The use of a nurse-led education program in reducing pediatric eczema

Abstract

Atopic eczema is a chronic relapsing inflammatory skin disease commonly associated with atopy. The disease is common in early childhood and is characterized by dryness of skin, itchiness and skin flexures. There has been no cure for the disease. Treatments of atopic eczema focus on relieving symptoms, maintaining skin integrity and preventing secondary infection. With good compliance to the treatment, most patients may obtain optimal control. Education is essential for good compliance to the treatment. In local public acute hospitals, the current service provided restricts the time for comprehensive patient education during follow-up by physicians. Some studies indicated that nurse-led programs are effective in managing chronic illness because patients have longer consultation time and more information. The effect of nurse-led program in managing common chronic disease like atopic eczema may be promising. However, there was no systematic review on the use of nurse-led education program in reducing pediatric eczema in the local setting.

Against the above background, this dissertation aims to systematically evaluate the current evidences on the effectiveness of nurse-led education program for pediatric eczematous patients in reducing the severity of eczema, to develop an evidence-based guideline of the program, to assess the implementation potential and to develop implementation strategies and evaluation plan.

A systemic review of the literature from Medline (Ovid SP), PubMed and CINAHL (EBSCOhost) was conducted. A total of 298 citations were retrieved after the database search. Finally, 5 studies were identified and included in the systemic review. Data were extracted and the quality of each included studies was assessed with the help of the appraisal instruments. In which, one study was methodologically strong, two studies were of moderate methodological qualities and two studies were of poor methodological qualities. Among the four studies with severity of eczema as outcome measures, three studies showed significant in reducing severity of eczema. Therefore, we considered sufficient evidence that supported the use of nurse-led education program in reducing pediatric eczema.

An evidence-based guideline of the program was developed. The characteristics of the patients in the local setting are similar to those of the identified studies. The availability of the resources and the readiness of the staff towards the proposed innovation are supportive in the local setting. Thus the findings of the reviewed studies were transferable and the proposed innovation was feasible. Cost-benefit analysis showed that the proposed program could be able to generate a potential saving of about $ 550,000 in the local setting annually.

In the implementation plan, a three-month pilot study on ten patients will be conducted before the implementation of the program. Evaluation will be made after the end of the pilot study and the end of the implementation program. Refining of final protocol will be done according to the evaluation and comments from the pilot study. The severity of eczema and the patient’s satisfaction are considered as primary and secondary patient outcomes respectively. The healthcare provider outcomes are the staff morale and the workload. Systematic outcomes are the admission rate of pediatric ward and the attendance rate of pediatric outpatient clinic, and the cost of innovation. Finally, patient outcomes, healthcare provider outcomes and systemic outcomes would be evaluated in order to identify the effectiveness of the program.