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On Call: Leadership in Nursing

Organ Health – Brain, Lungs and Heart Hit the Charts, but What About Skin?

Published April 19, 2016 10:54 AM by Martie Moore
Imagine having this conversation with someone you are caring for, "Let me talk with you about keeping your skin healthy. It is just as important as your brain, lungs and your heart."  Unfortunately, it's not common nursing practice I've witnessed very often across the nation.  Skin in many ways is the forgotten organ of the body.  Utilitarian in its function, until it declares weakness or breakdown and then skin steals the show with open and difficult wounds.  In my own practice, I also did not give much thought to teaching or addressing skin health.  I thought about skin breakdown and worked to prevent issues but did not promote health.

It took a personal experience to change my way of thinking.  Being a chief nursing officer of a Magnet hospital, I and the team worked hard to keep our outcomes or incidences of skin injuries below benchmark.  I always felt that I was chasing the wrong work, but never understood what the right course of action should be until I met a patient I will call Mrs. W. 

Mrs. W was in her later 70s and having surgery for the first time. I was rounding and stopped in to visit her before she went down for surgery.  She was amazing.  Her skin was comparable to mine and there was a 25 year delta between us.  She worked hard to be healthy and she felt her skin was one of the most important tools she had to keep "young."  Step one for her was using a pH balanced cleanser.  She did not use soap and water as she knew that it would dry her skin.  Research now supports her actions that utilization of a pH balanced cleanser reduces potential dryness, erythema and irritation.  Her second step for skin health was to moisturize her skin two to three times a day.  She fed her skin from the outside to assure integrity of the organ. Returning to research on skin health, we now know that moisturizers that contain protectants like silicones, plant oils such as safflower/corn/coconut oils, humectants such as glycerol and hyaluronic acid, as well as nutritional components like vitamins, proteins and amino acids either individually or as plant extracts, are all part of keeping skin at its most optimal level of performance.   

Mrs. W. knew she needed to feed the skin from within as well.  She understood nutrition and hydration.  She worked hard to take in a balanced diet and fluids.  She was almost obsessed with her protein intake and felt that the hospital diet selection was less than desirable.  She also understood her vitamin and mineral needs and assured that she had an adequate ascorbic acid intake.  She was a renaissance woman when it came to skin.  She understood better than many, what needed to be done to care for herself and the skin she was in. I have often questioned our practices within healthcare.  Do we create skin issues by not understanding the role that nutrition and hydration play into the breakdown of the cells?

For your own nursing practice, think about what you can do to promote skin health.  Educate and promote the use of pH balanced cleansers.  Assure that those who you are caring for understand the need to moisturize their skin.  I have seen slathering rounds done twice a day to assure that skin is being cared for on a consistent basis. While this might seem like more tasks or work, it's beginning to translate into higher satisfaction with care and better skin health.  How is this being done?  You can do it while rounding. Or, consider offering a hand massage when you take vitals then provide moisturizer to the patient or resident and encourage them to apply it to the rest of the body.  A challenge for your practice is to change your thinking from moisturizing just when you assess dryness to never having to assess for dryness.  Promote nutrition and hydration and understand that your practice has to work within restrictions, based on disease and organ function.  Most people, especially the elderly, do not have balanced diets and good hydration.  Protein is one of the building blocks of healthy skin.  Remember for your practice, healthy skin can be achieved when you feed the skin from the inside and out.

Click to check out a video on how to care for geriatric skin. Learn more about Medline's unprecedented and holistic approach to skin health and a comprehensive program called Skintegrity by visiting

How often do you think about skin with your patients and residents and what are you doing to help them achieve healthy skin?


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