Page 95 - APPENDIX B: Trials Investigating the Management of Acute Radiation-Induced Skin Reactions Reading Qualitative Research

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WOUND CARE

always removed in some centres, they are left in place for palliative patients at other centres.

The qualitative data suggests that there is inconsistency in whether to remove or radiate through

wound dressings because 1) it is standard practice to never radiate through dressings; 2) because

it is beyond their scope or field of practice as other team members are the decision makers; 3)

individual patient’s co-morbidities or preference; 4) goals of care i.e., curative or radical and

palliative or supportive; and 5) a possible change in practice is in process at one of the centres.

Thin dressings are sometimes left in place at a few centres based on patient preference or team

decision as learnt from one of the qualitative interviews, experience at the local Radiation

Oncology Centre, where I am working and as suggested in the literature.

A comparison of the questions, “How often is a patient's wound assessed” to “How

consistent is nursing practice regarding the use of skin assessments and wound dressing changes

during radiotherapy?” showed that four respondents who answered ‘as needed’ also reported

their practice as being ‘very consistent’. Though the comparison illustrated a different

perspective and perhaps contradicts the assumption that ‘as needed’ assessments (41%) might

not be ‘very consistent’, for the most part the respondents reported consistency (81%) in nursing

wound care practices. This apparent contradiction could speak to the perceived difference

between how often the wound is assessed, the role of the nurse in decision-making in patient

specific wound care practices and the broader context of clinical decision-making, particularly

around wound management. Without a tested scale to measure consistency in practice, a firm

conclusion cannot be made, based on this study.

Nonetheless, the term “consistency” in wound care practices seems to be interpreted on

individual perspectives rather than standardized practices. In other words, nurses may view

their own professional practice as consistent, even though there may be variation from nurse to