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Poster Abstracts From DNA 2019 Annual Meeting

Journal of the Dermatology Nurses' Association: September/October 2019 - Volume 11 - Issue 5 - p 231–233
doi: 10.1097/JDN.0000000000000482
DEPARTMENTS: Abstracts
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Using Appearance-Based Feedback to Reduce Indoor Tanning Intentions

Caitlin Britt Schwartz, DNP, ARNP, FNP-C, Loyola University New Orleans, New Orleans, LA. E-mail: caitlin.britt.schwartz@gmail.com

BACKGROUND OF STUDY/INQUIRY: Skin cancer is the most common form of cancer in the United States with one in five Americans developing skin cancer in their lifetime. College-aged students engage in high-risk indoor tanning behavior as a perceived appearance enhancement. As a strongly modifiable risk factor, indoor tanning largely contributes to skin cancer prevalence among the young adult population with 450,000 cases linked annually to indoor tanning.

PURPOSE OF STUDY/INQUIRY: The objective is to reduce intentions to indoor tan among college-aged students using appearance-based feedback obtained through Sunface, a socially progressive photoaging smartphone application using Fitzpatrick skin type, ultraviolet (UV) light exposure, and sun protective behaviors as variables.

METHODOLOGY/METHODS—ANALYTICAL APPROACH: The Sunface application photoages the users’ self-portrait (“selfie”) based on Fitzpatrick skin type, intentional UV exposure, and sun protective behaviors. Participants complete a postintervention 5-point Likert scale survey after viewing the Sunface application’s appearance-based feedback (i.e., the “selfie”) to measure (a) personal intentions to indoor tan, (b) perceived attractiveness of UV indoor tanning “selfie,” (c) perceived susceptibility to skin cancer, and (d) personal intentions to use sun protection.

FINDINGS/IMPLICATIONS: Findings from the appearance-based feedback from the Sunface application include (a) reduced personal intentions to indoor tan, (b) decreased perceived personal attractiveness with indoor tanning, (c) increased perceived susceptibility to skin cancer, and (d) increased intentions to use sun protection. Implications for individualized appearance-based feedback include increased awareness and advocacy for the harmful effects of intentional indoor tanning to skin’s appearance as well as the increased risk for malignancy.

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Virtual Dermatology Grand Rounds

Theresa Coyner, MSN, ANP-BC, DCNP, Randall Dermatology, West Lafayette, IN. E-mail: tecoyner@gmail.com

Katrina Masterson, DNP, FNP-BC, DCNP, Randall Dermatology, West Lafayette, IN. E-mail: kmaster@tctc.com

BACKGROUND: For many years, grand rounds have been utilized as a teaching tool in academic centers. Recent technological advances allow for more widespread use. Individuals can now participate from multiple locations. This teaching tool was implemented by the Dermatology Nurses’ Association (DNA) Nurse Practitioner Society to allow for member interaction on challenging dermatology patient cases.

PURPOSE: The objectives are to enhance dermatology nurse practitioners’ knowledge of diagnosis and testing and increase networking opportunities for dermatology nurse practitioners.

METHODOLOGY: Four case studies were presented via PowerPoint with provisions for participant interactions in determination of differential diagnoses and treatment strategies. Each presentation was presented via teleconference on the DNA continuing education platform. Presentations were offered during work lunch hours in each of the four U.S. time zones. Continuing education credit was awarded to participants after completion of program evaluation. Each presentation was archived and placed upon the DNA enduring continuing education to allow individuals unable to attend the “live” presentation to participate in the learning activity.

FINDINGS/IMPLICATIONS: Participant evaluations were extremely positive for each presentation. Rates of participation were highest when offered during the lunch hour in the east coast and west coast time zones, which reflects the membership patterns of the DNA. Although the evaluations were positive, attendance was less than expected. The members of the Nurse Practitioner Society leadership are evaluating how to utilize this teaching tool in the most cost-effective platform, allow for best attendance, and enhance member engagement.

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Case Study: New and Emerging Treatment for Primary Cutaneous B-Cell Lymphoma

Allona Metcalf, LPN, Mayo Clinic Dermatology, AZ. E-mail: Metcalf.Allona@mayo.edu

Jennifer Ernst, MSN, MS, APRN, GCNS-BC, Mayo Clinic, AZ. E-mail: Ernst.Jennifer@mayo.edu

BACKGROUND OF STUDY/INQUIRY: Cutaneous B-cell lymphoma is a cancer that develops from skin-based B-cells. The most common forms are slow growing and respond well to localized therapy. Historically, treatment options for cutaneous B-cell lymphoma included radiation, surgery, topical steroids, topical chemotherapy, and infusions of rituximab.

PURPOSE OF STUDY/INQUIRY: The objective is to identify an additional treatment option for primary cutaneous B-cell lymphoma that is safe and cost effective and that can produce disease remission.

METHODOLOGY/METHODS—ANALYTICAL APPROACH: Case Study: A man in his 40s presented with a 2-year history of spontaneously developed nodules on his scalp. Biopsy confirmed primary cutaneous B-cell lymphoma. The patient favored localized treatment options. Pretreatment included 1000 mg of Tylenol and 50 mg of Benadryl. Lesions were treated with intralesional rituximab three times over 1 week’s time. Each lesion was treated with 2.5–20 mg of rituximab with a cumulative dose of 158 mg. The patient reported low-grade fever after the first injection; thus, 60 mg of prednisone was added to his pretreatment schedule. The patient denied any further side effects and tolerated injections well.

FINDINGS/IMPLICATIONS: The patient has had no signs of recurrence after 24 months. He tolerated therapy well with little to no side effects noted. The average dose of intralesional rituximab is significantly less, and therefore, a more affordable option to infusion therapy. In 2015, the annual cost per-patient expenditure for rituximab 375-mg/m2 infusions was $33,425–$45,771. Interlesional rituximab is a safe and effective treatment for primary cutaneous B-cell lymphoma at a fraction of the cost of infusion therapy.

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The Nurse’s Role in Melanocyte–Keratinocyte Transplantation Procedure

Nicole VanHaaren, BSN, BBA, RN, Henry Ford Dermatology, Detroit, MI. E-mail: Nvanhaa1@hfhs.org

BACKGROUND: Vitiligo is a long-term and noncontagious skin condition that causes the skin to lose its normal color. Vitiligo can affect a person’s daily life with a negative body image and depression. Over the last 6 years, I have been working with patients with vitiligo and assisting with melanocyte–keratinocyte transplantation procedure (MKTP). I have also participated in the evolution of the nurse’s role in MKTP over the last 6 years

PURPOSE: The objective is to explain the importance of the nurse’s role in MKTP and the impact on patient care.

METHOD: The nurse’s role in MKTP starts at the beginning of patient interest to months after the procedure has been completed.

▸ Prescreen for candidacy and education, patient consult, and patient email

▸ Room and laser setup, safety details

▸ Preoperative: medications, patient history, vitals, weight, photos, shave donor and recipient sites

▸ Anesthetize donor site

▸ Monitoring patient during procedure

▸ Patient cell separation completed by Registered Nurse

▸ Application of cell suspension and application of specialized dressings

▸ Postoperative: vitals, postoperative instructions

▸ Patient follow-up for continuity of care

IMPLICATIONS: After a review of the poster, the reader will be able to identify the steps in the nurse’s role for MKTP, the details of cell separation, proper MKTP dressing application, and the importance of continued education and follow-up care post MKTP.

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Implementation of an Evidence Based Practice (EBP) Project Using an External Vibratory Device to Decrease Patient Pain With Analgesic Infiltration

Jessica Snyder, RN, BSN, Mayo Clinic Dermatology, AZ. E-mail: Snyder.jessica@mayo.edu

Allona Metcalf, LPN, Mayo Clinic Dermatology, AZ. E-mail: Metcalf.allona@mayo.edu

Jonna Allen, RN, BSN, Mayo Clinic Dermatology, AZ. E-mail: Allen.jonna@mayo.edu

Jennifer Ernst, MSN, MS, APRN, GCNS-BC, Mayo Clinic Dermatology, AZ. E-mail: Ernst.Jennifer@mayo.edu

BACKGROUND OF STUDY/INQUIRY: Buffering lidocaine with sodium bicarbonate has been shown to reduce pain with injections of local anesthetic. Because of changes in pharmaceutical regulations related to compounding medications, this preparation of lidocaine is no longer supported and has been eliminated from our practice.

PURPOSE OF STUDY/INQUIRY: The practice change has directly resulted in an increase in patients experiencing pain with injections of local anesthetics. In an effort to reduce patient pain with infiltration, our search led us to an external vibratory device that has been shown to reduce pain experienced during injection in similar settings.

METHODOLOGY/METHODS—ANALYTICAL APPROACH: The success of this device has been attributed to the gate control theory of pain. By placing the vibratory device between the pain and the brain, the vibration closes the gate between the site and the spinal cord interrupting the signal to the brain. We obtained four devices and dedicated nursing resources in pursuit of this practice change. Staff was educated on the theory and use of the vibratory devices. Baseline pain score data were obtained for the month before implementation.

FINDINGS/IMPLICATIONS: With the addition of the external vibratory device to our injection work flow, we have a decrease in patient-reported pain scores. Use of nonpharmacologic interventions successfully decreases pain during injections. This nursing intervention can be initiated without a physician’s order and has not increased length of appointment.

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