Nurses Must Counsel Safety for Clients Seeking Fun in the Sun

June 15th, 2012


By , BSN, RN

I grew up in south Texas. In the summers I was running around outside all day long. My friends and I would ride bikes, go to the park, go to the pool, or just hang out in my neighbor’s very cool tree house. We lived our young lives outdoors.

When I reached my teen years I had summer jobs as a camp counselor, a lifeguard, and as a swimming teacher. I didn’t really lie around in the sun much because I was out in it all day.

As a young adult, my summers were not much different from the rest of the year because now I had a career. My only real outside time was on weekends or holidays, where I inevitably overdid it and came back to work sporting sunburn of honor, the badge of well-earned time off.

What all this has in common is a lack of attention to sun protection. As a kid I never thought about sunscreen, very few people did then and it wasn’t very effective anyway. As a teen that tan was part of a look and we all thought it looked good. As a young adult I knew it wasn’t healthy, but really, I thought, how much damage can one or two sunburns really do.

A Tan May Be Pretty But…

Now, we know better. The sun is dangerous. Besides the pain of sunburn, the dehydration of being out all day and staying hot all night, there is the very large risk of developing skin cancer.

As a nurse, this summer will be like all the rest. Depending on where you work, you are going to see victims of too much sunshine. You may work in an emergency department, a family practice clinic, or even an operating room, but it is very likely you will see patients with sunburn maladies. And that doesn’t even take into account your neighbors calling to ask what they can do for their kid’s ballpark sunburn. It’s a problem all nurses need to understand.

Sunburn is the reddening of the skin caused by overexposure to the sun’s harmful ultraviolet radiation. While it may seem like a temporary problem, a little pain and tenderness for a few days, it can cause long lasting damage and lead to potentially fatal disease.

According to the Skin Cancer Foundation, 42 percent of people who replied to a sunburn survey report getting burned at least once in the previous year. Now, some folks are at a greater risk for sunburn than others:

  • All infants and children of all races.
  • People with diabetes or thyroid disease.
  • People who take certain types of medications, such as some antibiotics, some tranquilizers, and some birth control pills, which can make skin more sensitive to the sun.
  • People living in higher altitudes or people who travel to high altitudes.
  • Anyone who works outdoors.

So, as you can see, almost everyone falls into a high-risk area for sunburn at least once in their lifetime. There are a lot of myths surrounding exposure to the sun including getting a “base” tan will prevent future burning and that people of color do not burn, tanning beds are safer since they aren’t really the sun. These are simply untrue and as nurses we must continue to inform our patients that no matter their skin tone or color they need to use sunscreen when outside.



Sun Signs and Symptoms

The signs and symptoms are pretty recognizable to even a layperson:

  • A mild or case of sunburn usually results in minor skin redness and pain. The skin tends to redden within 2-6 hours after exposure and peak effects are noted within 12-24 hours.
  • In more severe cases of sunburn or sun poisoning the skin will blister, there is a lot of fluid loss and dehydration and the burned person may suffer from an electrolyte imbalance.
  • If a sever sunburn goes untreated the person can experience infection, shock (poor circulation to vital organs), and even death.

There are a number of other symptoms, which can accompany a mild or severe burn, including:

  • Chills
  • Fever
  • Nausea and/or vomiting.
  • Blistering may range from a very fine blister that is only found when you begin to "peel" to very large water-filled blisters with red, tender, raw skin underneath. When blisters pop, the skin that covered them will slough off.
  • Skin loss or peeling usually starts about 4-7 days after the initial exposure.

These are just the everyday, run of the mill, problems that accompany a sunburn. However, the problems can be much larger and more hazardous to a client’s health.

Skin Cancer

One or more blistering sunburns in childhood or the teen years more than doubles a person's chances of developing melanoma later in life, according to the Skin Cancer Foundation. To make matters worse, a person's risk for melanoma doubles if they have more than five sunburns at any age.

In an article a few years back in the journal Preventive Medicine, researchers explained that, “Skin cancer incidence now roughly equals that of all other cancers combined (approximately 1.3 million cases per year) and continues to increase. The primary cause of skin cancer is chronic unprotected exposure to the sun’s ultraviolet light, as well as intense, intermittent exposures such as those that occur at the beach.”

To give you some more ammunition when talking to your clients about the dangers of the sun and getting a sunburn here are a few more melanoma facts:

  • About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old. This would be the most prevalent sunbathing years.
  • One person dies of melanoma every hour (every 62 minutes).
  • One in 55 people will be diagnosed with melanoma during their lifetime.
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation from the sun and tanning beds.

Melanoma is a scary disease and it can appear on anyone, child or adult. Having a little pretty color on your skin is certainly not worth the health risks associated with laying out by the pool.


Most folks don’t need to consult a nurse or a doctor to diagnose sunburn. The remedies of cool showers, lots of lotion, ibuprofen, and hydration will take care of the symptoms until the burn heals. However, people who experience any of the following symptoms should contact a dermatologist immediately:

  • A growth on the skin that wasn’t there before the sunburn.
  • A sore that bleeds, crusts over or doesn’t heal within two weeks.
  • A change in the size, color, or texture of a mole.
  • A large, flat, dark spot on the skin that is gradually getting bigger.

Summer is upon us and all the good and bad that goes with it. It’s great to get outside, go for a swim, take in a ball game, or have a barbecue; just do it safely. Advise your clients and your family and friends to wear sunscreen with at least an SPF of 15 or higher and reapply it frequently, keep infants under six months of age out of the sun altogether, and wear a hat and sunglasses (yes, they can develop melanoma of the eye). No amount of fun and sun is worth the consequences.

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