Page 149 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

 Complexity: The perception of complexity in nursing role and clinical judgment
in the area of wound management during radiotherapy is evident from the data
analysis.

 Inconsistency in Practice: The qualitative data suggests that there is
inconsistency in whether to remove or radiate through wound dressings because
(i) it is standard practice to never radiate through dressings or (ii) because it is
beyond their scope or field of practice as other team members are the decision
makers, or (iii) because of the individual patient’s co-morbidities or preference
and (iv) a possible change in practice is in process at one of the centres.
 Inter-professional Relationships: Participants were invited to describe how
inter-professional relationships may affect collaborative practice. All participants
articulated teamwork through team meetings, interdisciplinary co-ordination,
patient allocation and patient flow in the ambulatory care setting. Participants
described their role as patient advocates in their cancer trajectory. A participant
provided an insight into wound care as being holistic. Wound care is further
described to have an interdisciplinary approach, involving the different members
of the team.
In summary, the findings of the literature review and environmental scan illustrate that there is
considerable variability between centres in regards to radiating through wound dressings during
radiotherapy. The analysis suggests that evidence-based standardization of wound care practices,
particularly in the area of radiating through dressings during cancer radiotherapy, requires further
research. While one of the participants shared that their centre is looking at changing practices in
regards to removal of dressings prior to daily radiotherapy, it appears to be a local practice
change that is in process. When their practice change is evaluated, it may well be resourceful for
future directions of this project.

Phase III: Consensus-Building for Recommendations

The final phase of consensus-building with clinical experts is now being initiated. Radiating
through dressings may be an innovative practice and it is hoped that the thesis will serve as
foundation for a national standard. The study results will be used to make recommendations for
future research. Based on preliminary analysis of findings, recommendations are:
 Identify the composition or properties of available and most frequently used wound care
products.

 Collaborate with Physics Department to test and measure in a phantom lab setting the
bolus effect when dressings are left in place.

 Conduct a cost analysis of dressings when dressings are removed on a daily basis.

 Clinical research such as a Randomized Controlled Trial with patient groups to evaluate
best practice.