12/19/2019 Clinical - The role of the practice nurse in Treating common skin problems

Clinical - The role of the practice nurse in Treating common skin problems

The practice nurse has an important role in the management of patients with skin disorders, writes Sarah
Broderick
Multi-faceted role

Patient-oriented role: explain, reassure, help with social and psychological consequences
Public health role: educate patients and public about eczema, psoriasis, acne and skin cancer; also duty
to inform health authority of any notifiable disease
Audit: ensure a high standard of care
Research: increase knowledge of the aetiology and mechanism of skin disease and current treatments.

Many dermatological conditions are best managed in the primary healthcare system. As many as 20% of the
population may have a skin condition requiring medical treatment, and skin disease accounts for about 10% of
all consultations with GPs.1

The practice nurse should be involved at all stages of patient care assessment, diagnosis, planning,
implementation and ongoing evaluation. But perhaps the most important role of the practice nurse is that of
health educator.

It is essential to assess the skin in detail for correct initial diagnosis and to monitor the effectiveness of
treatment. For assessment, a warm room, good light and a clean magnifying lens is important. A nurse's skill in
physical assessment combined with an understanding of integumentary anatomy and function will ensure that
deviations from the normal are recognised and documented.2 A careful, detailed history is an invaluable
baseline.3

Body image being linked to mental concept of self and self-esteem, is of vital importance to all those with a
skin problem. Social, psychological and sexual implications should be identified, as they have an effect on the
outcome of treatment.

Allowing patients to express how they feel will encourage a sense of support and understanding, providing a
foundation for ongoing partnership between the GP, practice nurse and patient, and lead to greater autonomy
and self-acceptance for the patient.

The practice nurse reinforces the information given by the GP about the nature of the condition. It may be
helpful to have a friend/relative present for support and to listen to instructions.2 Initially the nurse:

Outlines a simple plan of treatment and gives information

Makes a follow-up appointment to check correct implementation of treatment and reinforce advice
Informs patient sensitively that in the treatment of eczema and psoriasis, control and care are the goal5
Encourages patient to keep a diary of treatment and progress.

The nurse should give the patient careful instruction on how to apply topical medication, demonstrating the
exact amount to be applied, how often, and the size of the area to be treated. Any side effects should be
discussed. The nurse may also take clinical photographs (with patient consent) to show the nature and extent of
the skin condition and to record progress following treatment.

Given that it may take time to find a product to suit the individual, the practice nurse must acquire an in-depth
knowledge of the products available. Manufacturers recognise that nurses are a major influence on choice of
product. This underlines the responsibility to know the products, and the subtle differences between them.4

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12/19/2019 Clinical - The role of the practice nurse in Treating common skin problems

The nurse needs to keep abreast of current developments and relevant research and perhaps undertake some
research herself.

Patients with eczema should come to understand that the goal of breaking the itch-scratch cycle is attainable.
Dryness, flaking, weeping and crusting of the skin can effectively be controlled with a good skin care routine.

Teaching parents about the measures necessary to prevent recurrence is vital. Parents may need support with
positive messages, eg. there may as yet be no cure but most children grow out of the condition, even if there is
a family history.5

Evidence shows that 58% of patients with chronic venous ulcers have a complicating factor of eczema, both
endogenous and exogenous.6 Patients with psoriasis should be educated to identify the precipitating factors and
reduce stress factors.

The practice nurse also has a role to play in educating patients on the effects of the sun on the skin and drugs
which may cause photo-sensitivity.

The major aims in the management of patients with skin disorders are to: prevent damage to healthy skin;
prevent secondary infection; reverse the inflammatory process; and relieve symptoms.2

Sarah Broderick is a practice nurse in Milford, Co Cork and is the winner of the Stiefel Laboratories (Irl) Ltd
Irish Practice Nurses Bursary Prize

References

1. Skin Conditions: The Role of the Nurse. Nursing Times 1995; 9(28):5,8
2. Brunner and Suddarth. Textbook of Medical Surgical Nursing 7th Edition. 1992
3. Buckley, D. Forum Dermatology Handbook: A Practical Guide to Dermatology in General Practice,
1994
4. Heenan L. J Prof Nurse, 1996; 11:744
5. McDonald S. Rash Promises for Eczema. Practice Nurse, 1994; 331
6. Cameron J. Skin problems at the ulcer site. Practice Nurse, 1994; 285

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