Nurse Works to Change Perception of Tattoos
Monday November 3, 2008
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"There are a lot of professional women, including nurses, who have tattoos, but most put them in places where they can control who sees them," says Myrna Armstrong EdD, RN, FAAN, professor and regional dean of the Texas Tech University Health Sciences Center School of Nursing at Highland Lakes in Marble Falls. "Many dress codes prohibit them, and lots of people in healthcare facilities are not happy to see tattoos and piercings."
Armstrong has seen tattoo trends come and go while researching body art for 20 years. "One of my goals is to help healthcare professionals have a non-judgmental approach," she says. "I don't care if they want it. I'm very concerned that they know how to get it, care for it and how to remove it. About 25% of 18- to 30-year olds have them now, and it's predicted to reach 40% in a few years."
Most of them choose tattoos to reflect their internal feelings and life experiences, says Armstrong. Typically they'll think about it for a year or two. "Most don't care what others think, but they don't consider it deviant or 'in-your-face,'" she says.
Armstrong studied reasons for tattoo removal in 1996 and, a decade later, published the results in the July 2008 Archives of Dermatology with five co-researchers, including Texas Tech colleagues Jana Saunders, PhD, RN, and Donna Owen, PhD, RN.
"Although women make up about 45 to 65% of those with tattoos, they experience significantly more negative remarks and stigmatization in public, work and school," says Armstrong. "More than half [of the subjects] said they weren't interested in getting other tattoos, but a third said they planned to get more."
Tattooed Nurses
"Nurses are never, ever to judge patients by their covers, so it's very hypocritical to implement different standards for colleagues," says LaJuan Majar, RN, Lampasas, Texas. "I'm covered with tattoos, and it never hampered patient care during 28 years in ED, med/surg, home health, prison, rehab and school nursing. Having tattoos can actually remove barriers with some patients. They respect me as a nurse, but see me as 'cool' and open up about their lives, pain activities and other information they don't share with the doctor or other nurses. And it helps people identify me as their nurse."
For the past 10 years, while working in rehabilitation and geriatrics, Majar's tattoo-artist husband worked at covering her arms in tattoos. The older patients she's worked with for the past 10 years in rehab and geriatric facilities were often enthusiastic about her evolving body art, and the conversational opportunities it offered. "They wanted to see the new tattoos, and introduce me to their kids and grandkids. I was like the nursing home puppy dog, a different ray of sunshine. One very aphasic, post-stroke gentleman would wheel up as fast as he could and say 'Let me see beautiful painting.' He was so excited and thrilled, and my appearance enabled him to articulate thoughts. He thanked my husband and said 'they make me feel good.'"
Majar admits she's amazed that employers judge her skills instead of her skin, and allow her to work in scrubs. "A nurse should always have good judgment in all areas including tattoos," she says. "Some are a very tasteful form of art. There's an appropriate time and place for some tattoos, but very few circumstances that would warrant a lab coat."
Take It Off
"We have lots of clients with several small tattoos, and it can seem to be an addiction," says Lynette Kennedy, FNP, CLS, co-owner and nurse practitioner at New Look Laser Tattoo Removal in Houston and Dallas. "If they have two, they seem to want more. For some people, tattoos are a way to cope with their lives, and we often see clients who are in the process of removing one while getting another."
Thirty percent of her clients either want to remove a specific tattoo or clear space in that area for another, and some want to obliterate signs of past affiliations and relationships.
While Armstrong's studies found people typically consider removal for several years, once they decide, they want it done immediately. Some opt for surgical excision, which can scar. Others try salt scrubs, quack creams, electric sanders and hot metal, and "tattoo remover" that's probably a clothes iron.
"Even while their power was out due to [Hurricane] Ike, we had daily calls from clients who wanted to start. Once committed, they want to complete it ASAP," says Kennedy. "Removal creams don't do anything. People get so desperate they'll try abrasives, acid and burning. Those may be unable to remove the ink, but cause severe infections requiring hospitalization, extreme pain, tissue damage and significant scarring, sometimes in the shape of the tattoo."
Since pigments aren't standardized, even tattoo artists don't know if they can be removed. They're reluctant to use the only FDA-approved product because it was formulated for easier removal. The most effective method is laser treatment, but its success depends on the type of laser, ink color and operator expertise.
"Lots of clinics use whatever type of laser they have for hair removal and other procedures, but those can send the intense pulsed light past the tattoo, much deeper than necessary, and burn," says Kennedy, who is also a certified laser specialist and laser safety officer.
The number of treatments required depends on ink color and components, size and individual healing. "It's a fine line between enough injury for a good treatment and overboard, causing damage," says Kennedy. "You want to see enough swelling to be sure the immune system is bringing fluids to carry ink away and heal the area. Penetrating the right depth and duration creates very shallow superficial blisters that scab to absorb ink and heal without scarring." To do so, she says, the operator should be a certified laser specialist trained specifically for tattoo removal.
The site should be cleaned with alcohol and numbed through chilling, preferably with a cooling machine rather than ice-packs. For three days, patients should keep it dry, covered in gauze, and apply a topical antibiotic every eight hours.
Editor's Note: Read more about the issues surrounding the care of people who have had body piercing or tattooing, and earn 1.0 hour of continuing education credit, on our Web site at www.nurse.com/CE/CE194-60.
To comment on this article e-mail editorSC@nurseweek.com.
