Date of Award

Spring 5-22-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Sharon B. Kepple, PhD, MSN, FNP-C, PHN (Chickasaw)

Second Advisor

Sanjeev Jain, MD, PhD

Abstract

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action Plan, using the template created by the American Academy of Dermatology (AAD), for patients less than 18 years of age at multiple private allergy clinics in California and Washington. The EAP provides written instruction for how to cleanse and moisturize skin when symptoms are controlled and during a flare, what medications should be used during a mild and moderate flare, and what symptoms should prompt the patient to follow up with their allergist. The implemented clinical intervention included providing an individualized EAP, in addition to standardized written education materials about eczema and its treatment compiled into one handout from the National Institute of Health (NIH) and the AAAAI to the parent or caregiver of the pediatric patient. Patient outcomes were measured using the University of Nottingham’s validated Patient Oriented Eczema Measure (POEM) form and parental outcomes were measured using Parental Self-Efficacy Care Index (PAESCI) survey at the introduction of the EAP and again at 6-9-weeks post-intervention. Of the 24 participants enrolled, 20 completed the study. Patient ages ranged from 9 months to 17 years. PAESCI scores increased from an average of 47/70 pre-intervention to 60.9/70 post-EAP use, indicating increased caregiver self-efficacy. POEM scores decreased from an average of 8.65/28 pre-EAP to 4.1/28 post-EAP, indicating a reduction in eczema severity. At the time of receiving the EAP, parents had an average understanding of 8.9/10. This increased to an average understanding of a 9.65/10 after using the EAP for 6-9 weeks, indicating increased understanding after use. Benefits of EAPs along with written education materials include reduction of patient costs on office visits and medications due to flares, improved medication adherence, improved patient and caregiver understanding, and improved patient quality of life. Use of an EAP within an allergy clinic can also allow for better continuity of care between the patient’s primary care providers and their allergists.

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