VOL: 103, ISSUE: 26, PAGE NO: 30
Jane Freak, RGN, SEN, NNEB, is Macmillan skin cancer clinical nurse specialist, surgical directorate, the Royal Bournemouth Hospital, DorsetThere is good evidence to suggest that sunburn before the age of 15 increases the risk of developing melanoma in la...
There is good evidence to suggest that sunburn before the age of 15 increases the risk of developing melanoma in later life. This makes it particularly important to target children with advice about protection against sunburn.
Sun Awareness Week, an annual event promoted by the UK Skin Cancer Working Party, provides opportunities for skin cancer clinical nurse specialists (CNSs) to promote sun safety messages to the general public.
Its key health education messages are:
- Avoid excessive sun exposure throughout your lifetime but especially in childhood;
- Enjoy the benefits of fine weather without putting yourself at risk;
- Avoid remaining in direct sunlight during the midday hours;
- When in the sun, wear sun-protective hats with wide brims to protect your ears, face and neck;
- When in the sun, wear clothing that protects against the sun;
- Wear sunglasses to protect the vulnerable skin around the eyes;
- Before going out in the sun, make sure you apply suitable high-protection factor sunscreens (Buchanan, 2006).
Statistics show that the south-west of England has a particularly high incidence of skin cancer compared with the rest of England and Wales. Malignant melanoma is the sixth most common cancer in the region (South West Cancer Intelligence Service, 2006).
PRIMARY SCHOOL PROJECT
Working with schools or school nurses to educate children about sun safety is part of the role of the skin cancer CNS.
Knowledge, attitudes and behaviour with regard to sun exposure are poor among young children (and their carers) and they are therefore an important target group for promoting sun awareness.
I approached a local primary school of approximately 200 children aged 4-7 years, to see if the headmistress would be interested in the school becoming a pilot site for Sun Awareness Week. The response was enthusiastic.
The headmistress and I met regularly to hold brainstorming sessions and discuss the aims and objectives of the scheme. The main aim was to develop a programme that could be incorporated into the children's weekly environmental studies.
This programme would engage children in sun safety activities over a period of several weeks with completion aimed for Sun Awareness Week itself.
The headmistress wrote to parents explaining the project and asking permission for their children to take part. As well as educating children it was just as important to educate adults about sun safety, so the headmistress and I also devised a series of educational sessions for both parents and teachers.
I attended an assembly so I could meet the children and teachers and explain the project. I invited the children to talk about how they looked after their skin when they went to the beach or played in the sunshine and to describe what they thought sunburn really was.
To alert them to the connection between sunburn and discomfort I read them a story in which one of the characters experiences painful sunburn. I also invited them to take part in two competitions. One of these involved them coming up with a name for the sun awareness project while the other required them to draw a picture to show how they could protect themselves on a hot, sunny day.
The children were given questionnaires to complete before and after the programme. By using these I could assess their level of sun awareness before the project began and then gauge whether or not it had succeeded in increasing that awareness and their motivation to adopt sun-protective behaviour.
Education sessions for parents and teachers were held in the evening over a two-week period. They were also invited to help to develop a training manual for people working with children and school guidelines/policies for using sun protection in school.
I emphasised the importance of shady areas in the school playground and the need to cover up with suitable clothes and hats (Freak, 2004). This included promoting the Australian 'no hat, no play' policy, which has now been successfully implemented in some British schools (Buchanan, 2001). The school has a 'no coat, no play' policy for winter so it was agreed that having a hat in summer was equally important.
Staff at the school appreciated the support and information they received and stressed that they would continue to incorporate sun safety into the curriculum.
In May 2006 the 'no hat, no play' policy was introduced at the school. If a child forgets to bring their hat into school they are not allowed outside to play. The rule extends to teachers, who are now wearing hats in the playground.
The pre-education questionnaire revealed a lack of knowledge and the post-education questionnaire showed a remarkable improvement. During Sun Awareness Week I visited the school with the hospital consultant to thank the children, teachers and parents for participating in the sun awareness project. Prizes were distributed to the competition winners and each child was given a certificate for participating. The event was publicised in the local press.
Although evaluation forms were not distributed at the parent/teacher sessions feedback was encouraging, with those who attended saying they found the sessions interesting and that they were more knowledgeable than before. Many questions were asked and parents and teachers appeared to be pleased that their school had been selected as the pilot school. They also voiced their approval of the 'no hat, no play' policy.
Sunscreen was discussed at great length. The general consensus was that children should be able to self-apply this when at school. The school may purchase sunscreen dispensers so that children and teachers can self-apply before outdoor activities.
Unfortunately there were no volunteers to assist with the development of a sun safety school protocol/policy for sunscreen but it is something the headmistress and I aim to develop in the future.
I am confident that the sun awareness programme will be more than just a one-off event and that the school will continue to promote sun safety annually. I also hope the older pupils will take the 'care-in-the-sun' messages with them when they move to secondary school.
The headmistress and I decided the way forward was to continue with sun safety education programmes that could be extended to more primary school children within the Dorset area.
This would be too big a project for one person but sun awareness/safety education sessions could be organised for professionals (teachers/classroom assistants and school nurses). This information could then be disseminated to schoolchildren of all ages.
The main aims of an education programme would be:
- To ensure that children know that it is fine to be pale;
- To increase children's awareness of using clothing and shade when outside;
- To promote the importance of avoiding being in the sun between 11am and 3pm;
- To promote the importance of using sun protection with an adequate sun protection factor (SPF>15). This should be applied frequently (at least 30 minutes before going outside, then reapplied every two hours or more frequently according to the manufacturer's instructions) and not rubbed in - a thin film should be evident.
These messages could be communicated to children, teachers and parents via:
- Visual aids such as books, CD-ROMs, DVDs, videos and the hospital website;
- Teaching resources;
- Articles in school magazines/newsletters for parents and pupils, and teaching union magazines for teachers;
- Radio/TV programmes;
- Public and school libraries;
- Teaching/education sessions.
Further information on Sun Awareness Week, sun safety educational strategies and the British Association of Specialist Skin Cancer Nurses can be obtained from the author at email@example.com.
IMPLICATIONS FOR PRACTICE
- To reduce the incidence of skin cancer it is vital to continue with annual skin cancer education programmes for health professionals and the general public. These programmes need to be publicised well in advance.
- Sun awareness programmes need to focus on ways so that the general public can enjoy the sun's beneficial effects while at the same time protecting their skin from burning.
- Ensure that people know that the best all-round defence is to limit the time spent in the sun and to use good sun protection lotion (SPF >15). Sun protection should begin in infancy and continue throughout one's lifetime. It is never too late to start.
- Stress the importance of protecting children so that the future incidence of skin cancer can be reduced.
- In seaside areas there is an ideal opportunity to target holidaymakers by placing sun safety information leaflets in places such as hotels, guesthouses, leisure centres and supermarkets.
- More than 75,000 new cases of skin cancer are diagnosed in the UK each year. Many cases are not reported, however, so the real number of cases is probably much higher.
- The number of cases reported has almost tripled since the early 1980s and more than 2,300 people die from skin cancer each year (Cancer Research UK, 2006).
- Sunburn before the age of 15 appears to increase the risk of melanoma developing in later life. Children and young adults need to be advised about protection against sunburn.
This article has been double-blind peer-reviewed.