Page 82 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

Bridging knowledge from different types of wound and its management assisted in innovative

wound care practices among patients undergoing radiotherapy described by a participant as

follows, “Brava protective sheets, they are through Coloplast. They are actually for Peristomal

patients’ complications but we found them quite effective for radiation patients” (P#4).

Anecdotal evidence and patients’ preferences were also used in clinical decision-making, as

communicated by one participant:

We try to be as evidence-based as possible. Sometimes patients will come and say “I
didn’t like that dressing I need something else, something different”. In that case, of
course we are going to make adjustments based on the patient’s comfort. (P#1)

Patients’ positive feedback regarding their own comfort relating to pain and ease of dressing

removal helped to guide the RTNs choice of dressings, as explained by one nurse:

Well, I find that with great success we use Mepilex®, if a wound for example…, some
head and neck patients. You know they can be very painful, their moist desquamation, we
use Mepilex®. So what we will use is saline soak, Flamazine◊, and then apply the
Mepilex® dressing and patients love it. It doesn’t stick, absorbs the exudate, and
because the nerve endings are covered, the patient is very comfortable. They love it!
(P#3)

This practice of using a saline soak diverges from how the dressing is designed to be used, but

the nurse is patient-focused in describing why this practice is used. The survey findings revealed

that this practice is widespread (94% of respondents reported the use of saline compresses). At

my own site of practice, patients with radiation induced dermatitis describe saline soaks as

soothing. In our particular setting, after the application of saline compresses for 10 - 15 minutes,

the treatment area is allowed to air dry, a thin layer of a prescribed antimicrobial agent is applied

to open or peeling areas of moist desquamation and the area is covered by a dressing of choice

depending upon the amount of exudate.

A related sub-theme regarding RTNs’ perception of their role in clinical decision-making

is that of Networking. Connecting with other members of organizations, such as the Canadian