Understanding dressing evaluation: A pragmatist perspective

Abstract

This thesis shed light on the complexities of dressing evaluation. Dressings are categorised as medical devices and as such manufacturers are not required to provide evidence of effectiveness. Instead, they promote their products by offering clinicians samples to try during their clinical work. Researchers using trial methodologies have been unable to provide a clinically helpful body of evidence. Placed within the movement critiquing Evidence-Based Practice, this thesis brings the discussion to the world of dressing evaluation, where an alternative methodology is proposed. This study takes inspiration from John Dewey’s pragmatic philosophy; based on experimentalism, clinician’s experience is given a key place within a structured inquiry and offers a vision for the development of this important branch of wound care. This offers a unique contribution to knowledge. In order to understand the world of dressing evaluation, the study begins with the collection of qualitative data, with focus group and interviews with seven Tissue Viability Nurses and two Pharmacists. Having gained an insight into the way dressing evaluations are undertaken in clinical practice, the data inform a subsequent, mixed-methods study, with participant observation, interviews and review of documents take place with ten patients, thirty-one nurses, one orthopaedic surgeon and five trauma sisters. Using this newly designed methodology, a PHMB foam dressing is evaluated in the care of pin sites, enabling the development of a clinical protocol that has since been adopted regionally. This offers a unique contribution to practice