Page 151 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

EXCERPT #2: A respondent (P#1) reflects on practice change and other factors such as
resource management (e.g., dressing availability and cost) that influence wound
management.

R: Can you tell me more about your own experience with wound management in
radiation therapy?
P#1: I know there are some practices that have been dispelled since I started in
radiotherapy. Before people would be putting on baby powder and talc and now we
really avoid those because now we know that it can cause fungal infections. So we have
changed some of our recommendations what we tell patients to do and how to take care
of their skin. In terms of dressings, there are a few things that we are doing in our
department. We do use Flamazine for moist desquamation for anybody who is not
allergic and we do however cover that with Adaptic and dry gauze. I know colleagues in
other centers are using Mepilex or Mepilex Lite, umm but we haven’t gone that route. It’s
not available in the hospital, it’s more costly to the patients, it’s not necessarily available
…We practice primary nursing so we are very advocative for the patient.

EXCERPT #3: Respondents (P#1, P#2 & P#3) articulated nursing leadership and
autonomy in clinical judgment particularly in radiation oncology wound management and
highlighted the permeable inter-professional boundaries that exist in the clinical setting.

R: How do nurses in your cancer center perceive their role in clinical decision making in
the area radiation oncology wound care?
P#1: It would be the physician who decides about removing the dressing but honestly I
have been here 16 years, I can’t even think of maybe five times that we haven’t removed
the dressings, we always remove the dressing.
P#2: We are pretty much the frontline even though radiation therapists are mainly the
front line healthcare professionals. But nursing is the one who does the primary
assessment and make some clinical judgments and you know we have opinion from the
oncologist, 9/10 it’s kind of a combined effort from nursing and oncologist to decide
what’s best treatment for skin care. They are open and receptive to the nurse’s opinion,
so I find it’s good.
P#3: Assessment, we have fair amount of liberty to decide management. umm it’s so
consistent, but when a prescription is required for Flamazine, we do have to speak to
with the physician to get it. They are quite comfortable with our assessment skills to
provide that. We follow the lead, certainly depending on the patient.