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As the pandemic winds down and in-person outpatient visits increase, we need to reflect on skin and wound care interprofessional practice across the continuum. This month's excellent Practice Reflections article by O'Rourke and Stone highlights challenging professional obligations that have led to postpandemic isolation and burnout, such as granular electronic health record navigation, administrative barriers to care, and complex patient circumstances. Intentional professionalism needs to set standards within the limits of a reasonable work-life balance.


Interprofessional collaboration should aim to enhance patient connections. O'Rourke and Stone describe the benefits of providers practicing mindfulness during patient interactions, eliminating all outside distractions to focus their attention on the patient. The concept of mindfulness originated in Buddhism and is associated with moral teaching and meditation. Alternative interpretations include a retentive reflection of your surroundings or a concentrated attention or awareness.


Building connections with patients was also explored by Keller and Carroll,1 who defined the 4 Es:


* Engage. Elicit something about the patient other than the reason for their visit (eg, a memory or upcoming event). This connection helps make patients feel welcomed as a person, not just a patient.


* Empathize. Empathy is the ability to demonstrate true concern for and share in other people's feelings. O'Rourke and Stone carry this concept one step further, defining "conscious empathy" as active empathetic engagement. There are several ways that empathy can be encouraged and improved (for more information, watch Dr Helen Riess speak about the power of empathy at TEDxMiddlebury.2)


* Educate. Patients need to comprehend their disease processes and treatment rationale. Enablers are helpful to reinforce patient comprehension and adherence.


* Enlist. It is the patient's responsibility to be part of the solution and monitor their diagnosis and treatment progress. Clinicians should provide patients with clear directions on documentation and expected outcomes.



The pandemic has also resulted in an increased incidence of hand dermatitis among healthcare professionals. Kacan and Buran conducted a cross-sectional study on 241 nursing students in Turkey during clinical rotations in the second to fourth years of their degree program. A self-assessment form identified that 41.9% of the students had hand dermatitis--a higher rate than has previously been reported (29-34.2%). Further, 53.9% of nursing students with hand dermatitis had contact irritant dermatitis. Nursing students who experienced symptoms of hand dermatitis reported lower quality of life.


The increased incidence related to precautions taken during the pandemic, including frequent hand washing and glove wearing. The antiseptic hand cleaner used in the study had a chlorhexidine base and some individuals may have an allergic sensitization to the active agent or incipients. Frequent use may result in contact irritation. Further, among glove options, vinyl gloves may be least likely to cause adverse reactions. Healthcare professionals should use liquid soap after every five to six alcohol hand rubs because of residual build up on the hands. Feces are best removed with a lower allergen containing soap. Remember to remove soap with water because most soaps are alkaline, and the skin has an acid mantle.


All patients and most healthcare professionals with hand dermatitis should use moisturizers on their hands frequently. The most important time for moisturizer application is after hand washing or alcohol hand rubs, while the skin is still damp. Low allergen moisturizers may be emollient (preventing insensible loss of water from the skin surface) or humectant moisturizers (which have components [ceramides, lactic acid, urea, or glycerin] to bind water in the stratum corneum).


Intentional professionalism and healthy hands (Supplemental Figure, can help re-establish and improve the performance of interprofessional wound care teams. Let's re-examine how we connect with our patients through the four Es as well as how we protect our carefully washed hands as part of our intentional professionalism and patient responsibility to avoid spreading microbial disease.


R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM


Elizabeth A. Ayello, PhD, MS, RN, CWON, MAPWCA, FAAN




1. Keller VF, Carroll JG. A new model for physician-patient communication. Patient Educ Couns 1994;23(2):131-40. [Context Link]


2. The Power of Empathy: Helen Reiss at TEDxMiddlebury. Last accessed April 2, 2023. [Context Link]