspected cases each week. Before the introduction of the nurse biopsy role there was an 8-week wait for a biopsy by the doctor and a further 8-week wait for the removal of the tumour. Now, a patient with a suspected skin cancer can have a biopsy on the first visit to the clinic, reducing the wait from 8 weeks to 0 weeks. This reduction in waiting time facilitates improved mortality and morbidity from the skin cancer. It took 3 years to develop the nurse biopsy role in Nottingham and another 2 years to provide the service that is currently available. The nurse-led biopsy service is now being adopted nationwide, as recommended by the All Parliamentary Group on Skin (2003). The dermatology department at Queen's Medical Centre in Nottingham also runs an annual course to teach the surgery skills required to primary- and secondary-care nurses.

Wound Care Issues in the Patient with Cancer

As cancer continues to represent a major health problem in the United States and in other developed countries, MCWs will continue to represent a complex problem for patients and health care professionals alike. Goals of care may range from healing to palliation, depending on the underlying pathology and patient preferences regarding their personal goals of wound or disease management. Palliative wound care should focus on patient comfort and quality of life as the goals, instead of wound. As evidence related to wound healing, products, and technology continues to increase,nurses can be at the forefront of putting into practice the science of wound healing for the benefit of patients.

Increased role for nurses in provision of skin cancer care

Skin cancers are the most common group of cancers affecting the U.K. population and their incidence is rising steadily. Draft guidance from NICE outlines initiatives that are needed to tackle the problem, including new developments in the provision of nursing care.

A nurse-surgical post cuts waiting times and extends nurses' skills base

Government initiatives, including the reduction in junior doctors' hours, has resulted in nurses exploring new ways of expanding their roles to address unmet patient needs. This paper reports on the development of a nurse biopsy role in a dermatology department, which has not only extended the skills base of those involved, but also improved the care provided.