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A developing area of expertise

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VOL: 96, ISSUE: 45, PAGE NO: 1

Mark Collier

There is little doubt that the number of photographs being taken of wounds will continue to rise, particularly for the purposes of wound assessment and documentation, but nurses must remember that some important issues need to be considered before committing any patient image to film (p9). These include identifying the purpose of the photograph, obtaining written consent, ensuring that the image is taken with the right equipment and following an approved protocol, and guaranteeing safe storage and that any further use will be appropriate.

There is little doubt that the number of photographs being taken of wounds will continue to rise, particularly for the purposes of wound assessment and documentation, but nurses must remember that some important issues need to be considered before committing any patient image to film (p9). These include identifying the purpose of the photograph, obtaining written consent, ensuring that the image is taken with the right equipment and following an approved protocol, and guaranteeing safe storage and that any further use will be appropriate.

Before seeking permission for a photograph to be taken, nurses should be able to identify its purpose. Is it for record-keeping, to highlight the progress of healing? Is it for inclusion in a case report folder because the patient has been recruited to a clinical evaluation or research trial? Or is it for historical archiving because the wound is rare or unique?

If the answer to all these questions is 'no' then perhaps the need to take the photograph should be reconsidered. The same could apply if the wound is likely to deteriorate or is never going to heal because of the patient's condition and prognosis. Patient documentation, including photographic records, should inform subsequent actions.

It is essential to obtain written consent from all patients before any photographs are taken, as well as approval from the local research ethics committee for this assessment technique to be used if the patient is involved in an evaluation or research trial. It is also the responsibility of those taking clinical photographs to ensure, wherever possible, that the images are securely stored and are not used for anything other than the purpose for which consent was given.

With low-cost digital cameras and the wider use of computer-based wound assessment programmes, there is a danger that all nurses will assume they can take quality medical photographs. This is not the case. Some difficulties are also associated with using photographic images for comparative purposes. For example, the extent of the wound may not be clear, as in a case of undermining, or its position may preclude this method of data collection. But most importantly, the purpose of photographing a wound must always be considered carefully and clearly identified.

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