Swedish patients' perceptions of a preoperative skin test

AORN Journal,  March, 2005  by Rosalie Hammarsten,  Cathrine Hildingh

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Today's health care and nursing objectives are formulated based on more than just a patient s disease. Nursing care and treatment are founded on holistic principles that consider individuals' physical, psychological, social, and spiritual needs. Fulfilling these needs requires providing care based on scientific and tested experience. (1) Moreover, it is important to know how patients perceive their care.(2)

Postoperative wound and skin complications constitute a major medical and economic problem. (3) During surgical procedures, patients come in contact with a number of substances that can cause an allergy or skin irritation. (4,5) Some materials (eg, surgical drapes, electrodes, tape, wound dressings) use adhesive substances that are applied directly to patients' skin. Sensitivity to these materials varies from patient to patient. Patients who are facing a surgical procedure depend on perioperative staff members' knowledge regarding products, how they are used, and potential health-related consequences.

In a previous study, a preoperative skin test was developed to minimize the risk of inappropriate materials being applied to a patient's skin and, thus, reduce the potential for postoperative complications. The test was performed on patients with allergies, asthma, or eczema to determine what substances might cause intraoperative skin reactions. (4) Patients who underwent a skin test were told why the test was necessary, how it would be performed, the benefits it would provide intraoperatively and postoperatively, and the risks involved. (4)

A number of products containing an adhesive substance often used in an operating department were tested on the patients (Figure 1). The results of the study showed that 3% to 50% of patients experienced reactions, including reddening, itching, or development of rashes or blisters. (4) To ensure nursing quality in regard to this skin test, however, patients' attitudes must be considered.

LITERATURE REVIEW

As the number of chemical substances used in society and, consequently, in health care has increased, the risk of developing contact allergies also has increased. (6) The number of people in Sweden who suffer from allergies, asthma, or eczema has grown steadily. (7-11) More than one-third of the population aged 16 to 84 years reports having an allergy or some other type of hypersensitivity. More women than men experience pronounced allergic discomforts. (8)

Of the allergic diseases, eczema is the most common among both adults and children. (6) Approximately 7% of the population between 16 and 84 years of age has asthma. (8) Atopy is an inherited inclination to develop atopic dermatitis, allergic conjunctivitis, rhinitis, or asthma. In Sweden, 20% of the population is atopic, and 50% of these people suffer from atopic eczema. People with a predisposition to develop atopic eczema are particularly sensitive to skin-irritating chemicals and easily develop nonallergic contact dermatitis. (12) Nonallergic contact dermatitis is a nonimmunologic skin reaction that causes eczema in people who do not have an underlying allergy. (12,13)

SKIN TESTS. Skin tests are used to diagnose allergies and skin diseases. (12) There are two basic types of skin tests: prick tests and patch tests. A prick test is used to diagnose an allergy to substances such as pollen, furred animals, dust mites, and rubber products. (12,14) Patch tests are used to diagnose contact allergy caused by substances such as cosmetics, chemicals, plastic materials, and metals. (12,15) A patch test may involve risks because the test can result in contact allergy or anaphylactic shock. (12,16) These complications are rare, however.

No previous studies on how patients perceive a preoperative skin test have been conducted, and few studies have been published on how patients perceive other types of skin tests. In one study, a questionnaire given to 105 patch-tested patients showed that more than half of the patients (ie, 56%) experienced one or more positive allergic reactions in connection with the skin test. (17) As a result of the patch test, half of the patients with contact dermatitis subsequently were able to avoid allergens of different types. Most patients (ie, 86.7%) knew about the result of the patch test, but some patients (ie, 27.6%) perceived that no information had been given after the skin test. Some patients (ie, 37%) thought that the result of the skin test had not been explained in sufficient detail. (17)

PREOPERATIVE PREPARATIONS, Preoperative preparation is preventive care aimed at identifying early symptoms of disease or a lack of well-being on the part of the patient. Another purpose of preoperative preparation is to prevent the development of diseases. (18) Swedish health and nursing directives state that the objectives of such activities are to prevent ill health, offer high-quality nursing care, and design and implement nursing activities in cooperation with the patient. (19) Nurses should make patients feel secure by giving them an opportunity to express their wishes and feelings. (19-21) Nursing care should be based on routines that prevent injuries, adverse events, and inappropriate treatment. (20-23) Perioperative nurses should consistently consider the basic needs and wishes the patient has in connection with a surgical procedure. (20)