ENHANCING SKIN PROTECTION KNOWLEDGE AND PRACTICES OF VETERANS ADMINISTRATION NURSES
Creators: name: Jallorina, Remedios Agualin
Publisher: name: Zenodo
Year: 2019

description: Skin cancer is the most common cancer in the United States with rates increasing for all types of skin cancers. Ultraviolet radiation (UVR) exposure, as well as genetics, contribute to skin carcinogenesis. Veterans and persons living in sun-rich areas such as desert communities are at increased risk due to UVR exposure. The annual cost of skin cancer care is predicted to be near $5 billion for treating nonmelanoma skin cancer and approximately $3.3 billion for melanoma. In addition to skin carcinogenesis, UVR is the primary cause of premature photoaging which has a $300 billion dollar antiaging industry worldwide. Studies conducted among medical and nurse practitioner students show lack of skin protection knowledge and inadequate practices. This DNP project developed, implemented, and evaluated a 2-hour training module for advanced practice nurses (APNs) at the VAMC in Las Vegas, Nevada, using Health Belief Model constructs and Knowles’ Adult Learning Theory. The module was presented summer 2018 with 31 participants. A pre and immediate post-test assessing knowledge, practices and beliefs was administered, and a second post-test was administered 12 weeks later. Post-training, participants increased their knowledge (mean score 59% pre-test to 76% post test). The highest score increase was related to the cause of premature photoaging, p &lt; .001. Sunscreen was the primary method of skin protection reported by 78% of the participants. Actual skin protection practices increased: from 3.3 times per iv week at pre-test, an intention of 6.4 times at immediate post-test, to 4.9 times per week at 12 weeks. This indicates an overall effect of time, F(2) = 8.489, p = .001, partial eta squared = .207, with a significant increase in actual use at 12 weeks. Also, Chi-squared analysis showed significant increases in patient education attempts at 12 weeks, X 2 (4) = 24.2, p &lt; .0001. Moreover, there was a significant decrease in the number of nurses who “rarely” recommend skin protection of from 17% pre-test to 1% at 12 weeks. Significant increases were found in items indexing HBM constructs of perceived susceptibility, perceived severity, and the likelihood of practicing skin protection from pre- to immediate post-test. The threat of skin cancer and photoaging prevention moderately influenced nurses’ practice (perceived benefits). These results support prior studies showing that skin cancer and premature photoaging prevention knowledge is lacking among APNs. This implies that the USPSTF recommendation of providing patient education for skin prevention is not being implemented. Short training such as that done in this project can enhance APN knowledge and skin protection practices, as well as change nurse behaviors with patients related to skin protection, skin cancer causes, protection methods, and routine skin examination recommendations should be added to the curriculum in APN/MSN programs, and should be one of the required training for the nurses at the VAMC for their own benefits and to educate the Veterans.