Download The use of emollient therapy for ageing skin

Continuing professional development
The use of emollient
therapy for ageing skin
NOP580 Watkins P (2011) The use of emollient therapy for ageing skin.
Nursing Older People. 23, 5, 31-37. Date of acceptance: March 28 2011.
Abstract
Skin ageing has intrinsic signs and symptoms, often complicated by extrinsic photo-ageing symptoms and
concurrent disease processes. It progresses with age but varies between individuals and its symptoms are
numerous. Skin ageing has physical and psychosocial repercussions that can influence coping.
Emollient therapy can help to reduce two symptoms – dryness and loss of the skin’s barrier function.
Better understanding of skin ageing and the usefulness of emollients can be reinforced by education and
encouragement from healthcare professionals.
Such interventions should encourage self-management and confidence in using emollients. The
partnership between healthcare professionals and older people helps to overcome co-existent ageing
difficulties, such as cognitive impairment, hearing loss and impairment of manual dexterity and mobility,
which enhances self-reliance.
Aims and intended learning outcomes
The aim of this article is to help develop nurses’
knowledge of the characteristics of skin ageing and
their contribution towards deterioration and loss of skin
function. It will also help to develop nurses’ knowledge
of emollients and emollient therapy, and how this
can help to reduce some of the detrimental effects
of skin ageing, as well as improve understanding of
the role of healthcare professionals in educating older
people in emollient therapy and encouraging optimal
self-management and self-reliance.
After reading this article, you should be able to:
■■ Summarise the characteristics of skin ageing and
the associated deterioration and loss of
skin function.
■■ Describe the types of emollients and their roles in
maintaining the skin barrier.
■■ Discuss the influence of effective emollient
therapy in helping to minimise skin ageing and
loss of function.
■■ Describe the educational and supportive role of
healthcare professionals when helping older patients
to cope with the management of ageing skin.
Introduction
In mid-2008, the most numerous age groups
included those born in the post-world war two baby
NURSING OLDER PEOPLE
boom of 1946/51 and the baby boom of 1966/71.
Life expectancy in the UK is expected to rise from
77.8 years to 83.1 years for men and 81.9 years
to 86.9 years for women between 2008/09 and
2032/33 (Office for National Statistics 2010).
This progressive, dramatic rise in the number of
older people helps to frame the importance of skin
ageing. More people will live to an older age and many
will be concerned with skin function and appearance.
The physiological and psychosocial effects of skin
ageing on older people have created a demand for
better understanding of the process, and particularly
for effective interventions (Yaar et al 2002). Patients
want to understand how skin ages and how skin
appearance and integrity can be preserved for as long
as possible.
Some skin changes are part of normal ageing,
they are intrinsic and genetically related. Others are
extrinsic and influenced by the environment. Whatever
the source of skin ageing, the concern remains to
preserve its integrity by sustaining moisture content
and potential as a barrier against infection. Maintaining
the suppleness of the skin, reducing cracking and
redness also have psychological benefits, making the
skin look healthier.
Generally, emollient therapy is the primary
treatment recommended for skin care (Lawton 2004,
Philip Watkins is
clinical nurse specialist,
dermatology, Epsom and
St Helier University Hospitals
NHS Trust, Surrey
Keywords
Emollients, older people,
skin ageing
These keywords are based on
the subject headings from
the British Nursing Index.
This article has been
subject to double-blind
review and checked using
anti-plagiarism software.
For related articles visit our
online archive and search
using the keywords.
June 2011 | Volume 23 | Number 5 31
Continuing professional development
National Institute for Health and Clinical Excellence
2007). Emollients are useful to ensure that the skin
remains intact and healthy (Aycliffe 2007, Radley and
Shaw 2007).
However, emollient therapy is poorly acknowledged,
leading to under-prescribing (Bridgett et al 1996,
Lawton 2004, Clark 2006). With understanding and
support, most people can apply emollients simply and
regain some independence from healthcare professionals
(Cork et al 2003, Cork 2006a, Cork 2006b).
Effects of ageing skin
1
Ageing skin
Time out
Box 1 shows the factors associated with skin ageing.
Intrinsic skin ageing is experienced by everyone and
primarily affects skin function rather than appearance.
However, extrinsic photo-ageing, related to chronic
exposure to ultraviolet light, superimposes chronic sun
damage on skin affected by intrinsic ageing.
Photo-ageing is not universal or inevitable but
is likely in people who have been exposed to
ultraviolet light through sunbathing or during working
hours, for example, roadside workers and farmers.
Photo-ageing affects the appearance and structure of
the skin.
Now do time out 1.
Box 1 introduces some of the features
associated with ageing that are likely to
trigger or exacerbate skin problems. Think
about three older people you have nursed.
How do they describe their skin now?
Are they upset, alarmed or resigned to its
appearance and how it has changed?
What do they say about how they have
looked after their skin?
Time-aged skin appears dry, pale, finely wrinkled, lax
and marked by a variety of benign lesions. In contrast,
the appearance of photo-aged skin depends on skin
type and degree of damage. It may look dry, irregularly
pigmented and yellow-tinged. It may display deep
furrows, severe atrophy, multiple spider-like blood
vessels (telangiectasis) on the skin surface and a variety
of pre-malignant lesions such as mildly sun-damaged,
rough, superficial, pink-red defects (actinic keratoses)
(Yaar et al 2002).
Ageing progresses cumulatively from unrepaired
damage to cells. Deterioration in cell function, with
reduced response to lifelong stressors affecting cell
growth and multiplication, increases the risk of
chronic changes and eventual cell death (Farage et al
2009). In later life, skin cells reproduce at a slower
rate to replace surface damage or loss of skin. Sebum
32 June 2011 | Volume 23 | Number 5
production slows, resulting in less natural oil production
and drying out of skin surfaces. Elasticity of the skin
is compromised by a loosening of the connections
between elastin and collagen fibres. Skin becomes
flaccid. It thins out and loses fat, leaving it less plump
and smooth. Furthermore, gravity pulls at the skin and
causes it to sag. Underlying layers of subcutaneous
fat cells decrease in thickness, leaving the skin more
vulnerable (Finch 2003, Farley et al 2006, American
Academy of Dermatology 2011).
Epidermal thinning during ageing reduces the
effectiveness of the skin as a barrier. The hard
keratin-based skin cells (corneocytes) of the outer
stratum corneum lose their binding ability. This
reduces their capacity for trapping and collecting
water, the result of which is further drying of the skin
(Lawton 2007). In addition to this, production of
Langerhans cells is curtailed, leaving fewer cells to
bind with harmful antigens. Older skin then becomes
more susceptible to infection, and healing is slower
(Ersser et al 2007).
During ageing, recovery of the skin’s barrier function
after damage is delayed, and the barrier to water loss is
more easily disturbed. The time needed to reconstitute
competent stratum corneum is more than doubled in
older people, partly due to a decreased capacity to
synthesise lipids. Age-associated decreases in female
hormone levels significantly influence lipid composition
in the stratum corneum, suggesting an effect on barrier
function in older people (Yaar et al 2002).
Additional threats to skin integrity
Some older people develop incontinence, exposing their
skin to faeces and urine. The skin’s surface becomes
softer and waterlogged, and its barrier function is
weakened. The groin area is most susceptible to this,
and friction from rubbing the damp, warm skin adds
to the risk of skin breakdown (Burr 2007). These
warm, moist creases or flexures can breed fungal and
bacterial communities. Infestations and infections are
likely to result if fine cracks appear in the skin. In
these situations, the breakdown of the skin barrier is
exacerbated (Burr 2007).
Itching (pruritus) can have variable origins.
Localised itching is usually attributable to skin
problems (More 2010). Dry ageing skin can stimulate
localised itching, and people naturally respond to this
by scratching (Bridgett et al 1996). This can rupture
the skin’s surface and disrupt the barrier. Chronic
scratching thickens the skin’s surface and further
contributes to barrier abnormality, which is seen in
conditions such as nodular prurigo and lichen simplex.
Emollients can be effective in ameliorating dry skin and
associated itching, reducing the risk of scratch damage
and ulceration.
NURSING OLDER PEOPLE
Box 1 Factors associated with skin ageing
Lack of fluids
■■ Dehydration.
Dryness
■■ Often affects lower legs, elbows and lower arms, rough, scaly skin.
Itching
■■ Common in older people because of:
– Reduced sebum production (unavoidable).
–■Increased central heating in residential homes (avoidable).
–■Unnecessarily frequent washing in residential homes (avoidable).
–■Pruritus (unavoidable).
–■Asteatotic eczema – dry skin (partially avoidable).
–■Scratching causing bleeding, ulceration and infection (avoidable).
■■ Increased sensitivity to fabric preservatives, wool, plastics, detergents, bleaches,
soaps and other irritants (avoidable).
■■ Prolonged itching may lead to lack of sleep and fatigue (partially avoidable).
Bruising (purpura)
■■ Through rubbing and minor trauma (partially avoidable).
■■ Skin thinning and sun damage (partially avoidable).
■■ Loss of fat and connective tissue weakens support around blood vessels, making
them more susceptible to injury (unavoidable).
Excessive use of soap, antiperspirants, perfumes,
hot baths
■■ Increased use of soap increases pH to 7.5, at which point chymotrypsin enzyme
activity increases by 50 per cent leading to breakdown of the barrier function of the
skin (avoidable).
■■ Can be avoided by reduced use, using warm rather than hot water and frequent use
of emollients as an alternative to soap and perfumes.
■■ Increased sensitivity in ageing skin to detergents, bleaches and soaps (unavoidable).
Sun exposure, tanning, sun beds, lack of clothing
to cover skin and no sun protection
■■ Main cause of skin cancers – actinic keratoses, solar keratoses, basal cell carcinomas,
squamous cell carcinomas, malignant melanomas (avoidable).
■■ Sun spots (lentigines) (Figure 1, page 35), skin tags and wrinkles (partially avoidable).
■■ Raised dermal collagen due to scarring from repeated inflammation and sunburn
(avoidable).
■■ Elastosis from photo-ageing – thickened yellow bumps and loss of elasticity;
thickened dermis loses elasticity and is weaker than normal (avoidable).
Smoking
■■ Skin ageing accelerated (avoidable).
■■ Long-term smokers have more facial lines and yellowish sallow complexion
(avoidable).
■■ May also increase the chance of skin cancers (avoidable).
Stress and frowning
■■ Can lead to wrinkling of skin in the long term (partially avoidable).
Skin types and heredity
■■ Fairer skin damages more easily in ultraviolet light (avoidable).
■■ Tendency to wrinkles is inherited (unavoidable).
Common skin disorders (actinic keratoses,
adult acne, discoid eczema, rosacea, psoriasis,
pemphigoid, seborrhoeic dermatitis, seborrhoeic
keratoses and varicose/asteatotic eczema)
■■ Become more prevalent with age (unavoidable).
■■ Thickening of dermis (unavoidable).
■■ Loss of elasticity (unavoidable).
■■ General weakening of skin (unavoidable).
Outdoor occupation and hobbies – for example, golf, ■■ Exposure to sun and development of skin cancer and photo-ageing.
gardening, bowls, sitting in conservatories
■■ May be avoidable or unavoidable depending on opportunities and availability
of alternatives.
Dry air conditions
NURSING OLDER PEOPLE
■■ Dehydration (partially avoidable).
■■ Possibly avoidable indoors but less avoidable outdoors.
(Continued over page)
June 2011 | Volume 23 | Number 5 33
Continuing professional development
Box 1 Factors associated with skin ageing (continued from page 33)
Loss of sweat and oil glands
■■ Loss of heat control and natural skin oils.
Reduced bone development
■■ Bones shrink away from the skin due to bone loss, which causes sagging skin.
Collagen synthesis and degradation
■■ In women, bone mass and skin collagen decline rapidly in the immediate
postmenopausal years.
Pigmentary changes
■■ Solar lentigo, guttate hypomelanosis and freckles.
Blood discrepancies
■■ Telangiectasis, cherry angiomas and senile purpura.
However, pruritus can be symptomatic of other
problems. If pruritus is universal and not just localised,
a blood test may be needed to rule out a systemic or
drug-related cause. This should include a full blood
count; kidney, thyroid and liver function tests; and in
some cases iron concentrations, stool specimens for
parasitic origins and chest x-rays for lymphomas (More
2010). Box 2 gives a limited list of alternative causes
of pruritus. In my clinical practice I have often been
called out to an older patient to review a suspected
outbreak of scabies. In many cases, the initial
treatment has been prescribed already, but simpler
associated problems are likely to prolong the dry
reddened skin, such as lack of sufficient fluid intake,
being left in clothes contaminated by urine or faeces,
being left next to hot radiators or at windows exposed
to direct sunlight, and overuse of soap or inappropriate
bath products. Cowdell (2009) provides an excellent
and detailed account of pruritus and its many causes.
Now do time out 2.
Box 2 Alternative causes of pruritus
Itching with inflammation
■■ Allergic and contact dermatitis.
■■ Drug-induced reaction.
■■ Eczema.
■■ Reaction to insect bite.
■■ Psoriasis.
■■ Seborrhoeic dermatitis.
■■ Infestations – particularly scabies and mites.
Itching without inflammation
■■ Brain tumours or abscesses.
■■ Cholestasis or renal failure.
■■ Liver disease, hepatitis C or HIV.
■■ Iron deficiency and polycythaemia.
■■ Thyroid disease.
■■ Phantom itch and post-stroke pruritus.
■■ Drug sensitivity.
■■ Xerosis.
(Ward and Bernhard 2005)
34 June 2011 | Volume 23 | Number 5
2
Perceptions of skin care
Time out
(American Academy of Dermatology 2009, 2011, Cowdell 2009, National Institute on Aging 2010, New Zealand Dermatological Society 2010a)
Look through Box 1 again. You have already
thought about how older people in your
care view their skin and how they have
looked after it in Time out 1. Now, what
about their perceptions of skin care? Do
they believe that exposure to sun is healthy
or that soap is good for keeping their skin
clean? What do you think about their ideas?
Can you think of any alternative ideas you
could offer that might tactfully challenge
misconceptions?
Box 3 offers some suggestions on how to avoid
ageing and damage to skin resulting from exposure to
ultraviolet light.
Emollient therapy
Emollients (from the Latin for ‘to smooth and soften’) or
moisturisers (adds moisture) are interchangeable terms
for topical applications that help to stop hardening and
irregularities in the outer horny layer of the skin through
the addition of moisture (Ersser et al 2007, New
Zealand Dermatological Society 2010b).
The essential ingredient of an emollient/moisturiser
is lipid, an inclusive term covering fats, waxes and
oils. Emollients come in a variety of formulations.
Ointments contain a larger percentage of lipid,
whereas creams have a mix of lipid and water plus
emulsifier to mix the water and lipid. Lotion and gel
preparations are also available. Ointment is ideal for
dry skin but messy to apply. Creams are less messy
and more cosmetically acceptable. Lotions or gels are
useful for hairy areas, where entrapment of greasy
preparation is unwelcome.
The function of emollients can be divided into:
■■ An occlusive covering – they provide a layer of oil on
the surface of the skin, trapping water and stopping
evaporation, thereby increasing the moisture content
of the stratum corneum.
NURSING OLDER PEOPLE
Box 3 Photo damage and photo-ageing
Figure 1
Person with sun spots (lentigines)
Wear protective clothing/avoid tanning
■■ A hat with a wide brim can shade the neck, ears,
eyes and head.
■■ Wear sunglasses that block 99 to 100 per cent
of the sun’s rays.
■■ In the sun, wear loose, lightweight, long-sleeved
shirts and long trousers/skirts.
(American Academy of Dermatology 2009, 2011, National Institute
on Aging 2010, New Zealand Dermatological Society 2010a)
■■ A humectant – they penetrate the stratum corneum,
where their low molecular weight and ability to
attract water help to draw water from the dermis and
retain it in the epidermis; glycerine, urea, lactic acid
and glycolic acid are humectants.
Some emollients operate as a humectant and
occlusive covering (Ersser et al 2007, New Zealand
Dermatological Society 2010b). Sometimes, added
ingredients can be helpful. Ingredients such as
polyvinyl pyrrolidone form a film over the skin’s surface,
increasing water retention while blocking access to
harmful antigens and irritants (Cork 2006b). Emollients
containing agents such as lauromacrogols have
anaesthetising properties that help to reduce itchiness
(Davies 2007).
NURSING OLDER PEOPLE
To be effective, emollients should be applied
frequently, in suitable quantities (Table 1 and Table 2,
on page 36). Formulations should contain the right
mix of ingredients to treat the particular area of skin on
which they are applied. Emollient formulations include
bath additives, soap substitutes, skin cleansers and
topical preparations (Watkins 2008).
Now do time out 3.
3
Examples of emollients
Time out
Limit time in the sun
■■ Keep out of the sun between 11.30am and
3.30pm, when the sun’s rays are strongest.
■■ Ultraviolet rays can pass through clouds.
■■ Ultraviolet rays penetrate glass and water in
pools, lakes or the sea.
■■ Use sunscreen.
■■ Use a sunscreen with a sun protection factor
(SPF) of 15 or higher.
■■ Choose sunscreens with ‘broad spectrum’ on
the label.
■■ ‘Water resistant’ sunscreen remains on wet or
perspiring skin, but it is not waterproof and it
needs replacing at least two hourly.
Science Photo Library
■■ Ageing is accelerated in those areas exposed to
sunlight (photo-ageing).
■■ Photo-ageing is due to damage caused by
ultraviolet radiation, and may cause, for example,
lentigines (Figure 1).
■■ Short wavelength ultraviolet radiation (UVB)
affects the outside layers of the skin or
epidermis.
■■ Longer wavelength ultraviolet radiation (UVA)
affects the middle layers or dermis.
■■ Infrared A radiation affects the deeper dermis
and subcutaneous tissue.
Choose four or five examples of emollients
and where you have used them. Are your
examples ointments, creams, bath oils, gels
or lotions? Read on to see why this matters.
The term complete emollient therapy incorporates all
of these formulations (Cork 2006a, Waistell 2007).
This complete approach relies on combined use of
an emollient cream or ointment, emollient bath oil
or shower gel, and an emollient soap substitute, and
most importantly adequate education on effective
application. Complete emollient therapy replaces
the need for soap, detergent and bubble baths
(Watkins 2008).
Ersser et al (2007) argue that emollients are
important for promoting skin health in vulnerable
June 2011 | Volume 23 | Number 5 35
Continuing professional development
Suitable quantities of emollient to be prescribed for specific areas
of the body
Site
Creams and ointments
Lotions
Face
15–30g
100ml
Both hands
25–50g
200ml
Scalp
50–100g
200ml
Both arms or both legs
100–200g
200ml
Trunk
400g
500ml
Groin and genitalia
15–25g
100ml
Healthcare worker and older patient
partnership
Healthcare workers who regularly care for older people
are most likely to have to introduce emollient therapy
and negotiate its use. A discussion between an older
patient and the healthcare worker can lead to a decision
on which emollient combination will suit that person.
Now do time out 5.
These amounts are suitable for twice daily application for an adult for one week
(British National Formulary 2011)
5
Decisions about care
Time out
Table 1
In the previous time outs, you considered
the beliefs held by older people in your
care about their skin’s appearance and
management, what makes an emollient,
and in which situation each formulation
is useful.
Now, think about the setting for each
of your contacts: is it a hospital or care
home with busy schedules? Do you know
the patients’ or residents’ work background
and what interests they have? Do they have
certain limitations to self-directed care, such
as partial sight or hearing, restricted mobility
and flexibility, compromised thinking and
memory retention?
4
Patient choice
Time out
groups such as older people. Cork (2006a) stresses
the importance of patients’ choice of emollients
according to cosmetic acceptability. He argues that
the best emollient for a person is the one that the
user prefers, because the likelihood is that usage
will increase.
Now do time out 4.
Do you work in a hospital or care
home setting? Have you seen older
patients encouraged to use their own
wash and moisturising products? Is a
‘one-product-fits-all’ attitude prevalent?
To what extent is the quantity, type and
frequency of emollients considered?
Table 2
Decisions about care may be viewed as shared contracts
between the patient and the healthcare worker. This
is known as concordance, and it should have at its
core the patient’s informed and educated wishes. The
decision is based on a consultation between two people
with equally important beliefs about health. However,
the most important determinant is the patient’s wishes,
not those of the healthcare worker (Marinker 1997,
Emollient measures appropriate for an adult for one application
Site
Light-dose regimen
Medium-dose regimen
High-dose regimen
Arm (x2)
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Chest
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Abdomen
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Upper back
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Lower back
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Thigh (x2)
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Shin (x2)
2 pumps, 1 teaspoon
5 pumps, 1 dessert spoon
10 pumps, 1 tablespoon
Total
20 pumps, 20g
50 pumps, 50g
100 pumps, 100g
(Adapted from Britton 2003)
36 June 2011 | Volume 23 | Number 5
NURSING OLDER PEOPLE
Conclusion
Essentially, skin cannot remain as it was during
a person’s earlier years. Some of the changes are
unavoidable, while others can be reduced by, for
example, avoiding drying of the skin and exposure to
ultraviolet light. The study of ageing skin is complex and
absorbing, but the people occupying ageing skin are
even more varied and interesting.
Many residents in care homes require considerable
help and are dependent on others to perform frequent
tasks such as application of emollients. However, many
people with ageing skin live full and independent lives,
and this group require appropriate management to
release their own potential to care for their skin simply
and effectively.
6
Practice profile
Time out
Royal Pharmaceutical Society of Great Britain 1997).
Opportunities for healthcare professionals to
strengthen concordance arise in simple everyday
routines. When assisting patients to bathe, change
clothes or shave, the intimacy of tasks can be an
opening for talking and sharing ideas and knowledge.
Touch during these tasks can improve awareness of
dryness of skin or breaks in the skin’s integrity. It can
help to expose a need for better skincare practices – for
example, by noticing skin odours or inappropriate use
of drying products such as soap or powder. Talking to
visitors can be a useful way of discovering otherwise
forgotten factors such as the home environment – is this
damp, cold, unclean or lacking in basic amenities, such
as a bath or shower?
Now that you have completed the article
you might like to write a practice profile.
Guidelines to help you are on page 38.
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June 2011 | Volume 23 | Number 5 37
Continuing professional development
Practice profile
What do I do now?
■■ Using the information in section 1 to guide
you, write a practice profile of between
750 and 1,000 words – ensuring that you
have related it to the article that you have
studied. See the examples in section 2.
■■ Write ‘Practice Profile’ at the top of your
entry followed by your name, the title of
the article, which is: The use of emollient
therapy for ageing skin, and the article
number, which is NOP580.
■■ Complete all of the requirements of
the cut-out form provided and attach it
securely to your practice profile. Failure to
do so will mean that your practice profile
cannot be considered for a certificate.
■■ You are entitled to unlimited free entries.
■■ Using an A4 envelope, send for your free
assessment to: Practice Profile, RCN
Publishing Company, Freepost PAM
10155, Harrow, Middlesex HA1 3BR by
June 2012. Please do not staple your
practice profile and cut-out slip – paper-clips
are recommended. You can also email
practice profiles to practiceprofile@
rcnpublishing.co.uk. You must also provide
the same information that is requested on
the cut-out form. Type ‘Practice Profile’ in
the email subject field to ensure you are
sent a response confirming receipt.
■■ You will be informed in writing of your
result. A certificate is awarded for successful
completion of the practice profile.
■■ Feedback is not provided: a certificate
indicates that you have been successful.
■■ Keep a copy of your practice profile and
add this to your professional profile –
copies are not returned to you.
1. Framework for reflection
■■ Study the checklist (section 3).
■■ What have I learnt from this article?
■■ To what extent were the intended learning
outcomes met?
■■ What do I know, or can I do, now,
that I did not/could not before reading
the article?
■■ What can I apply immediately to my
practice or client/patient care?
■■ Is there anything that I did not understand,
need to explore or read about further, to
clarify my understanding?
■■ What else do I need to do/know to extend
my professional development in this area?
■■ What other needs have I identified in
relation to my professional development?
■■ How might I achieve the above needs?
(It might be helpful to convert these to
short/ medium/long-term goals and draw
up an action plan.)
2. Examples of practice profile entries
■■ Example 1 After reading a CPD article on
‘Communication skills’, Jenny, a practice
nurse, reflects on her own communication
skills and re-arranges her clinic room so
that she will sit next to her patients when
talking to them. She makes a conscious
decision to pay attention to her own body
language, posture and eye contact, and
notices that communication with patients
improves. This forms the basis of her
practice profile.
■■ Example 2 After reading a CPD article on
‘Wound care’, Amajit, a senior staff nurse
on a surgical ward, approached the nurse
manager about her concerns about wound
infections on the ward. Following an audit
which Amajit undertook, a protocol for
dressing wounds was established which
led to a reduction in wound infections
in her ward and across the directorate.
Amajit used this experience for her
practice profile and is now taking part in
a region-wide research project.
3. Portfolio submission
Checklist for submitting your practice profile
■■ Have you related your practice profile to
the article?
■■ Have you headed your entry with: the title
■■ ‘Practice Profile’; your name; the title of
the article; and the article number?
■■ Have you written between 750 and
1,000 words?
■■ Have you kept a copy of the practice
profile for your own portfolio?
■■ Have you completed the cut-out form and
attached it to your entry?
Continuing professional development: practice profile
Please complete this form using a ballpoint
pen and CAPITAL letters only, then cut out
and send it in an envelope no smaller than
23 x 15cm to:
Full title and date of article:
Job title:
Place of work:
Address:
Practice Profile
RCN Publishing Company
Freepost PAM 10155
Harrow, Middlesex HA1 3BR
38 June 2011 | Volume 23 | Number 5
Article number:
First name:
Postcode:
Surname:
Daytime tel:
NURSING OLDER PEOPLE