REVIEW ARTICLE

Skills of specialist nurses in Dermatology: a scoping review

Lara Carlete Cavalcante Muniz Pereira1, Euzeli da Silva Brandão2, Maristela Belletti Mutt Urasaki3, Dayse Mary da Silva Correia2, Renato Tonole4, Nathália Machado de Souza2, Maria Helena Santana Mandelbaum5, Bárbara Stohler Sabença de Almeida2

1State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

2Fluminense Federal University, Niteroi, RJ, Brazil

3São Paulo University, São Paulo SP, Brazil

4José Alencar Gomes da Silva National Cancer Institute, Rio de Janeiro, RJ, Brazil

5Taubate University, Taubate, SP, Brazil

ABSTRACT

Objective: To map the competencies of specialist nurses in Dermatology. Method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute (JBI). The Population, Concept, and Context framework established the research question. The search for publications was carried out in different sources, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health Sciences (LILACS), National Library of Medicine (MEDLINE) via PubMed, Scopus, Embase, and the Cochrane Library. Additionally, expert association websites and Google Scholar were searched. No language or time restrictions were applied. Results: Seventeen publications were selected, originating the categories: integral evaluation of the dermatological patient, drug prescription, early detection and prevention of skin cancer, wound care, and aesthetics. Conclusion: Faced with the vast possibilities for nurses to work in Dermatology, there is a need to expand the discussion and research on the subject.

Descriptors: Nursing; Professional Competence; Dermatology.

INTRODUCTION

Dermatology, considered the oldest medical specialty, aims to prevent, diagnose and treat skin diseases(1), an extremely relevant area since dermatological conditions strongly influence the person's quality of life and increase treatment costs, significantly compromising public health(2).

The United States has a high frequency of skin diseases in the general population, costing the system more than 39.3 billion dollars/year. In Brazil, skin diseases are among the top three causes of demand for health services(3).

To illustrate the reality above, according to the National Cancer Institute (INCA), although skin cancer is the most frequent in Brazil and accounts for about 30% of all malignant tumors registered in the country, melanoma represents only 3%, being the most severe type, due to its high possibility of causing metastasis. Non-melanoma is the most frequent type of skin cancer and, when detected and treated early, has a high percentage of cure(4).

Regarding other skin conditions, a study points out that psoriasis and psoriatic arthritis represent the skin diseases with the highest prevalence worldwide. Leprosy also presents significant numbers, especially in Brazil, occupying second place globally, ranking 586,112 new cases from 2013 to 2018. It is important to mention that, in the same period, more than 300,000 cases of Leishmaniasis were registered(5).

An investigation in São Paulo verifying the epidemiological profile of patients assisted by a Dermatology service in 2017 revealed that the most frequent diseases were acne, melasma, onychomycosis, psoriasis, and vitiligo(3).

Given the data presented above, it is emphasized that the training of nurses must follow the recommendations of the National Curriculum Guidelines for Nursing Courses since graduates from the undergraduate course will have, as their object, care focused on social needs combined with generalist, humanistic, critical, reflective, political and ethical-legal training, aiming to carry out the activities inherent to the profession in the different levels and scenarios of health care, according to article no. 6 of the National Health Council (NHC) recommendations(6). Given their general training, one of the challenges for nurses is facing situations requiring knowledge beyond their skills(7).

Concerning the maintenance and recovery of skin integrity, nurses work at different levels of health care, including leprosy, Leishmaniasis, and psoriasis programs, among others(8). Thus, given the recognition of this area as a specialty, according to Resolution 389/2011 of the Federal Nursing Council (COFEN), revoked by Resolution 581/2018, and the physical, emotional, and social repercussions of skin disease in people's lives, we consider that it is important to understand the competencies of specialist nurses in this area(7,9,10).

Nurses need to develop skills to work in the specific area of skin health, especially given the demands of the population in this regard. Given the above, the study aimed to map the competencies of specialist nurses in Dermatology in different healthcare settings.

It is important to note that a preliminary search in the International Prospective Register of Systematic Reviews (PROSPERO), Joanna Briggs Institute (JBI), and The Cochrane Library databases did not reveal protocols and reviews on the subject.

METHOD

A scoping review was conducted using the steps recommended by the JBI: establishment of inclusion criteria, the definition of strategies and evidence selection sources, data extraction, analysis of evidence, and presentation of results(11).

Inclusion criteria

The Population, Concept, and Context (PCC) framework was used, as shown in Figure 1.

Source: Prepared by the authors, 2021.

Figure 1 - Population, Concept, and Context Framework (PCC). Niterói, RJ, Brazil, 2021

Based on the strategy above, the following guiding question was established: "What are the competencies of the specialist nurse in Dermatology in the different healthcare settings?".

Evidence selection strategies and sources

The search was carried out in three stages, the first using the descriptors "Nursing", "Professional Competence," and "Dermatology" extracted from the controlled vocabulary Medical Subject Headings (MESH), with the application of the Boolean operator "AND". This search was limited to the Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, and The Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, aiming to analyze the words in the title, abstract, and descriptors. In the second stage of the review, other descriptors were added, making it possible to identify more articles using the Boolean operators: AND and OR, as shown in Figure 2.

Source: Prepared by the authors, 2021.

Figure 2 - Databases and search strategies used. Niterói, RJ, Brazil, 2021

In the second stage, a definitive search was carried out in the electronic databases CINAHL, Latin America and the Caribbean Literature on Health Sciences (LILACS), MEDLINE (via PubMed), Scopus, Excerpta Medica Database (Embase) and the Cochrane Library.

In the third stage, a gray literature search was carried out on associations/societies of specialists in Dermatology Nursing and Google Scholar websites. To find more relevant documents, we searched the reference lists of the included studies.

The search was conducted in February 2021 using no language or time restrictions. Among the publications, we considered randomized and non-randomized clinical trials, observational studies including prospective and retrospective cohort studies, case-control studies, case series, qualitative research, consensus, recommendations, texts, editorials, and case studies. Studies whose primary analysis through the abstract was unfeasible were not included.

Selection of studies

The selection was made by a pair of reviewers independently, excluding studies that did not provide full text. Subsequently, the publications were grouped and sent to the Rayyan software, with the removal of duplicates. Articles that did not contemplate the object of study were eliminated by title and abstract screening. The articles included were selected after full text screening.

The search in all databases totaled 949 publications. After applying the mentioned criteria and removing the duplicates, 407 remained. After thoroughly reading the titles and abstracts, 18 studies were selected. After full text reading, we concluded that only 11 studies were adequate for the research question and six publications from the gray literature search, totaling 17.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flowchart guided the search process(13), as shown in Figure 3.

Source: Prepared by the authors, 2021.

Figure 3 - Flowchart of selecting articles and publications in the gray literature. Niterói, RJ, Brazil, 2021

RESULTS

The selected studies are shown below in Figure 4.

Source: Prepared by the authors, 2021.

Figure 4 - Characterization of selected studies, concerning title, authors, journal/year, database, country, and publication type. Niterói, RJ, Brazil, 2021

Among the selected studies, six refer to nurses' skills in Dermatology in a general and broad way, highlighting training that includes the integral assessment of the person and knowledge about skin conditions, considering the repercussions in the clinical, emotional, social, and work spheres. Eleven studies discussed the professional competence limited to specific activities, namely: medication prescription (4), identification of skin cancer (4), treatment/debridement of wounds (2), and aesthetic approach (1).

Based on the findings, the following categories were elaborated: 1) integral evaluation of the dermatological patient, 2) medication prescription, 3) early detection and prevention of skin cancer, 4) wound treatment, and 5) aesthetics, described in Figure 5.

Source: Prepared by the authors, 2021.

Figure 5 - Nursing skills in ​​Dermatology according to selected publications. Niterói, RJ, Brazil, 2021

DISCUSSION

Comprehensive evaluation of the dermatological patient

In this review, six studies(8,14,20,22,25,27) emphasized the importance of comprehensive and individualized assessment through professional/patient interaction, focusing on the skin affected by lesions and the repercussions of cutaneous involvement in the clinical, emotional, and social spheres. This approach is justified by the need to extrapolate the exclusively clinical assessment and the impossibility of hiding the skin disease from society, as it is imprinted on the skin, a fact that influences self-image, self-esteem, and the relationship with the other(7).

Nurses' competencies in ​​Dermatology cannot be focused on the exclusive treatment of lesions, requiring, in addition to technical competence, sensitivity, and availability for an individualized and comprehensive assessment(14) to promote comfort.

In this context, nurses must demonstrate availability and develop sensitive listening to understand aspects that directly impact people's lives and bring discomfort, influencing adherence to treatment, self-care, recovery, and quality of life(14). One of the articles points out the concepts proposed by the theorists Henderson and Kolcaba. Henderson emphasizes the need to understand the cultural diversity of people and their specific abilities, considering mind and body inseparable, highlighting the physiological, psychological, sociological, and spiritual components(30). Kolcaba, in turn, mentions that unmet comfort needs presuppose the need for intervention to maximize comfort, confirming the relationship between comfort and care and the concern to establish comfort measures as a synonym for nursing intervention(30).

To ensure high-quality care for individuals with skin conditions, healthcare professionals need to develop skills that encompass comprehensive and effective care. This involves utilizing cognitive resources, including knowledge, values, attitudes, perceptions, evaluation, and critical reasoning(8).

In this perspective, a light technology called "Protocol for the Assessment of Clients with Skin Conditions" stands out to understand the clinical history of people with skin conditions. This protocol was developed and later validated by experts, aiming to contemplate speech and behavioral manifestations, favoring liberating semiology. It comprises ten parts covering clinical, emotional, and social aspects and provides 92 nursing diagnoses, according to the North American Nursing Diagnosis Association. This technology promotes a person-centered approach and demystifies the exclusive importance of injuries, promoting dialogue, sensitivity, and solidarity between the professional and the client. It is a useful tool that guides the nursing process phases and could serve as a data source for nursing research in Dermatology(31).

Medication prescriber

The competence to prescribe medication was mentioned in four publications(15,17,19,21). It is important to mention that the legislation regarding drug prescription by nurses differs in different parts of the world. Public Health Programs and approved routines in health institutions, both public and private, set the legal boundaries for this practice in Brazil. These boundaries are established per COFEN Resolution 271, issued on July 12, 2002. However, this resolution was revoked by Resolution 317 in 2007(32).

Although legally guaranteed by the Law of Professional Nursing Practice, nurses in Brazil face challenges when carrying out this assignment. Despite international evidence supporting its benefits for quality of care and health system efficiency, there are doubts, particularly from the medical community, regarding the legality and effectiveness of this practice. Such doubts are contrary to the legal foundations of the nursing profession and lead to conflicts related to the social, political, marketing, and cultural aspects in which this profession is situated(33).

A documentary study reveals that nurses contributed to the legalization of prescription but not to its legitimation. The role of nurses as medication prescribers in Primary Care is well-established through protocols and legislation, but there is no clear follow-up strategy from the Ministry of Health. Despite this, there is resistance to some norms within the health sector. The authors conclude that nurses tend to prescribe medication only within the bounds of legality, and the main challenge is to achieve legitimacy(34).

Aside from the aforementioned challenges, there are others to consider, such as the need to mobilize the nursing profession, build new relationships with other professionals, users, and health service managers, and eliminate the polarization that exists regarding this function within the nursing work process (some nurses refuse to prescribe, while others take on this function in isolation)(34).

The International Council of Nurses (ICN) emphasizes that for nurses to practice advanced roles, they must hold a professional master's degree or a postgraduate degree in advanced practices. Furthermore, it is important to expand investments in educational institutions, representative class entities, and health establishments(35).

Thus, to adequately prepare specialist nurses in Dermatology, it is important to prioritize specific programs in the syllabus, such as those related to leprosy, Leishmaniasis, and other skin conditions.

Prevention and detection of skin cancer

According to INCA, skin cancer is the most frequent in the country and corresponds to about 30% of all registered malignant tumors(36). Skin cancer is highly prevalent in Brazil, and specialist nurses in Dermatology can play a crucial role in preventing and educating the population about it. This professional's educational function stands out in this context, guiding the population on preventive actions and the main signs and symptoms.

Thus, it is necessary to know the elementary lesions, including those suggestive of the main types of skin cancer (basal cell carcinoma, squamous cell carcinoma, and melanoma), and characteristics such as asymmetry, the aspect of the edges, color, and size, favoring the possibility of shape recognition precocious.

Nurses' competence in preventing and detecting skin cancer was highlighted in four publications(16,18,24,28). However, an article published in the United States cites inconsistency in precisely identifying this type of injury(16). To change this situation, we must develop, validate, and implement new technologies to assist professionals in acquiring the necessary skills(24).

In addition, the organization of qualification and training programs becomes essential for expanding the scope of action of this professional class, especially among specialist nurses in the area, whether within the public policy discussion spaces or to encourage cancer prevention and control policies.

Wound care

Despite the considerable number of specialization courses in Brazil that address the treatment of wounds, a significant number of nurses need to gain knowledge on the subject(23).

In this sense, it is highlighted that the competence of the specialist nurse involves not only the treatment of the wound itself but all aspects involving the patient. In this context, the Regional Council of Nursing of Rio de Janeiro (COREN-RJ) issued 2013 opinion nº 003, forwarded by the Technical Chamber of Management and Assistance in Nursing. Specialized care must go beyond the exclusive focus of wound assessment and prescription of products and dressings, involving a comprehensive and personalized assessment and contemplating clinical, emotional, and social aspects, as these can negatively influence the case evolution(36).

Despite the importance of the comprehensive assessment of the injured person, the two publications that address the topic(23,29) gave special attention to technical procedures to the detriment of the person's assessment. One of the publications addresses the different types of debridement(29), a fact that deserves discussion, given the different approaches on the subject in the opinions issued by Regional Councils in different states of Brazil(31).

Aesthetics

Although the aesthetics subarea is on the rise, only one publication was selected that addresses the competencies of Nurses in Aesthetic Dermatology(26), which reveals the scarcity of publications on the subject(37).

The role of nurses in this area was regulated by Resolution COFEN 529/2016, attributing to postgraduate professionals in lato sensu aesthetics in a course approved by the Ministry of Education and Culture (MEC), with at least 100 hours of practical classes, the performance of procedures of greater technical complexity(36). This Resolution was partially suspended due to injunctions(37).

Subsequently, COFEN Resolution 626/2020 approved the standardization of the performance of qualified nurses in this area, being able to perform procedures such as dermopigmentation, vacuotherapy, electrotherapy/electrothermophototherapy, combined ultrasound and microcurrent therapy, carboxytherapy, cosmetic and cosmeceutical procedures, lymphatic drainage and cavitational ultrasound(38). Despite the emphasis on technical procedures, it is emphasized that aesthetics is directly related to image disorders, eating disorders, self-mutilation, and depression(37), a fact that highlights the need to privilege professional attention in addition to technical procedures.

In addition, it is considered that although, historically, aesthetics is considered a sub-area of Dermatology, COFEN Resolutions 529/2016 and 626/2020 mention the nurse in aesthetics without establishing a link or prerequisite with the area of Dermatology(38,39). Given the above and the precariousness of studies in this area, the need to create interest groups stands out, aiming to conduct research, exchange experiences, and organize scientific meetings to disseminate knowledge and develop skills.

CONCLUSION

The study achieved the proposed objective by mapping the competencies of specialist nurses in Dermatology in different healthcare settings. Given the vast possibility for nurses to act in this area and considering Resolution 581/2018 of the Federal Nursing Council, which considers wounds, burns, and podiatry as areas of activity, there is a gap in knowledge and a need to expand the discussion and research on the subject. In this sense, attention is drawn to meeting the real needs of the population, considering the epidemiological, regional, and cultural characteristics, in addition to the need for permanent updating and improvement.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. Ferreira IG, Weber MB, Bonamigo RR. History of dermatology: the study of skin diseases over the centuries. An Bras Dermatol. 2021;96(3):332-345. https://doi.org/10.1016%2Fj.abd.2020.09.006

2. Mittag BF, Krause TCC, Roehrs H, Meier MJ, Danski MTR. Care of Skin Injuries: Nursing Actions. Estima. 2017;15(1):19-25. https://doi.org/10.5327/Z1806-3144201700010004

3. Sena NV, Alves AFV, Pontes LM, Santos e Silva PR, Amarante MSLD, Souza MLP, Brandão BJF. Epidemiological profile of the patients treated in the dermatology service of the BWS, São Paulo – SP. BWS J [Internet]. 2020 [cited 2021 Mar 21];3:e20050074:1-9. Available from: https://bwsjournal.emnuvens.com.br/bwsj/article/view/94

4. Instituto Nacional de Câncer José Alencar Gomes da Silva (BR). Estimativa 2020: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2019 [cited 2021 Mar 25]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2020-incidencia-de-cancer-no-brasil.pdf  

5. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Vigilância em saúde no Brasil 2003|2019: da criação da Secretaria de Vigilância em Saúde aos dias atuais. Bol Epidemiol [Internet]. 2019 [cited 2021 Mar 25];50(n.esp.):1-154. Available from: https://ameci.org.br/wp-content/uploads/2019/09/boletim-especial-21ago19-web.pdf

6. Ministério da Saúde (BR), Conselho Nacional de Saúde. Resolução nº 573, 31 de janeiro de 2018. Normatiza as “Recomendações do Conselho Nacional de Saúde à proposta de Diretrizes Curriculares Nacionais (DCN) do curso de graduação Bacharelado em Enfermagem”. Diário Oficial da União [Internet]. 2018 [cited 2021 Mar 25];213(Seção 1):38. Available from: https://conselho.saude.gov.br/resolucoes/2018/Reso573.pdf

7. Brandão ES, Urasaki MBM, Tonole R. Reflections on the skills of the specialist nurse in dermatology. Res Soc Dev. 2020;9(11):1-11. http://dx.doi.org/10.33448/rsd-v9i11.10439 [included in the review]

8. Mandelbaum MHS. Dermatology nursing in Brazil: reality, challenges and perspectives. BDNG [Internet]. 2016 [cited 2021 Mar 26];15(2):06. Available from: http://sobende.org.br/pdf/DOC-20160802-WA0005.pdf

9. Conselho Federal de Enfermagem (BR). Resolução 389, 18 de outubro de 2011. Atualiza, no âmbito do Sistema Cofen/Conselhos Regionais de Enfermagem, os procedimentos para registro de título de pós-graduação lato e stricto sensu concedido a enfermeiros e lista as especialidades [Internet]. Brasília: COFEN; 2011 [cited 2021 Mar 26]. Available from: http://www.cofen.gov.br/resoluo-cofen-n-3892011_8036.html

10. Conselho Federal de Enfermagem (BR). Resolução 581, 19 de julho de 2018. Atualiza, no âmbito do Sistema Cofen/Conselhos Regionais de Enfermagem, os procedimentos para registro de título de pós-graduação lato e stricto sensu concedido a enfermeiros e lista as especialidades [Internet]. Brasília: COFEN; 2018 [cited 2021 Mar 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-581-2018_64383.html

11. Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI. 2020 [cited 2021 Mar 26]. Available from: https://synthesismanual.jbi.global/.  https://doi.org/10.46658/JBIMES-20-01  

12. Perrenoud P. As competências para ensinar no século XXI. Porto Alegre: Atmed; 2002. 176 p.

13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71). https://doi.org/10.1136/bmj.n71

14. Santos I, Brandão ES, Clos AC. Dermatology nursing: sensitive listening skills and technology for acting in skin care. Rev Enferm UERJ [Internet]. 2009 [cited 2021 Mar 30];17(1):124-129. Available from: http://files.bvs.br/upload/S/0104-3552/2009/v17n1/a022.pdf [included in the review]

15. Stenner K, Carey N, Courtenay M. Nurse prescribing in dermatology: doctors’ and non-prescribing nurses’ views. J Adv Nurs. 2009;65(4):851-859. https://doi.org/10.1111/j.1365-2648.2008.04944.x [included in the review]

16. Loescher LL, Harris JM, Lewandrowski CA. A systematic review of advanced practice nurses’ skin cancer assessment barriers, skin lesion recognition skills, and skin cancer training activities. J Am Acad Nurse Pract. 2011;23(12):667-673. https://doi.org/10.1111/j.1745-7599.2011.00659.x [included in the review]

17. Carey N, Stenner K, Courteney M. Stakeholder views on the impact of nurse prescribing on dermatology services. J Clin Nurs. 2010;19(3-4):489-506. https://doi.org/10.1111/j.1365-2702.2009.02874.x [included in the review]

18. Oliveira AS, Nehal KS, Christos PJ, Sharma N, Tromberg JS, Halpern AC. Using nurse practitioners for skin cancer screening: a pilot study. Am J Prev Med. 2001;21(3):214-217. https://doi.org/10.1016/S0749-3797(01)00354-3 [included in the review]

19. Courteney M, Carrey N, Burke J. Preparing nurses to prescribe medicines for patients with dermatological conditions. J Adv Nurs. 2006;55(6):698-707. https://doi.org/10.1111/j.1365-2648.2006.03960.x [included in the review]

20. Bobonich M, Nolen M. Competencies for dermatology nurse practitioners. J Am Assoc Nurse Pract. 2018;30(11):606-613. https://doi.org/10.1097/JXX.0000000000000137  [included in the review]

21. Amiza, S. Expert views, opinions, and recommendations. J Dermatol Nurses Assoc. 2016;8(5):312-317. https://doi.org/10.1097/JDN.0000000000000250 [included in the review]

22. Anthony J. Dermatology Nursing Standards of Clinical Practice. Dermatol Nurs [Internet]. 2003 [citado 2021 Mar 30];15(2):160-7. Available from: https://web-a-ebscohost.ez24.periodicos.capes.gov.br/ehost/pdfviewer/pdfviewer?vid=3&sid=25d92ebd-d1a6-4f63-a14a-52d577ad8a37%40sessionmgr4008 [included in the review]

23. Faria GBG, Prado TN, Lima EFA, Rogenski NMB, Borghardt AT, Massaroni L. Knowledge and practice of nurses on the care of wounds. Rev enferm UFP. 2016;10(12):4532-4538. https://doi.org/10.5205/reuol.9978-88449-6-ED1012201614 [included in the review]

24.Machin C. The Evolution of advanced practice for nurses working in skin cancer care. Br J Nurs. 2020;29(3):140-141. https://doi.org/10.12968/bjon.2020.29.3.140 [included in the review]

25. Davies A, Joseph CD, Page WB, Parrish FL, Price AM, Reeken S, et al. Dermatology Nursing Competencies: Developing dermatology nurses from noviceto expert. Dermatol Nurs [Internet]. 2012 [cited 2021 Mar 30]. Available from: https://bdng.org.uk/wp-content/uploads/2017/02/nursing_competencies_2.pdf [included in the review]

26. Souza MPW. Competências profissionais do enfermeiro para atuação no mercado de trabalho de estética [undergraduate thesis on the internet]. Florianópolis: Universidade Federal de Santa Catarina; 2019 [cited 2021 Mar 30]. Available from: https://repositorio.ufsc.br/bitstream/handle/123456789/202347/TCC%20-%20MARIA%20PAULA%20WS%20-%20FINAL.pdf?sequence=1&isAllowed=y [included in the review]

27. Bohonich M, Cooper DK. A Core Curriculum for Dermatology Nurse Practitioners: Using Delphi Technique. J Dermatol Nurses Assoc. 2012;4(2):108–120. https://doi.org/10.1097/JDN.0b013e31824ab94c [included in the review]

28. Christos PJ, Oliveira AS, Mâsse LC, McCormick LK, Halpern AC. Skin cancer prevention and detection by nurses: attitudes, perceptions, and barriers. J Cancer Educ. 2004;19(1):50-57. https://doi.org/10.1207/s15430154jce1901_12 [included in the review]

29. Santos ICR, Oliveira RC, Silva MA. Surgical debridement and the legal responsibilities of nurses. Texto Contexto Enferm. 2013;22(1):184-192. https://doi.org/10.1590/S0104-07072013000100022 [included in the review]

30. Brandão ES, Santos I. Theories of nursing in promotion of comfort in dermatology. Rev enferm UERJ. 2017;27:e38330. http://dx.doi.org/10.12957/reuerj.2019.38330

31. Brandão ES, Santos I, Lanzillotti RS. Validation of na instrument to assess patients with skin conditions. Acta Paul Enferm. 2013;26(5):460-466. https://doi.org/10.1590/S0103-21002013000500009

32. Conselho Federal de Enfermagem (BR). Resolução nº 317, 02 de agosto de 2007. Regulamenta as ações do Enfermeiro na consulta, prescrição de medicamentos e requisição de exames [internet]. Rio de Janeiro: COFEN; 2007 [cited 2021 Apr 02]. Available from: http://www.cofen.gov.br/resoluo-cofen-3172007_4351.html

1 33. Martiniano CS, Andrade PS, Magalhães FC, Souza FF, Clementino FS, Uchôa SAC. Legalization of nurse prescribing of medication in brazil: history, trends and challenges. Texto Contexto Enferm. 2015;24(3):809-817. https://doi.org/10.1590/0104-07072015001720014

34. Martiniano CS, Andrade PS, Magalhães FC, Souza FF, Clementino FS, Uchôa SAC. Legalização da prescrição de medicamentos pelo enfermeiro no Brasil: história, tendências e desafios. Texto Contexto Enferm, 2015 [cited 2022 Dec 15] 24(3):809-17. Available from: https://www.scielo.br/j/tce/a/wgJMDkGsN4QtX8LYpRdGHkF/?lang=pt&format=pdf

35. Oguisso T, Freitas GS. Enfermeiros prescrevendo medicamentos: possibilidades e perspectivas. Rev Bras Enferm. 2007;60(2):141-144. https://doi.org/10.1590/S0034-71672007000200003

36. Instituto Nacional de Câncer José Alencar Gomes da Silva (BR). Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2019.

37. Conselho Regional de Enfermagem do Rio de Janeiro (BR). Parecer CTGAE nº 003, 17 de julho de 2013. Aborda a Prescrição de curativos pelo enfermeiro no âmbito hospitalar e domiciliar” [internet]. Rio de Janeiro: COREN; 2013 [cited 2021 Apr 03]. Available from: http://www.coren-rj.org.br/wp-content/uploads/2015/02/ctgae_003-2013.pdf

38. Jurado SR, Jurado SV. Aesthetic nursing: advances, dilemmas, and perspectives. Glob Acad Nurs. 2020;1(1):e8. https://doi.org/10.5935/2675-5602.20200008

39. Conselho Federal de Enfermagem (BR). Resolução nº 529, 09 de novembro de 2016. Normatiza a atuação do Enfermeiro na área de Estética [internet]. Brasília: COFEN; 2016 [cited 2021 Apr 05]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-05292016_46283.html

40. Conselho Federal de Enfermagem (BR). Resolução nº 626, 20 de fevereiro de 2020. Altera a Resolução Cofen nº 529, de 9 de novembro de 2016, que trata da atuação do Enfermeiro na área da Estética, e dá outras providências [internet]. Brasília: COFEN; 2016 [cited 2021 Apr 05]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-626-2020_77398.html

Submission: 21-Dec-2021

Approved: 24-Apr-2023