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Nursing is making a key contribution to the development and evaluation of atopic dermatitis (AD) education. Educational interventions have long been recommended and used as a critical adjunct at all levels of therapy for patients with AD to enhance therapy effectiveness. These interventions may be directed toward adult patients or the parent/caregi...
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Context 1
... key component of effective educational intervention is the nature and quality of the educational support material aids that are provided, so due regard needs to be given to the quality of evidence-based resources, such as educational booklets or posters (Fig. 1, highlighting the different categories of steroid potency as a clinic educational tool) and the use of multimedia resources, such as DVDs or, as highlighted earlier, other technologies such as video. 36 Work has begun in examining the effectiveness of nurse-led evidence-based educa- tion in groups on a large scale to parents of children ...
Citations
... Nurses play a key role in the development and provision of systematic education on AD, both to patients, their relatives, and the wider healthcare community, on disease background, standards of care, and detailing risks and benefits of the available recommended treatments. In most therapeutic patient education (TPE) programmes, nurses often play a primary role in providing evidence-based and often individualised information to support self-management and promote active participation in shared decision making [20,[50][51][52][53][54]. Educational needs that are required to support self-care varies between patients, and needs-assessment can be difficult; simple scoring tools have been developed for this purpose [55]. ...
... Educational needs that are required to support self-care varies between patients, and needs-assessment can be difficult; simple scoring tools have been developed for this purpose [55]. While such education should be universal it is of particular importance in those patients with recalcitrant or refractory disease, or where treatment adherence or treatment concerns exist, and for those patients or families with poorer QoL, or who require additional psychological support [50,52]. ...
... Two main service delivery models for education delivery exist; nurse-led focused group education and a broader multidisciplinary "eczema school" approach [50,56]. To date, most experience and evaluation of the benefits of education is in children, where education may be directed towards children and their parents. ...
Background
The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions.
Main body
Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools’ are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life.
Conclusions
Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.
... *Multiple answers were allowed; † Others include center (treatment room) for atopic dermatitis and asthma for individual-level education, as well as hospital auditorium and patient ward for group-level education; ‡ Others include cases wherein the clinician, primary investigator, or specialized nurses provided the education. quently involved (23 participants), followed by residents or fellows (19), dieticians (five), pharmacists (two), and clinical psychologists (one). Similar results were found for group-level programs. ...
... Therefore, dieticians must also be involved in the education. 19 The deleterious effect of psychological stress in AD has been well-recognized. AD results in social intimidation and reduced quality of life. ...
Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.
... This important educational facet of care management is becoming increasingly difficult to accomplish in routine care visits and seems to be equally difficult to measure and evaluate. 53 Treatment of severe AD needs to incorporate an individualized written treatment plan based on a shared decision-making process between patient or caregiver and their clinician. Figure 2 is an example of an AD Action Plan used at the authors' institution. ...
... Patient and caregiver education should address this topic, because steroid phobia could be a factor when adherence is not optimal, and if not resolved by information and counseling, then other treatment options should be discussed. 26,53 Topical calcineurin inhibitors. TCIs are a class of nonsteroid anti-inflammatory agents currently approved by the FDA as second-line agents in the management of AD. ...
Patients with severe atopic dermatitis (AD) are reported to represent between 10% and 18% of all patients with AD. However, in this subgroup of patients, quality of life is significantly affected and patients may have a number of atopic and nonatopic comorbidities. Treatment of this severe population has often been reactive with inappropriate use of systemic corticosteroids and unapproved immunosuppressants. Recent insights point to the systemic nature of AD, which has important therapeutic implications. Management of severe AD requires a comprehensive approach that incorporates proper diagnosis, assessment of disease severity, and impact on patient's and caregiver's quality of life, along with education regarding the chronic relapsing nature of the disease as well as treatment options. Biologics such as dupilumab offer a novel, targeted therapeutic approach for this systemic disease.
... Another important area is patient training when prescribing auto-injectors with adrenaline for patients at risk of anaphylaxis, in order that they receive the correct training [32]. In addition, the nurse has also been shown to play an important role in the management of atopic dermatitis [33]. One of the nurse's main tasks in the MDT is to provide patientcentred and holistic education and support for self-care. ...
The multi-disciplinary team approach is an effective model for patient care. Allied health professionals (AHPs) are an important part of such teams, bringing specific knowledge and skills related to the target patient population. The AHPs most often involved in allergy care are nurses and dietitians. Nurses are often involved in the care of patients with all types of allergy and also with asthma, whilst allergy-specialist dietitians provide vital nutritional and dietary support for the diagnosis and management of food allergy. There are many other AHPs who have a role to play in allergy care, including physiotherapists, psychologists, pharmacists and speech therapists, and their involvement is likely to develop as allergy care becomes more rooted in the community. With the development of multi-professional teams comes the requirement for disease-specific knowledge and skill sets, with all allergy team members required to have baseline knowledge and competency of the condition being managed. Whilst some competencies for AHPs practising in other disease states have been published, none are available for allergic disease against which AHPs can be benchmarked. The European Academy of Allergy & Clinical Immunology (EAACI) recognised this need, and supported the establishment of a Task Force to develop allergy-focussed competencies for AHPs. The varied skills, expertise and professional background of the Task Force members enabled the creation of a set of allergy competencies relevant to all AHPs working in allergy. It is recognised that the training and allergy expertise of AHPs, and their role within the allergy setting, will vary considerably depending on the country. However, it is important for patient care, that all AHP involved in allergy services have access to training, of a sufficiently high enough level to be aspirational and enable the continued growth and development of a wide range of allergy services, given the increasing need. The EAACI competencies will provide an important benchmark for allergy knowledge and skills against which education and training can be designed and health care professionals can subsequently be measured. However, more importantly, the EAACI AHP allergy competencies will enable the development and reach of specialist allergy services, with allergy-specialist AHPs undertaking key roles, especially in the community care setting.
Electronic supplementary material
The online version of this article (10.1186/s13601-018-0218-7) contains supplementary material, which is available to authorized users.
... 12,13 In this approach, the importance of teaching patients or caregivers skills to self-monitor and manage disease with the help of an individualized plan is a key component. 14 In the authors' center, the multidisciplinary team is composed of pediatric allergist-immunologists with extensive experience in basic and clinical research in AD, pediatric nurse specialists, behavioral clinicians, fellows-in-training, physician assistants, nurse educators, child-life specialists, art therapists, social workers, dietitians, and rehabilitation therapists. Dermatologists are available for consultation if the diagnosis of AD is in question or alternative therapies, such as phototherapy, are being considered. ...
National and international guidelines address stepwise atopic dermatitis (AD) management. Wet wrap therapy (WWT) is important as an acute therapeutic intervention for treatment of moderate to severe AD. Using clothing instead of bandages makes this intervention simpler, less time intensive, and less expensive. Education of patients and caregivers is critical to success; methodology must be standardized. Future studies must carefully describe all procedure components. Incorporation of validated outcomes tools would help with interpretation. WWT should be considered as a potential treatment option ahead of systemic immunosuppressive therapies for patients failing conventional therapy.
... Given time limitations during traditional medical consultation visits for AD, nurses (ie, nurse practitioners and registered nurses) play a critical role in educating patients and parents about the disease and treatment plan. 43 Nurse-led educational interventions for pediatric patients with AD have demonstrated improvement in outcomes, such as disease severity, use of prescribed skin care plans, and parental confidence in their ability to follow the treatment plan. [44][45][46][47] Clear education about the pathophysiology and chronic nature of the disease can help set the stage for more consistent use of all prescribed elements of the treatment plan. ...
... 48,49 Detailed teaching about application of topical medications and emollients, including demonstration and observation, can help reduce confusion about skin care. 43,44 Sufficient time should be spent during the visit carefully reviewing the patient's individualized written eczema action plan, which will guide treatment at home, depending on fluctuations in disease control. 50,51 Anticipation and discussion of common concerns with the plan can facilitate improved treatment adherence (eg, information about medication safety and side effects and comparison of bleach baths to use of chlorine in a swimming pool to kill bacteria). ...
Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.
... There is evidence that a systematic educational program considering the factor of age substantially improves AD severity scores 53 . Workshops and educational sessions led by a doctor, nurse, or other health care professional 57 , as well as live video or practicing interventions, can be beneficial to patients by improving their knowledge of AD and the use of bathing, skin clearing, and moisturizers and other topical treatments (2b, B) 4 . Recommendations are summarized in Table 4 28,48-50,52-55 . ...
Background:
Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management.
Objective:
We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD.
Methods:
We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations.
Results:
Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD.
Conclusion:
This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
... Children and parents must gain the practical skills needed to manage the condition, including the correct application of the various topical preparations and they need to learn how to discern the subtle changes in skin condition indicating the need for adjustments to the treatment (Barbarot et al. 2013). As well as requiring the knowledge and practical skills, children and parents need to develop the resilience required to manage the condition in the long term, ensuring that they adhere to the treatment requirements (Nicol & Ersser 2010). Algorithms help healthcare providers diagnose and treat eczema, but these give little help on how to provide eczema education following the diagnosis (NICE 2007, RCPCH 2011, Newland et al. 2012. ...
... A search of the literature from 2003-2013, limited to English language, was undertaken using terms 'eczema OR atopic dermatitis', 'education*', 'knowledge', 'framework OR model', 'nurs*', 'parent' in Scopus, Web of Science, Medline, PubMed and CINAHL databases to identify if any frameworks or models had been made explicit in nurse-led eczema education. Six papers were identified where reference was made to a representative framework or model (Ersser et al. 2007, Chisolm et al. 2010 A further eight papers reported success with nurse-led eczema educational interventions, focussing on various aspects, all of which seem to be important (Cork et al. 2003, Grillo et al. 2006, Moore et al. 2009, Nicol & Ersser 2010, de Bes et al. 2011, Friedman et al. 2011, Barbarot et al. 2013, Stalder et al. 2013). This highlights the need for a framework, which synthesizes these elements and which is based on sound educational theory. ...
... At no point were health behaviours, an important aspect of SCT, linked to patients' or parents' existing and newly gained knowledge about eczema. These are needed to master eczema care (Nicol & Ersser 2010). None of what is currently known about learning and knowledge was examined, with authors, concluding that future research was needed. ...
AimsA discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators.Background
Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions.DesignA discussion paper.Data SourcesA literature search of online databases was undertaken utilizing terms ‘eczema OR atopic dermatitis’, ‘education’, ‘parent’, ‘nurs*’, ‘framework’, ‘knowledge’, motivation’, in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003–2013.Implications for NursingThe framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema.Conclusion
Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions.
... 7 There are a wide range of educational approaches to support parents and children with eczema. 8 Health policy strongly advocates self-management for longterm conditions. 9 The Expert Patient Programme 10 is a lay-led generic training programme for adults with long-term conditions; it is not disease specific. ...
The systematic support of parents of children with eczema is essential to their effective management; however, we have few models of support. This study examines the rationale, evidence base and development of a large-scale, structured, theory-based, nurse-led intervention, the 'Eczema Education Programme' (EEP), for parents of children with eczema.
To outline development of the EEP, model of delivery, determine its feasibility and evaluate this based on service access and parental satisfaction data.
Parent-child dyads meeting EEP referral criteria were recruited and demographic information recorded. A questionnaire survey of parental satisfaction was conducted 4 weeks post EEP; parental focus groups at 6 weeks provided comparative qualitative data. Descriptive statistics were derived from the questionnaire data using Predictive Analytics Software (PASW); content analysis was applied to focus group data.
A total of 356 parents attended the EEP during the evaluation period. Service access was achieved for those in a challenging population. Both survey data (n = 146 parents, 57%) and focus group data (n = 21) revealed a significant level of parental satisfaction with the programme.
It was feasible to provide the EEP as an adjunct to normal clinical care on a large scale, achieving a high level of patient/parent satisfaction and access within an urban area of multiple deprivation and high mobility. The intervention is transferable and the results are generalizable to other ethnically diverse child eczema populations within metropolitan areas in Britain. A multicentre RCT is required to test the effectiveness of this intervention on a larger scale.
... 6 Health policies advocate support for self-management of people with long-term skin conditions. 7 There are examples of nurse-led clinics that have delivered education more systematically in primary and secondary care 8 ; however, their evaluation is limited. A Cochrane review, now being updated, revealed few robust trials evaluating educational interventions for child eczema, with some evidence for two models: multidisciplinary team-led education and nurse-led delivery. ...
The systematic support of parents of children with eczema is essential in effective disease management. The few existing support models have a limited evidence base. This paper reports the outcome-orientated service evaluation of an original, extensive, social learning-theory based, nurse-led Eczema Education Programme (EEP).
To evaluate the EEP using specified child and parental outcomes and service impact data.
From a sample of 257 parent–child dyads attending the EEP, a pretest–post-test design evaluated its child impact using health-related quality of life measures (Infants' Dermatitis Quality of Life index, which includes a small dermatitis severity element, and Children's Dermatology Life Quality Index), severity measures (Patient Orientated Eczema Measure), a new parental measure (Parental Self-Efficacy in Eczema Care Index) and service impact data based on general practitioner (GP) attendance patterns pre- and postintervention.
Statistically significant impacts were observed on infant quality of life (P < 0·001), child quality of life (P = 0·027), disease severity (P < 0·001) and parental self-efficacy (P < 0·001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post-EEP reduced by 62%.
The EEP appears to be an effective model of delivering structured education to parents of children with eczema, and one generalizable to other multiethnic metropolitan populations. As a noncontrolled study, this rigorous service evaluation highlights the model's significance and the case for an evaluative multicentre randomized controlled trial of this educational intervention to inform a nurse-led programme of care.
