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Ann Giles talks to DrB
Ann Giles, RGON, BHSc(Nursing), BA (Hons)(Nursing) qualified as a Registered Nurse in Auckland, New Zealand (NZ) in 1976 and found her passion in Dermatology in 1996. Since then she has worked as a dermatology nurse in the Department of Dermatology, Auckland District Health Board. Educating people with eczema about skin care is part of her everyday work. Ann is the President of the NZ Dermatology Nurses’ Society. She became a member of AtopicSkinDisease.com in 2012.
DrB: Ann, please tell us a little about the services in New Zealand for people with skin problems, and especially about the dermatology nursing service.
AG: The New Zealand Dermatology services are divided into those that are part of the public health service, and those that are available privately. A full spectrum of treatments are available, including dermatological surgery. The specialized role of the dermatology nurse has become established only in the last 20 years - previously in the public service general nurses worked in dermatology, while sometimes in private dermatology allied health professionals such as receptionists were trained to work alongside the dermatologist. There is currently no formal dermatology nursing qualification available in New Zealand. Rather, nurses gain experience in dermatology through ‘apprentice style’ learning, ‘on the job’ training and by attending dermatology conferences. However, several nurses now have specific overseas qualifications or higher tertiary qualifications, gaining titles such as Dermatology Nurse Specialist, and Dermatology Nurse Practitioner. Of course it is important that skin problems are also seen and treated in primary care, where increasingly now some family practitioners have a special interest in dermatology. In New Zealand there are also a number of support groups for skin conditions in general, and for eczema in particular.
DrB: How did you discover The Combined Approach, and this website?
AG: The Combined Approach was first mentioned to me by one of the dermatologists in my department who had recently returned from training and working in the UK. I was encouraged to look up the website with a view to considering using at least some aspects of The Combined Approach with our patients. The approach is good because it encourages the patient to take charge of their eczema, rather than letting it control their lives, and with the promise of an improved treatment success rate, there will be an overall decrease in the amount of medication required, and less likelihood of complications requiring for example sometimes multiple hospital admissions.
DrB: What on the site have you found useful so far?
AG: I have always been interested in skin conditions that cause people to itch and scratch, and I know from clinical experience that simply telling someone not to scratch never works! Such negative advice is impossible to follow. The articles on habit reversal, and optimal use of topical steroids, are especially useful, both for passing on to our patients, and for staff training. I have been invited to speak at an education day for dermatology nurses in Australia later this year. I will take the opportunity of introducing The Combined Approach and this website to the delegates.
DrB: Do you agree that providing The Combined Approach to atopic eczema does not require any special psychological training?
AG: Yes, I do agree, which is important, as we do not have any experts in behavioural medicine in our department. If we can negotiate appropriate dedicated time, with a nurse to coordinate the programme, we will be able introduce the full approach as described on this website. For us it is always a time issue. In my experience, it is never satisfactory to provide a patient education programme, like The Combined Approach to atopic eczema, if there are severe time constraints.
DrB: Thank you. I think you are right. The Combined Approach to atopic eczema is best seen as a dermatology patient education programme. The clinic-based format especially involves some professional time, but of course it then goes on to save time in the long run, both for patient and the patient’s family, as well as for the practitioner and the dermatology department. As an educational approach towards the effective and efficient self management of what is otherwise a chronic condition, it is at Level 1 in the recently published recommendations for Minimum Standards for Psychodermatology Services from the British Association of Dermatologists. As Dr Peter Norén explains, habit reversal is simple to explain, and very easy to use. The overall approach is best understood as supported self-help. The support can come from a Dermatologist, a Nurse, or a Family Practitioner, as well as through membership of AtopicSkinDisease.com.