Registered Deryn Thompson is part of the rollout of international best practice guidelines at the Women’s and Children’s Hospital nurse-led eczema clinic.
Typically described as a ‘deep itch that never goes away’, it is little wonder that eczema has greater psychological impacts than insulin-dependent diabetes. And the number of children affected by the condition—with its trademark dry, itchy and reddened skin—has tripled in the past 30 years.
Registered Nurse Deryn Thompson has been working diligently to help lessen the emotional and physical impact of the condition on children (and their parents)—for the past decade via an established nurse-led clinic at the Women’s and Children’s Hospital.
“Eczema is caused by a combination of genetics and the environment and has significantly increased in prevalence in western countries for reasons not yet understood,” Deryn says.
“Our goal at the clinic is to educate parents (and children when they’re old enough) to help each child function as though the condition is part of their world, not their whole world,” she says. “And international best practice guidelines (BPGs) are certainly helping us achieve that for families.”
The Women’s and Children’s Hospital (WCH) Network has this year achieved accreditation as a Best Practice Spotlight Organisation site for its rollout of evidence-based BPGs developed by the internationally acclaimed Registered Nurses’ Association of Ontario.
For four hours each week, Deryn’s nurse-led clinic at the WCH provides children and their parents or carers intensive one-on-one interactive eczema education and ongoing support.
“Managing eczema involves the whole family, so parent education is crucial for ongoing care, because there is no known cure.”
She says the chronic itch and fluctuating nature of the condition requires nurses to provide intense support and demonstrations to parents and children initially to enable them to learn how to master the condition.
“Nurses have a much bigger role in the beginning, when you’re starting the process and parents don’t know anything about the condition. As I help people to apply that knowledge, my role lessens and they become empowered to manage the condition autonomously.”
She says the BPGs on Person and Family Centred Care and Client Centred Learning are providing significant guidance in her role.
“The L.E.A.R.N.S. model is a central tenant of learning in both BPGs, which helps me to guide parents to develop the problem-solving and decision-making skills they need to be able to control the condition.”
The model guides Deryn to help parents interpret information, develop analytical thinking and reasoning skills, re-organise information, develop problem-solving capabilities and become motivated to change their behaviours in not only their thinking, but how they provide care to their child.
“Quite simply, I help parents join the dots. And everyone is an individual, joining the dots differently. I bring all the information together for families in a way that’s meaningful for them, it becomes knowledge they understand, and I can check that they understand what they need to do.”
Deryn leads the clinic with the support of an allergist and a dermatologist and sees around 200 children a year—from very young babies to older teenagers.
“The clinic is also linked to psychological medicine if the condition has reached the point where it is controlling the whole family.”
“Some parents have come to us and they and their child haven’t slept well for five years. Other families may have children who are bath-phobic because it hurts too much to have a bath.”
She says any degree of eczema has enormous impacts on sleep and daily activities, such as school, sport, work and peer relationships.
“Preventing the condition from controlling the lives of affected children and parents comes down to instilling confidence in parents to properly manage the condition and any flare-ups.”
“We identify the triggers, which can be soap, shampoos or overheating children by wrapping them up too much in winter or overheating the house. Food allergy links are complex and need allergy specialist input.”
While the various treatment options available can be overwhelming for parents, Deryn says the mainstay is to use enough moisturiser.
“To effectively manage the condition and reduce dry skin, a teenager should be using around 500gms of thick moisturiser a week, about half of that for a younger child. Moisturiser needs to be used a minimum of twice a day, more often is better.”
Medicated topical corticosteroid cream, wet wraps, cold compresses, anti-itch behaviour techniques and diluted bleach baths are also treatments that can have a significant impact on controlling the condition.
“Some parents fear the idea of bleach baths, but it’s just the same dilution as a swimming pool and these baths are a major help to children who have infected eczema.”
Facilitating the learning process in parents to understand the triggers and know what treatment to use, when and how often is helped by the nurse-led principles of the best practice guidelines.
“We’re already aligning our service to the client-centred learning BPG, which recommends breaking up the information into manageable pieces using a ‘metaphorical toolbox’ to compartmentalise the learning so it’s not so overwhelming.”
“The Person and Family Centred Care BPG provides significant guidance on nurses taking time to listen, identify clients’ cultural and personal beliefs, life circumstances, preferences for learning, learning styles, modes, readiness to learn and literacy levels to establish and respect clients’ perceptions of their health and previous health experiences.”
This shared care and partnership philosophy has led Deryn to some surprising discoveries.
“I discovered there is no word for ‘eczema’ in some African, Asian and Middle Eastern languages. Because of that, we were unknowingly translating the condition as ‘itchy skin’, leading the families to only be treating half of the problem with corticosteroid creams. We now make sure we translate eczema as ‘dry and itchy skin’ so moisturiser is used too.”
Health professionals understanding that, she says, can make a huge difference to a person with eczema.
“Ultimately, the best outcome is when you see families come into the clinic and they’re happy, smiling and sleeping. I can see the child’s skin is well moisturised, is not red and itchy, and their whole demeanour has changed.”
“They feel happy and confident. They know the eczema is not cured, but they can manage it confidently and get on with living their life.”