Page 86 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

management, I am looking at every other factor that is going into the care… So there’s
never just one issue happening with them…When it comes to wound care management
it’s the wound assessment, it’s looking at the patient’s overall health, looking at if they’re
having subsequent chemotherapy. What’s happening with their labs, general health,
nutrition? It depends on type of wound, it is as well. Are we assessing what type of
wound so we have to know the cause, is it healable, non-healable, are we in maintenance
mode because of different underlying factors that are happening. Is it a non-healable
palliative type wound?… we really have to look at fully at the whole patient before we
make any decisions regarding the wound, and then with the wound, It’s a full thorough
wound assessment before we make any determination of what kind of dressings we will be
using. (P#4)

Again, this nurse is describing how clinical decision-making and inter-professional collaboration

revolves around individualizing care for best patient outcomes, not only in wound management

but in what is best overall for the patient.

Another sub-theme is Practice change initiatives. A nursing policy change was

described earlier under clinical decision-making and its sub-theme, Nursing Autonomy. Another

participant described an inter-professional policy change in relation to radiating through

dressings and the objectives were explained:

Improve patient care, improve outcomes, reduce the amount of dressing changes,
improve comfort, be cost effective… We’re really looking at that right now is what
dressings really need to be removed, what dressings could stay on. So we’re in the
process of doing a bit of change in practice so we’re just been meeting the committee to
make a change overall. (P#4)

Theme Three: Nurses’ perceived role in inter-professional relationships is summarized

in the sub-themes Teamwork, Patient advocacy and Practice change initiatives. The flexible

relationships for best patient care and outcomes illustrated collaborative practice. The focused

area of inter-professional care delivery was seen as a vital aspect of the patient experience in the

ambulatory setting. While advocating for patients’ preferences, RTNs as valuable members of

the multidisciplinary team co-ordinated patient allocation and patient flow in the ambulatory care

setting. Additionally, successful initiation of practice changes in the clinical area strengthened