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More Than Skin Deep: The Unseen Impact of Chronic Hand Eczema on Nurses at Work · Amplify: A Podcast Powered by Patient Voice Partners

• 0:01
  SPEAKER_01: Welcome to Amplify, Elivating Patient Voices, a podcast powered by patient voice partners, where real stories spark bold conversations.
• 0:11
  SPEAKER_01: I'm Ursula Mann.
• 0:12
  SPEAKER_04: And I'm Brent Courty.
• 0:14
  SPEAKER_04: Together, we're talking with patients, caregivers, and the healthcare change makers who are listening and taking action.
• 0:21
  SPEAKER_01: From personal journeys to policy shifts, these are the voices shaping a healthcare system that listens.
• 0:33
  SPEAKER_02: This episode is sponsored by Leo Pharma.
• 0:36
  SPEAKER_02: Leo is a global research-based pharmaceutical company that is dedicated to advancing the standard of care for the benefit of people with skin conditions, their families, and society.
• 0:46
  SPEAKER_02: Amplify sponsorship helps support the podcast, but the conversation, perspectives, and final content are produced independently by PatientWise Partners guest.
• 0:55
  SPEAKER_02: Anne-Marie and I today are going to be talking about chronic canned eczema.
• 0:59
  SPEAKER_02: And this is a complex, underrecognized condition with a significant lifetime prevalence.
• 1:05
  SPEAKER_02: The Canadian Association of Critical Care Nurses says it's about 14%.
• 1:10
  SPEAKER_02: Anne-Marie, what are your thoughts on chronic canned eczema and the discussion we're going to have today?
• 1:15
  SPEAKER_00: Actually, I found it really interesting as I was reading up for this episode the number of nurses this actually impacts.
• 1:23
  SPEAKER_00: And then learning about how underappreciated it is in many of the institutions and sort of the lack of awareness about safe products and that sort of thing.
• 1:33
  SPEAKER_00: And it was just staggering to me that in with such a shortage of healthcare providers that we're not a little bit more aware about it.
• 1:40
  SPEAKER_02: An Maria, I really appreciate you sharing that.
• 1:42
  SPEAKER_02: And one thing I've never shared with you is I had to live this as a caregiver.
• 1:46
  SPEAKER_02: I had a little baby that out of nowhere, some face eczema appeared.
• 1:52
  SPEAKER_02: And the dripping and bleeding and itchiness and covering hands with socks and sleeping with a baby, holding their hands to try to get them to not scratch, it was a very difficult situation.
• 2:03
  SPEAKER_02: So when I hear the word itchiness and I think of that, it brings me right back to what that is.
• 2:08
  SPEAKER_02: And on today's episode, this is a work situation.
• 2:12
  SPEAKER_02: To be thinking of going to work and have your work impacted as well as other aspects of your life is so significant.
• 2:19
  SPEAKER_02: So I'm really interested to dive into this today.
• 2:22
  SPEAKER_02: I'd like to welcome Marley to today's show.
• 2:24
  SPEAKER_02: Marley is a critical care nurse who works in a large acute care and academic hospital in southwestern Ontario.
• 2:31
  SPEAKER_02: She also is the vice president of the Canadian Association of Critical Care Nurses and a first-year PhD student in nursing at the University of Ottawa.
• 2:40
  SPEAKER_02: She is passionate about education, research, and advocacy within nursing.
• 2:46
  SPEAKER_02: And we're going to have a conversation today as to what does this mean?
• 2:50
  SPEAKER_02: The national burden of hand eczema, including care disparities and system level gaps, stigma and psychosocial burden, and what this means and looks like as an occupational health condition, and what's happening at work and the impact on life.
• 3:05
  SPEAKER_02: And also what has work that has been done by the CACCN and what does this look like moving forward?
• 3:12
  SPEAKER_02: Marley, welcome to today's show and we're delighted to have you here.
• 3:15
  SPEAKER_03: Thanks so much for having me, Ursula and Henry.
• 3:18
  SPEAKER_03: I'm excited to be here as well.
• 3:20
  SPEAKER_02: So I want to ask first year PhD student in nursing, how are things going?
• 3:24
  SPEAKER_03: Things are going good.
• 3:26
  SPEAKER_03: I'm just finishing up my first year, so I feel like I'm getting over kind of the hump of all the firsts and it's feeling good.
• 3:33
  SPEAKER_02: I love that so much.
• 3:34
  SPEAKER_02: I have a nursing background myself and really enjoyed studying out at UBC.
• 3:39
  SPEAKER_02: What made you want to move on to take your PhD?
• 3:41
  SPEAKER_03: I did my master's and finished that about two years ago and felt that my kind of work and research wasn't done and that I really was quite interested in furthering and pursuing that kind of lens.
• 3:53
  SPEAKER_03: I think oftentimes we don't think of nurses as researchers, but there's a lot of problems that live in our kind of healthcare space that I think are worth exploring.
• 4:02
  SPEAKER_03: Thanks for sharing.
• 4:03
  SPEAKER_02: So let's talk a little bit about what's happening with chronic canned eczema.
• 4:08
  SPEAKER_02: And looking a little bit more at some stats, the Canadian Dermatology Association says 17% of Canadians will get at some point of time in their life some form of eczema.
• 4:19
  SPEAKER_02: So this affects Canadians across the board and significantly nurses, as we're going to talk about today.
• 4:26
  SPEAKER_02: Can you talk a little bit about your viewpoint as to what's happening across Canada?
• 4:32
  SPEAKER_02: And when we use the words like national burden, what does that mean?
• 4:35
  SPEAKER_02: Let's start there.
• 4:36
  SPEAKER_03: So I think it's interesting to look at those stats about the kind of prevalence in the general population, because it is quite a bit lower in the general population versus high-risk groups.
• 4:46
  SPEAKER_03: So nurses certainly aren't alone in this.
• 4:48
  SPEAKER_03: Anyone who has kind of exposure to chemicals, to frequent hand washing, to irritants is placed at the higher risk.
• 4:55
  SPEAKER_03: And individuals in that kind of category, their kind of risk of chronic hand eczema is actually up to 40%.
• 5:02
  SPEAKER_03: So quite a bit higher than the general population.
• 5:04
  SPEAKER_03: And I think when we look at that from a national lens, that's quite kind of an impact on our healthcare system and places quite a risk on our workers.
• 5:13
  SPEAKER_03: It's unavoidable for them to be washing their hands and that type of workplace setting.
• 5:18
  SPEAKER_02: It really is.
• 5:19
  SPEAKER_02: And that's a significant number of nurses that are dealing with us.
• 5:23
  SPEAKER_02: And what about in terms of getting care?
• 5:26
  SPEAKER_02: We think of people working in rural areas.
• 5:29
  SPEAKER_02: And what does that mean for system level gaps, access to specialists?
• 5:33
  SPEAKER_02: How are nurses in rural areas managing?
• 5:35
  SPEAKER_03: That's a great point you bring up.
• 5:37
  SPEAKER_03: I want to say in a past life, in one of my previous roles, I was a regional educator for a lot of kind of small rural hospitals in our area.
• 5:46
  SPEAKER_03: And as you say, there really isn't a lot of kind of backup or flexibility and staffing in those areas.
• 5:52
  SPEAKER_03: So sometimes in really small hospitals, you may have two or three nurses working in the entire hospital that day.
• 6:00
  SPEAKER_03: So if one of them's affected, that's already 30% of your staffing that may be taken out of the mix, which can be extremely challenging.
• 6:07
  SPEAKER_02: This really is significant, Marley, because I remember even as a student, the amount of hand washing.
• 6:12
  SPEAKER_02: And this was before COVID and before the days of hand sanitizer.
• 6:16
  SPEAKER_02: So to perhaps give us a little bit of context, what are the stats on how many times in a day nurses are washing their hands when they're in hospitals?
• 6:25
  SPEAKER_02: How we measured that?
• 6:26
  SPEAKER_03: I don't have a good hard and fast number for you, but I think certainly in our post-COVID context, that is something that we're spending more and more time on, right?
• 6:35
  SPEAKER_03: Certainly we were vigilant before, but now in this kind of new age of really risky infections that can spread quite quickly.
• 6:44
  SPEAKER_03: Everyone has a keen eye on those infection control practices and performing a lot of hand washing.
• 6:50
  SPEAKER_03: I would say in the course of my shift, it wouldn't be uncommon for me to sanitize or wash my hands upwards of 15 to 20 times in an hour, just with kind of routine patient interactions.
• 7:03
  SPEAKER_00: I am curious, what does the sort of path to finding out you have this look like?
• 7:08
  SPEAKER_00: Are there folks who walk around with irritated hands who aren't sure if it's just a bit of an irritation?
• 7:15
  SPEAKER_00: What does that look like?
• 7:17
  SPEAKER_03: That's a really good point, Anne-Marie.
• 7:18
  SPEAKER_03: I think it's quite difficult to diagnose this and support.
• 7:22
  SPEAKER_03: I know I certainly have struggled with hand eczema in the past.
• 7:25
  SPEAKER_03: It tends to flare up in the winter, and many of my colleagues have as well.
• 7:29
  SPEAKER_03: But there really is no kind of workplace support for identification, early management or even prevention of it.
• 7:37
  SPEAKER_03: So oftentimes you have to visit your family doctor or a nurse practitioner or a specialist, like a dermatologist, some sort of healthcare provider outside of the organization on your own time.
• 7:49
  SPEAKER_03: And that's can be, I think, of our family doctor shortage as well.
• 7:52
  SPEAKER_03: This can be really hard to do and may, for some people, not feel like it's like a priority enough to pursue, right?
• 8:00
  SPEAKER_02: I did some reading as well.
• 8:01
  SPEAKER_02: There is even some delay from nurses.
• 8:04
  SPEAKER_02: Their hands are hurting, they're dry, itchy, red patches, and they're just living with it.
• 8:11
  SPEAKER_02: And even the seeking care, it seems to be a little bit delayed.
• 8:15
  SPEAKER_02: And that makes it even trickier to start to get treatment.
• 8:18
  SPEAKER_02: But why do you think that is?
• 8:20
  SPEAKER_02: Why do you think there's that delay in terms of moving forward?
• 8:24
  SPEAKER_03: Yeah, I think there's a couple of things coming into play there.
• 8:27
  SPEAKER_03: So, number one, nurses are not great patients.
• 8:30
  SPEAKER_03: We sometimes do a very poor job of taking care of ourselves, right?
• 8:35
  SPEAKER_03: And if you think about the fact that this diagnosis could lead to time away from the bedside, I think a lot of people are hesitant to step away and leave their coworkers, their patients, and feel like they're leaving them in the lurch a little bit without kind of coverage.
• 8:50
  SPEAKER_03: So I think that's one main barrier.
• 8:52
  SPEAKER_03: And I think the other thing too is like I've heard from people that they're not always taken seriously.
• 8:58
  SPEAKER_03: So while it's something that's impacting their work, it's impacting their quality of life, their day-to-day function outside of work.
• 9:05
  SPEAKER_03: They just feel like it's not always a priority or that when they do seek out care, it doesn't seem to be recognized with the same urgency that they feel it it deserves.
• 9:14
  SPEAKER_02: Which further reinforces the hesitancy to seek care in the first place.
• 9:19
  SPEAKER_02: It's a bit of a vicious cycle.
• 9:20
  SPEAKER_02: You feel hesitant and then you perhaps get shut down a little bit.
• 9:23
  SPEAKER_02: And in fact, some of the work that the CACCN had done had nurses report that chronic hand eczema people found harder than other types of eczema.
• 9:34
  SPEAKER_02: You can't hide your hands.
• 9:36
  SPEAKER_02: And as a nurse walking in to give treatment when your hands are red, when they're open, that's significant.
• 9:42
  SPEAKER_02: Patients are looking at your hands.
• 9:44
  SPEAKER_02: And there has been also comments with regards to the pain and discomfort of hand washing and sanitizing.
• 9:51
  SPEAKER_02: The visual that sticks with me is having someone say, I feel like I'm dipping my hands in acid when I'm washing my hands.
• 9:57
  SPEAKER_02: And back to your comment that you made earlier, 15 to 20 times hand washing in an hour.
• 10:02
  SPEAKER_02: So you're hurting at work.
• 10:04
  SPEAKER_02: You're trying to do your job and you're dealing with a lot of stuff.
• 10:08
  SPEAKER_02: So, in terms of workplace protections, this is a significant consideration.
• 10:14
  SPEAKER_02: And both feels like on a national level, a visible and an invisible burden.
• 10:20
  SPEAKER_02: What are your thoughts on that?
• 10:21
  SPEAKER_03: Yeah, I would agree.
• 10:23
  SPEAKER_03: I think the visible piece we certainly see as far as the symptoms and what you're bringing into work.
• 10:29
  SPEAKER_03: And like you said, it's really unavoidable to keep being exposed to those triggers, right?
• 10:34
  SPEAKER_03: Even if your hands are already raw and cracking, you can't elect not to hand wash or sanitize after or before a patient interaction, right?
• 10:42
  SPEAKER_03: There's no way around that.
• 10:44
  SPEAKER_03: So I think those symptoms are quite visible.
• 10:45
  SPEAKER_03: But then I think that impact on individuals and what it means to them, that's the part that we're maybe under-recognizing and not seeing how far that actually goes.
• 10:55
  SPEAKER_03: So things like quality of life outside of work, right?
• 10:58
  SPEAKER_03: People reported difficulties just doing basic things, so getting dressed, preparing meals, household cleaning, their ability to just engage in physical activity or even sleep, right?
• 11:09
  SPEAKER_03: So that takes a huge toll on you outside of work and can really affect your body image too and how you feel about yourself.
• 11:17
  SPEAKER_02: Absolutely.
• 11:18
  SPEAKER_02: That sleep interruption is a huge thing.
• 11:20
  SPEAKER_02: And I don't know why it's itchier at night, but I've seen that.
• 11:25
  SPEAKER_02: So that is significant.
• 11:27
  SPEAKER_02: And that sleep interruption, I think, is really not even discussed enough.
• 11:31
  SPEAKER_02: And that speaks to how we function in a day when we're not sleeping.
• 11:34
  SPEAKER_02: So let's talk a little bit about the quality of life situation.
• 11:38
  SPEAKER_02: And there were a number of nurses that talked about anxiety, frustration, embarrassment, sleep interruption.
• 11:46
  SPEAKER_02: What else comes to mind when you're thinking about the stigma of this?
• 11:50
  SPEAKER_02: Because it doesn't sound like it's talked about very much at all.
• 11:53
  SPEAKER_02: And some of the psychosocial aspect.
• 11:55
  SPEAKER_02: What are things that you've heard?
• 11:56
  SPEAKER_03: Certainly, some of the things I've heard are, I think, people being embarrassed by it, right?
• 12:02
  SPEAKER_03: They feel like they should be able to have control of those symptoms and should be able to look and feel the way they want.
• 12:07
  SPEAKER_03: And it's quite frustrating when they're not able to get the support to be able to achieve that.
• 12:12
  SPEAKER_03: So I've heard from coworkers and friends that they'll avoid social activities.
• 12:16
  SPEAKER_03: They don't want to be seen.
• 12:17
  SPEAKER_03: They hide their hands and just really feel, like you said, stigmatized.
• 12:22
  SPEAKER_03: They feel like they should be able to have good control of it and they just can't get there.
• 12:26
  SPEAKER_03: And that kind of anxiety mixed with the frustration really takes a toll on them.
• 12:31
  SPEAKER_00: I would imagine as well, you know, the skin is a protective barrier.
• 12:35
  SPEAKER_00: So when the skin breaks down, it would actually put you at risk for infections and getting sick.
• 12:41
  SPEAKER_00: How do you deal with that as a healthcare provider?
• 12:44
  SPEAKER_03: I think that's another piece too, right?
• 12:47
  SPEAKER_03: There's so many places in the workplace that we could already be potentially exposed to all sorts of kind of bugs and germs and having those kind of like raw, dry, cracked hands are direct portals of entry for infection into the body, right?
• 13:00
  SPEAKER_03: So I think that becomes a safety issue for yourself, for your patients.
• 13:04
  SPEAKER_03: And that's really, I think, where that breaking point happens of having to take time off of work and be out of the patient care environment, maybe not as something that you want to do, but something you have to do to protect yourself and others.
• 13:18
  SPEAKER_02: And you mentioned winter making things worse.
• 13:21
  SPEAKER_02: And we hear the word chronic associated with this.
• 13:24
  SPEAKER_02: It's chronic hand eczema.
• 13:26
  SPEAKER_02: How hard is it if you give your hands a break, so to speak, and it's not winter and you're not constantly hand washing, then you're giving yourself some different time along with treatment to get better.
• 13:37
  SPEAKER_02: But here people are in a situation where they're working.
• 13:40
  SPEAKER_02: There's frequent hand washing, there's sanitization, there's gloves, there's wet work.
• 13:45
  SPEAKER_02: People at work want career sustainability, productivity, safety.
• 13:49
  SPEAKER_02: It's a conundrum, really.
• 13:51
  SPEAKER_02: You're wanting to do your job.
• 13:52
  SPEAKER_02: Your job is to help people and provide care, but yet in some ways your work is almost harming your own health.
• 13:59
  SPEAKER_02: And this is a real tough situation to be managing for people as they're continuing to work or possibly exploring changing their type of work into perhaps a different type of nursing or some other thing.
• 14:10
  SPEAKER_02: What else are you seeing on the occupational health side as to other comments people are making?
• 14:17
  SPEAKER_03: I think, like you said, it does really impact people's work.
• 14:20
  SPEAKER_03: And I've certainly heard from folks that they've had to shift into other jobs potentially that gets them out of that kind of direct patient environment.
• 14:30
  SPEAKER_03: That's not always something that they want to do.
• 14:32
  SPEAKER_03: I certainly have had lots of coworkers who are hesitant to set step back from the bedside.
• 14:36
  SPEAKER_03: They have a real passion for where they work and a real kind of care for their patients.
• 14:41
  SPEAKER_03: But because they're unable to manage these symptoms and get the help they need, they have to shift into another area that maybe is not their preference, but might result in less kind of exposure to those irritants.
• 14:54
  SPEAKER_02: That's tough.
• 14:55
  SPEAKER_02: We all want to be doing work that's meaningful and that we can continue doing.
• 15:00
  SPEAKER_02: And to have a situation where you're forced to change, so to speak, is gut-wrenching in many ways.
• 15:06
  SPEAKER_02: And there's emotional ramifications of that to process as well.
• 15:10
  SPEAKER_00: I was speaking to somebody else as well, and they were mentioning having difficult conversations with their institution.
• 15:18
  SPEAKER_00: I don't know what your experience with that has been, but it strikes me that when institutions are purchasing the products that they're going to provide for their healthcare providers, they should be thinking about safety.
• 15:31
  SPEAKER_00: Are they?
• 15:32
  SPEAKER_00: Is this a discussion that, you know, and I don't want to speak specifically about your institution or any specific institution, but are these conversations being had?
• 15:41
  SPEAKER_03: I think that's a great point you bring up.
• 15:43
  SPEAKER_03: I think one of the kind of pillars of really dealing with chronic eczema is preventing it.
• 15:49
  SPEAKER_03: And this is one area that comes into play.
• 15:52
  SPEAKER_03: I certainly will say, from my own experience and from what I've heard from folks who work at other organizations, it's not easy to access those products.
• 16:01
  SPEAKER_03: So you can go to the occupational health team and say, hey, I'm suffering with this.
• 16:05
  SPEAKER_03: Is there something gentler that I can use?
• 16:08
  SPEAKER_03: And oftentimes they will provide you with a gentler hand sanitizer and some sort of kind of barrier cream to use.
• 16:15
  SPEAKER_03: But you really have to seek that out.
• 16:17
  SPEAKER_03: And I think if we think about this from a prevention lens, that's not really prevention, right?
• 16:21
  SPEAKER_03: If it's not easily accessible to everyone, prevent the flare and the hand eczema from happening in the first place.
• 16:28
  SPEAKER_03: And it's really treated more as something that's instituted once you already have the symptoms and the issues, that's probably not the right approach.
• 16:36
  SPEAKER_03: And we could look at it from just having those products more available on kind of a widespread scale.
• 16:42
  SPEAKER_02: That would significantly be better on the prevention front to have the best possible products available that could possibly delay, prevent, alleviate for many people, and perhaps lead to not changing that work situation.
• 16:56
  SPEAKER_02: Are there other things that you feel continue to need to get talked about within systems to help support the awareness of what nurses are facing on the social side and the quality of life side in this that work could better consider?
• 17:13
  SPEAKER_03: I think we really need to equip our teams for kind of better recognition, treatment, and support of this condition.
• 17:21
  SPEAKER_03: Most organizations have an occupational health team or infection prevention and control team that often work together to manage these things.
• 17:29
  SPEAKER_03: So I think we really could benefit from more kind of education about what this looks like, not only within the occupational health lens, but just like to nurses who we know have an increased risk of developing this and what to recognize and some better pathways for support.
• 17:46
  SPEAKER_03: So whether that be in-house teams that can help recognize and treat, that have pathways for referral for more specialized care.
• 17:54
  SPEAKER_03: That certainly would be a great start to reduce the severity and have more tangible support to treat those symptoms immediately.
• 18:01
  SPEAKER_02: Those are all really good points, Marley.
• 18:03
  SPEAKER_02: I want to say thank you and shout out really to some outstanding work that the Canadian Association of Critical Care Nurses did around better understanding what's happening for nurses and how this group can help support this.
• 18:19
  SPEAKER_02: And also, this was done in association with the Canadian Association of Neonaal Nurses.
• 18:24
  SPEAKER_02: So tell us a little bit about what happened to lead to this and what were some of the learnings from nurses that the organizations had.
• 18:34
  SPEAKER_03: Yeah, thanks for that question.
• 18:36
  SPEAKER_03: We really worked together with a couple different groups on this who had quite an interest in this chronic hand eczema problem.
• 18:43
  SPEAKER_03: So working together with them, the CACCN, and then again, like you said, the Canadian Association of Neonatal Nurses, we worked together to help distribute the survey to members and other nurses across Canada.
• 18:55
  SPEAKER_03: And then came back with kind of findings and have been working very closely together to get the word out about the scale of this problem and some concrete and tangible advocacy to different groups about what is needed and what we think is important moving forward.
• 19:13
  SPEAKER_02: And I recall one of the findings was around, and we talked a little bit about this earlier, earlier diagnosis and education.
• 19:20
  SPEAKER_02: And so tell us a little bit about how that's starting to play out.
• 19:24
  SPEAKER_03: Yeah, I think we're coming at that from a couple different fields right now.
• 19:28
  SPEAKER_03: So certainly just being here today, talking about that, this is a great way to get the word out about what the problem is and help people, I think, feel as well, a little less alone in it and recognize that lots of people are suffering from it and it's a systemic issue.
• 19:45
  SPEAKER_03: Certainly moving forward, we're also doing some conference presentations.
• 19:49
  SPEAKER_03: I know CECCN has a conference coming up in September, and the neonatal nurses have a conference coming up in October as well.
• 19:56
  SPEAKER_03: So we're bringing these findings back to our members too and saying, here's the issue we have found, here are some things we've done to advocate about it, and here's some education about recognizing the symptoms and what you can do within your own organization.
• 20:11
  SPEAKER_03: I know our conference, we get members from across all of Canada.
• 20:14
  SPEAKER_03: So being able to bring that back to respective organizations, we're hoping that'll have an impact on kind of a national level.
• 20:21
  SPEAKER_02: That's fantastic.
• 20:23
  SPEAKER_02: I think that's really important.
• 20:24
  SPEAKER_02: And when the results come back, that 98% of nurses say they experience impact in their workplace.
• 20:31
  SPEAKER_02: That's significant.
• 20:32
  SPEAKER_02: And we talked a little bit about better workplace and environmental protections.
• 20:37
  SPEAKER_02: And I appreciate Anne-Marie's consideration as to what can workplaces do on the product side.
• 20:43
  SPEAKER_02: And you said we should have these available faster and more readily.
• 20:48
  SPEAKER_02: Is there anything else that's happening on the regional or the national front around workplace and environmental protections from some of the work you've done or other conversations that you're having?
• 20:58
  SPEAKER_03: I think another couple of key things that have come out of this work are really advocacy on a governmental level.
• 21:04
  SPEAKER_03: So we've gone out to several of the provincial governments recognizing that they had some pre-budget submissions that came up earlier this year, end of last year.
• 21:13
  SPEAKER_03: So we went out to them and said, hey, we think this is a really significant issue that impacts a lot of workers, again, not just nurses across Canada.
• 21:22
  SPEAKER_03: And we think there needs to be greater consideration of occupational health policies and really working in some good education, recognizing this issue and providing some better pathways for diagnosis and support on all workplaces.
• 21:37
  SPEAKER_03: And that's really interesting.
• 21:39
  SPEAKER_03: Yeah.
• 21:39
  SPEAKER_03: I was just gonna say we also reached out to the chief nursing officer and spoke to her directly.
• 21:45
  SPEAKER_03: She had a great message coming back to us that she's actually suffered from this herself.
• 21:49
  SPEAKER_03: So she was quite empathetic and eager to recognize on a governmental, provincial, and national level that we need to do a little bit more work surrounding this in the workplace to support.
• 22:00
  SPEAKER_02: Workers.
• 22:01
  SPEAKER_02: Isn't that often the case, Marley?
• 22:03
  SPEAKER_02: When we open the door to conversation, I shared with you in Anne-Marie what I faced with baby, and you had somebody share with you they faced chronic candeczema at work.
• 22:12
  SPEAKER_02: And I wonder how often, as we have this conversation more, that more nurses are going to step up and say, I face this.
• 22:19
  SPEAKER_02: And you mentioned that you experienced it for it sounded like a time period.
• 22:23
  SPEAKER_02: You experienced it yourself.
• 22:25
  SPEAKER_03: Yeah, mine tends to flare in the winter.
• 22:27
  SPEAKER_03: I think with that exposure to the cold air in Canada, right?
• 22:30
  SPEAKER_03: It's unavoidable.
• 22:31
  SPEAKER_03: There's going to be some skin irritation.
• 22:33
  SPEAKER_03: And then you couple that with certainly working more shifts during flu season over the summer and winter and increased hand washing.
• 22:40
  SPEAKER_03: And it's just the perfect storm putting the two together.
• 22:43
  SPEAKER_02: And in approaching the government, what do you feel went well and really resonated with them?
• 22:49
  SPEAKER_03: I think it was great to hear that this wasn't a foreign concept.
• 22:53
  SPEAKER_03: It was great to hear that some folks we had talked to had actually experienced themselves and were quite empathetic.
• 22:59
  SPEAKER_03: And I think just being able to get to bend that ear and really advocate for more kind of research about the prevalence of chronic anticzema.
• 23:08
  SPEAKER_03: This was a small study.
• 23:09
  SPEAKER_03: So we do think there needs to be more work done on a greater national level.
• 23:14
  SPEAKER_03: We really advocated for looking at treatment outcomes too.
• 23:17
  SPEAKER_03: One of the things that we found in our kind of survey and research is there was a wide variation in how people are treated for this.
• 23:24
  SPEAKER_03: And there's really no kind of one effective intervention.
• 23:27
  SPEAKER_03: So we think looking ahead into the future and being able to optimize treatment is another kind of great avenue to explore.
• 23:34
  SPEAKER_03: That's really important.
• 23:36
  SPEAKER_00: That's really interesting.
• 23:37
  SPEAKER_00: I was reading somewhere about the impact of nurse education on treating eczema.
• 23:43
  SPEAKER_00: So it's interesting that you may be suffering from it, but also in your hands, if you will, is the key to managing it better in the general population as well.
• 23:54
  SPEAKER_00: I don't know if you've thought about that in your ideas about research or future things that you might want to do, but it really struck me.
• 24:03
  unknown: Yeah.
• 24:03
  SPEAKER_03: And like I mentioned at the beginning, I think because as nurses and healthcare workers, we're embedded in the system and we see these problems happening, we are well positioned and uniquely situated to begin to address them, right?
• 24:15
  SPEAKER_03: If it's something that's impacting you personally, that's going to give you that passion and that drive to pursue it and really find solutions for it.
• 24:23
  SPEAKER_02: And Marley, you mentioned having mapped out there's some inconsistent care, which is challenging.
• 24:29
  SPEAKER_02: And the nurses in your report said for many of them, things are minimal improvement or not really getting better.
• 24:36
  SPEAKER_02: Why do you think there is such inconsistent care?
• 24:39
  SPEAKER_02: Does it have to do with access to newer therapies, awareness of new therapies?
• 24:43
  SPEAKER_03: What are some of the bigger challenges?
• 24:45
  SPEAKER_03: I think number one, the first thing we talked about is really that diagnosis piece.
• 24:49
  SPEAKER_03: So I think just the barriers to diagnosis presents the first challenge.
• 24:53
  SPEAKER_03: And then I think from there, because we pursue treatment with a wide variety of healthcare providers, whether it be your kind of primary care physician or a nurse practitioner or a dermatologist, there's often different kinds of approaches depending on who you're seeing.
• 25:08
  SPEAKER_03: And there's no kind of standardized approach.
• 25:11
  SPEAKER_03: So often you'll find your healthcare provider advocates for kind of a stepwise approach of try some moisturizers first and maybe some cotton gloves.
• 25:20
  SPEAKER_03: Often people have already tried this and need to be escalated to the next step.
• 25:24
  SPEAKER_03: But there really isn't good recommendations out there about a treatment pathway.
• 25:30
  SPEAKER_03: So I think that leads to a lot of inconsistency.
• 25:33
  SPEAKER_03: And I think too, what's important to highlight is that from our report, there wasn't a lot of folks that actually saw good control of their symptoms.
• 25:42
  SPEAKER_03: So about 56% said that their symptoms weren't controlled, were only somewhat controlled.
• 25:49
  SPEAKER_03: So that's a significant amount of people that just the treatment wasn't working for.
• 25:53
  SPEAKER_03: And I think again, because of that inconsistency and lack of kind of research or knowledge about what works.
• 25:59
  SPEAKER_03: That's really important.
• 26:01
  SPEAKER_00: Sounds like there's a lot of work to be done yet.
• 26:04
  SPEAKER_02: Yeah, Anne-Marie, a lot of work left to do.
• 26:06
  SPEAKER_02: And layered on top of that, 80% said they get worse at work with the hand washing and the sanitizers as part of it.
• 26:13
  SPEAKER_02: So that's significant.
• 26:15
  SPEAKER_00: Yeah, when you think about it, treatment guidelines, evidence-based treatment guidelines make a lot of sense.
• 26:21
  SPEAKER_00: So it's curious what is driving the lack of that and what do we do about that?
• 26:25
  SPEAKER_00: I don't know if you have thoughts on that, Marley.
• 26:28
  SPEAKER_03: I think part of it is because I think a lot of the exposure comes from groups who are engaged in really frontline work.
• 26:36
  SPEAKER_03: And a lot of people who are engaged in frontline work aren't necessarily involved in research and education, too, right?
• 26:42
  SPEAKER_03: There's a little bit of a divide there.
• 26:43
  SPEAKER_03: So I think some of the problems that folks experience directly in kind of the course of their work don't really have a good avenue to bring that forward.
• 26:52
  SPEAKER_03: And there isn't always a lot of interest from the other side.
• 27:04
  SPEAKER_03: So I think the more we can talk about it and connect with the people who are able to actually bring about change and have them recognize this issue, the better.
• 27:13
  SPEAKER_02: I appreciate that.
• 27:14
  SPEAKER_02: That driving change forward is so important.
• 27:16
  SPEAKER_02: And I am interested in you sharing a little bit about the work that the Canadian Association of Critical Care Nurses does.
• 27:25
  SPEAKER_02: What are you most proud of in terms of the work that they're doing?
• 27:28
  SPEAKER_02: What's a little bit about their mandate and what are you appreciative of with this group?
• 27:33
  SPEAKER_03: So the Canadian Association of Critical Care Nurses or C A C C N is our national kind of critical care nursing interest group.
• 27:41
  SPEAKER_03: It's a not-for-profit in Canada that really focuses on research, education, advocacy, and representing that group of nurses across Canada.
• 27:53
  SPEAKER_03: That is as a small specialty of all the nurses in Canada, but certainly a very proud and strong group of nurses who work with kind of the sickest patients.
• 28:03
  SPEAKER_03: So we often hear very loud and outspoken about issues that happen across Canada, not just in our kind of ICUs, but broadly across the healthcare system.
• 28:13
  SPEAKER_03: So I'm really proud of the impact we have at that kind of national level.
• 28:17
  SPEAKER_03: We have a lot of members who are very engaged and come out to education and are really passionate about teaching the next generation of nursing, of sharing those insights from maybe their own personal organization and saying, here are some things we're doing really well.
• 28:34
  SPEAKER_03: And I think that connection piece is so valuable because we're working across so many different health systems that having that point of connection to know what others are doing and to be at the forefront of that change is so exciting.
• 28:48
  SPEAKER_02: Marley, I really appreciate you sharing that.
• 28:50
  SPEAKER_02: And thank you for the work that you and the entire group are doing at the CACCN.
• 28:56
  SPEAKER_02: And everything you described on the advocacy priorities is significant.
• 29:01
  SPEAKER_02: This situation where we need earlier diagnosis and education for nurses, with nurses, perhaps by nurses or alongside other groups is really important.
• 29:10
  SPEAKER_02: It's within a system, so it's not nurses in isolation because we're talking about products being ordered for hospitals, but also the workplace and what can we do to make the environmental protections better?
• 29:22
  SPEAKER_02: And what does this mean for reducing the inconsistent management?
• 29:27
  SPEAKER_02: And hopefully, next survey, seeing some different results on treatment and care.
• 29:31
  SPEAKER_02: I want to say thank you for everything you've highlighted.
• 29:34
  SPEAKER_02: Is there anything else on the nursing front that you wanted to share with us that we didn't get to yet today?
• 29:40
  SPEAKER_03: I guess the only other thing I would share is just really feeling that supporting our healthcare workers in general is so important.
• 29:48
  SPEAKER_03: If we have this condition that's preventable, that's treatable, I'd like to see that happen.
• 29:54
  SPEAKER_03: And just knowing that can support our kind of already fragile workforce.
• 30:00
  SPEAKER_03: I'm not sure if you know this, but training a critical care nurse specifically and having them feel comfortable and confident in their setting takes about a year.
• 30:09
  SPEAKER_03: So if you have someone who's suffering from chronic hand exam and has to step away from work, it's not an easy thing to replace them.
• 30:16
  SPEAKER_03: It's not a plug-and-play situation, right?
• 30:18
  SPEAKER_03: While nurses come to the workforce as generalists, they become specialists in their own area.
• 30:23
  SPEAKER_03: So not only in critical care, but other areas.
• 30:26
  SPEAKER_03: You need this advanced training.
• 30:28
  SPEAKER_03: So I think recognizing the impact on our workforce and being able to mitigate that with easily preventable and treatable strategies is really important.
• 30:37
  SPEAKER_02: Thank you for sharing that.
• 30:39
  SPEAKER_02: That's significant.
• 30:40
  SPEAKER_02: And on that note, in terms of looking forward, because I'm excited to hear what's next for CACCN and excited to hear how things move and improve on the diagnosis and education front to get more people treated faster.
• 30:55
  SPEAKER_02: Interested, what's coming up for you around the corner that you're really looking forward to?
• 30:59
  SPEAKER_03: Yeah, thanks for asking, Arskelet.
• 31:01
  SPEAKER_03: I'm excited.
• 31:02
  SPEAKER_03: We've got our C A C C N conference in September.
• 31:04
  SPEAKER_03: It's in Charlottetown.
• 31:06
  SPEAKER_03: I've never been to PEI, so I'm quite excited to visit it.
• 31:09
  SPEAKER_03: I'll be taking some time off on either side of the conference to do some sightseeing and enjoying that kind of eastern part of our country.
• 31:16
  SPEAKER_03: So I'm really excited about that.
• 31:18
  SPEAKER_02: That's fantastic.
• 31:19
  SPEAKER_02: Are you going to go see Anne of Green Gables?
• 31:22
  SPEAKER_02: Is that on your list?
• 31:23
  SPEAKER_02: I'm hoping to, yeah.
• 31:25
  SPEAKER_02: Very cool.
• 31:25
  SPEAKER_02: I want to hear about it after.
• 31:26
  SPEAKER_02: It's on my bucket list, and I've never been.
• 31:28
  SPEAKER_02: So I'm excited for you to head to that area and wish you a wonderful trip and a great conference.
• 31:32
  SPEAKER_02: Marley, I also want to say thank you for joining us today on Amplify.
• 31:35
  SPEAKER_02: This has been a really eye-opening conversation around significant workplace considerations on chronic candyczema for nurses.
• 31:44
  SPEAKER_02: And special thanks to sponsors for today's episode of Amplify Leo Pharma.
• 31:50
  SPEAKER_03: Thank you.
• 31:50
  SPEAKER_03: So thank you so much for having me.
• 31:57
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