Page 148 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

 Most centres (71%) do not have a reference document such as local policy,
Clinical Practice Guideline or Best Practice Guideline for when to remove a
dressing during radiotherapy.

 A comparison of the questions, “How often is a patient's wound assessed” Vs.
“How consistent is nursing practice regarding the use of skin assessments and
wound dressing changes during radiotherapy?” shows four respondents who
answered ‘as needed’ also reported their practice as being ‘very consistent’.
Though the comparison illustrated a different perspective and perhaps contradicts
the assumption that ‘as needed’ assessments (41%) might not be ‘very consistent’;
for the most part the respondents reported consistency (81%) in nursing wound
care practices. This could speak to the perceived difference between how often
the wound is assessed, the role of the nurse in decision- making in patient specific
wound care practices and the broader context of clinical decision-making,
particularly around wound management.

 The environmental scan reveals that the most common topical treatment for moist
desquamation is antimicrobials such as silver sulfadiazine (69%) along with non-
adherent, thin dressings such as Mepitel® (38%), Adaptic® (31%) or Mepilex®
Lite (31%).

 Saline compresses and gauze are widely used for both the radiation dermatitis and
malignant wounds. In addition, hydrogels (69%), antimicrobial agent such as
metronidazole (62%) and wound care products such as Mepilex Border® (81%)
are also used across Canada for the management of malignant wounds.

 Based on the survey results, it may be concluded that the extent of the missing
and “don’t know” responses in the completed surveys (47%) are limited and
therefore the extent of the problem in relation to reporting bias is minimal.

Results of Qualitative Interviews:
The findings of the semi structured telephone interview presented an informative account
of the nurse participant’s views and experiences in clinical decision-making and inter
professional practice.
 Integration: The overarching theme of ‘integration’ is a key attribute that
Radiation Therapy Nurses use in their practice, especially in the area of wound
care management in radiation oncology. Integration of nursing skills and
knowledge, available resources, institutional policy and procedures is vital in the
context of nursing practice; clinical decision-making; inter-professional
relationships and client experience or preference. The salient aspect of integration
is the essence of collaborative practice among team members in wound care
management during radiotherapy