Page 30 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Wounds heal best in a moist environment because it facilitates healing, prevents wound

tissue from drying and minimizes the adherence to healing tissue (Bolton, 2007, p. 23).

Principles of moist wound healing are based on Winters’ (1962, 1965) theory that cell

epithelialization needs moisture. Moisture retentive dressings act like the skin and preserve a

physiological environment promoting adequate moisture, temperature, pH, blood supply, and

pathogen control (Rolstad & Ovington, 2007). Factors to consider when choosing a dressing

include 1) the purpose of the dressing and 2) ease of application and removal (Thomas, 2003).

Cioffi (2002) theorizes that efficient nursing care is dependent upon good choice of alternatives

involved in clinical decision-making, which in turn is based on precise judgments. Thompson

and Dowding (2002) define judgment as the “assessment of alternatives” (p. 15). The Wound,

Ostomy and Continence Nurses Society (WOCN) support the use of clean technique as opposed

to sterile procedure for the management of chronic wounds (Perry & Potter, p. 1004). Nurses

provide patient care by using clinical judgment which is part of the decision-making process.

The overview impels a query directed to nurses’ perceived role in clinical decision-making in

radiation oncology wound management which is addressed in the methodology portion of the

study. It is worthwhile to further review wound care during radiotherapy.

Wounds and radiotherapy. Hollinworth and Mann (2010) argue that while removing

dressings during daily radiotherapy is not ideal for preserving optimum wound temperature and

promoting wound healing, further research is needed to appraise and provide subsequent

conclusions about irradiating through dressings. The authors suggest:

Further consideration could be given to leaving the product in place and the radiotherapy

dose recalculated on an individual patient basis. For patients with fungating lesions, it is

accepted practice to irradiate with the dressing in place, but the presence of the dressing