Amending mindlines to improve eczema self-management and consultation experiences

Atopic eczema is among the fifty most burdensome diseases worldwide. Effective care requires diligent self-management. The cornerstone of treatment is regular and consistent use of topical emollients and use of topical corticosteroids (TCS) as required. Treatment failure is common and wastage of prescribed preparations is high. Primary care consultations can be unsatisfactory for patients and practitioners

"That's how we do it...we treat them all the same": an exploration of the experiences of patients, lay carers and health and social care staff of the care received by older people with dementia in acute hospital settings.

... we treat them all the same' This study aimed to explore the experiences of patients, lay carers and health and social care staff of care received by older people with dementia in the acute hospital setting. In view of the ageing population, an increasing prevalence of dementia and the emerging dignity agenda this is a particularly topical subject. Four elements are included in this thesis: a literature review, a research study, a practice development project and an integrative review. A literature review sets person-focused research in the context of dementia research as a whole. It also identifies ways in which studies have been conducted in an ethical and meaningful manner. An ethnographic approach was used in the research study to collect data through observation, conversations and interviews. Findings portray a bleak picture of the care of this vulnerable group. Patients demonstrated, through words and actions, how difficult they found the experience. Lack of communication was an issue as was the obvious distress caused by delivery of personal care. Lay carers were relatively uncritical although this may have been due, in part, to the recruitment process. Staff generally appeared to have good intention. Most stated that they had received little or no preparation or education in dementia care. Many staff functioned almost entirely within thebed and body'framework. They frequently avoided communication with patients. Staff worked in a deeply embedded habitus, in which they appeared not to really think about what they were doing. They demonstrated a lack of empathy with patients. The concept that staff were working in a 'switched off mode and lacked empathy called for a practice development project that engaged them on both cognitive and emotional levels. A practice development project based on the philosophies of confluent education and situated learning was implemented. Initial evaluation has demonstrated some tangible changes in practice. An integrative review draws these elements together into a coherent whole. Potential contributions to the body of knowledge are acknowledged, as are limitations of the work. This study has shown that people with dementia, even those at an advanced stage and with superimposed physical illness, can be engaged in research that is both ethical and meaningful. It has shown that improvements in practice are possible. They need to be underpinned by a belief in the personhood of staff as well as patients. Areas for further research and practice development in this vital subject have been identified

Knowledge mobilisation: an exploratory qualitative interview study to confirm and envision modification of lay and practitioner eczema mindlines to improve consultation experiences and self-management in primary care in the United Kingdom

Objectives: To investigate whether initial eczema mindlines, “collectively reinforced, internalised, tacit guidelines”, are an accurate representation of the experiences of lay people and practitioners in primary care and to explore how these mindlines may best be revised to improve eczema care. Design: Exploratory qualitative interviews with constant comparative analysis and data mining. Setting: United Kingdom, primary care Participants: People with eczema or parents of children with eczema (n=19) and primary care practitioners (n=13). Results: Interview data were analysed using constant comparison of new data with existing initial eczema mindlines to identify areas of agreement and disagreement. Data were mined for participant’s thoughts about whose mindlines should be modified, how this may be achieved and what core content is essential. Eczema mindlines and the spiral of knowledge creation, from which they evolved, intuitively made sense. Participants offered examples of how their eczema knowledge is continually produced and transformed as they interact with others. They reported diverse and wide-ranging influences on their thinking and recognised the critical relationship between lay and practitioner mindlines. For this reason they advocated modifying lay and practitioner mindlines in parallel. Participants advised amendment based on consistent information directed to all who influence eczema care. Information should come from trusted sources and be easy to access, distilled, practical, contextually relevant and amenable to assimilation. Conclusions: The purpose here is to improve primary care consultation experiences and self-management in eczema. The remaining challenge is to find novel, simple and pragmatic methods of modifying eczema mindlines to instill shared and consistent understanding. Given the prevalence of eczema and the scope of people who influence self-care, interventions should transcend patient-practitioner boundaries and address the wider community. One conceptually congruent approach is to create a Ba, which in this case would be a virtual space for generating and sharing eczema knowledge

Adjuncts to eczema care: different methodological approaches

The quest for acceptable and effective ways of managing eczema goes on. The mainstay of treatment is the regular application of topical preparations. This can be challenging patients, parents and children alike and it is well known that treatment concordance is hard to achieve. There is ongoing interest in non-pharmacological adjuncts to eczema care. Investigation of these approaches has been conducted using different research methods, each of which have a particular value. Review of three recently published papers illustrates how a systematic review, a randomised crossover trial and an exploratory qualitative study have contributed to knowledge generation around adjuncts to the treatment of eczema

Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK

Objective To investigate the way in which mindlines, ‘collectively reinforced, internalised tacit guidelines’, are constructed among lay people with eczema in primary care. Design Ethnographic study. Setting Observation in one general practice in the UK and interviews across central England. Participants In observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (n=16). Results Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people’s approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care. Conclusions This study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information

Skin health concerns in community-dwelling older persons: the nursing role in primary care

By 2050, the world population of people aged ≥65 years is estimated at over 2 billion (World Health Organisation 2018a). This represents a positive change, but is also a substantial socio-economic challenge which brings with it the need to enhance the ways in which nurses support healthy ageing. Skin is the largest organ of the body which, with ageing, undergoes, intrinsic and extrinsic changes which have physical and psychosocial sequeale. The purpose of this article is to review skin changes associated with ageing, synthesise existing knowledge about the experiences of community-dwelling older people of their ageing skin and examine how this may influence health care. The important role of the nurse in promoting maintenance of skin health for this population is explored

Nurses and dermatology research: A national survey

A working group was convened between the British Dermatological Nursing group (BDNG) and the UK Dermatology Clinical Trials Network (UK DCTN) to identify involvement, understanding and training requirements of dermatology nurses. A survey was constructed and electronically distributed to members of the BDNG. This article summarises the results of the survey and identifies first steps in developing resources to address the highlighted needs

Effects of short-term temperature change in the innocuous range on histaminergic and non-histaminergic acute itch

While temperatures in the noxious range are well-known to inhibit acute itch, the impact of temperature in the innocuous temperature range is less well understood. We investigated the effect of alternating short-term temperature changes in the innocuous range on histamine and cowhage-induced acute itch, taking into account individual differences in baseline skin temperature and sensory thresholds. Results indicate that cooling the skin to the cold threshold causes a temporary increase in the intensity of histamine-induced itch, in line with previous findings. Skin warming increased cowhage-induced itch intensity. Potential mechanisms of this interaction between thermosensation and pruritoception could involve cold-sensitive channels such as TRPM8, TREK-1 or TRPC5 in the case of histamine. The rapid modulation of cowhage induced itch - but not histamine-induced itch - by transient skin warming could be related to the lower temperature threshold of pruriceptive polymodal C-fibres (cowhage) as compared to the higher temperature threshold of the mechanoinsensitive C-Fibres conveying histaminergic itch