The Development and diffusion of wound healing theory and practice : a sociological case-study

The initial aim of this study was to tap the knowledge and experience of doctors and nurses caring for patients with fungating and ulcerating malignant lesions, and in recognition of the scant information available on the nature and treatment of this condition, to make this information available to the wider medical and nursing communities.

The discovery that experimental studies conducted in the 1960's on the physiological processes of wound healing contradicted the previously held dominant view that a 'dry' environment promoted healing. resulted in the researcher widening the remit of the study. This enabled its original focus on the management of patients with malignant lesions to be extended to encompass the extent and sources of clinicians' knowledge about wound healing matters in general and innovations in the wound care field in particular.

It became apparent that, in order to understand the factors which influence clinicians' adoption of innovations, it is not sufficient just to focus on the 'adopters' of new practices; one must also investigate the role which the 'suppliers' of new knowledge and technologies play in affecting the rate of adoption.

Investigation of these issues led to a wide-ranging study based on in-depth interviews with samples of nurses and doctors, research scientists and commercial personnel. The findings from this study indicate that various parts of the body can be a potential site for the development of malignant lesions, which may affect both sexes of all ages, although lesions in certain areas are particularly common, and sex and age-specific. Various conventional and unconventional treatments are used on these lesions, although there was little evidence that doctors and nurses operated on the basis of some clinical consensus when assessing wounds and deciding on the management regimes to employ. The finding that the choice of treatment for malignant and non-malignant wounds is governed by a whole host of social, institutional, psychological and economic factors dispels the myth that wound management is based on objective clinical criteria alone.

The education and socialisation of scientists and the settings in which they work were found to influence their practice, in much the same way as these factors influence clinicians' practice. Moreover, scientists and people working in the commercial world, like clinicians, often employ tacit and experientially based knowledge to inform their practice, frequently informally and often haphazardly acquired, as opposed to via formal learning.

The findings also indicate that the development, diffusion and adoption of medical innovations are influenced by various socio-economic, institutional, individual and political factors. Moreover, that as radical as an innovation may appear, it more often represents a continuation of that which it supercedes than a totally radical departure from it