TIME heals all wounds.
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Abbreviations as Topic↗
Biomedical subjects
Caroline Dowsett
Publications and source records attributed to Caroline Dowsett.
Wound bed preparation: a systematic approach to wound management.
The healing process in acute wounds has been extensively studied and the knowledge derived from these studies has often been extrapolated to the care of chronic wounds, on the assumption that nonhealing chronic wounds were simply aberrations of the normal tissue repair process. However, this approach is less than satisfactory, as the chronic wound healing process differs in many important respects from that seen in acute wounds. In chronic wounds, the orderly sequence of events seen in acute wounds becomes disrupted or "stuck" at one or more of the different stages of wound healing. For the normal repair process to resume, the barrier to healing must be identified and removed through application of the correct techniques. It is important, therefore, to understand the molecular events that are involved in the wound healing process in order to select the most appropriate intervention. Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures. Experts in wound management consider that wound bed preparation is an important concept with significant potential as an educational tool in wound management. This article was developed after a meeting of wound healing experts in June 2002 and is intended to provide an overview of the current status, role, and key elements of wound bed preparation. Readers will be able to examine the following issues; the current status of wound bed preparation; an analysis of the acute and chronic wound environments; how wound healing can take place in these environments; the role of wound bed preparation in the clinic; the clinical and cellular components of the wound bed preparation concept; a detailed analysis of the components of wound bed preparation.
Cell Proliferation↗
An overview of Acticoat dressing in wound management.
This article reviews the in vitro and in vivo studies available on a new nanocrystalline silver dressing, Acticoat (Smith & Nephew), and discusses their relevance to the availability of this product on the Drug Tariff. The addition of nanocrystalline silver dressings will make a valuable contribution to wound care in the community, in terms of providing continuity of care for patients who are discharged from hospital and also in preventing admission to hospital with non-manageable wound infection.
Bandages↗
Developing wound management guidelines for community nurses.
Quality improvements are at the forefront of the Government's agenda and the advent of clinical governance has increased interest in the evidence base on which clinical decisions are made. Clinical guidelines are seen as an important tool in achieving evidence-based practice and there has recently been a proliferation in guideline development, nationally and locally. This article describes the rationale for the development of wound management guidelines for community nurses and the key steps that were involved in this process. It discusses and highlights the importance of an implementation strategy, and the need to evaluate, review and ensure that guidelines are up to date. It is intended to be of use to those nurses in the community who are considering undertaking guideline development.
Community Health Nursing↗
The assessment and management of burns.
Each year many people seek medical advice or hospital treatment for burn or scald injuries. There is limited data on the number of burns patients seen in primary care, however a recent national survey suggested that there are 250,000 presentations of burn injuries to primary care teams in the UK per year (National Burn Care Review, 2001). This article discusses the nursing management of burns in the community, outlining the initial assessment of the burns patient in terms of trauma management, and focusing primarily on those patients with non-complex burns. A full patient assessment incorporates the patient's general condition, the type, cause, depth and extent of the burn and the effects on the individual patient. Good patient management is an essential element of care and the focus of this is the management of pain, prevention of infection, provision of evidence based wound care and onward referrals as appropriate. However not all patients can be managed solely in the community and the nurse needs to know when to refer and to whom to refer. The article outlines the recommendations from the National Burn Care Review in terms of patient referral.
Burns↗
Malignant fungating wounds: assessment and management.
Approximately 5-10% of patients with metastatic cancer will develop a fungating wound. The disfiguring or unpleasant nature of these wounds can lead to complex psychosocial problems in patients, which mean that many will seek medical assistance only when the wound is advanced. Curative treatment is often not an option, although a range of palliative treatments may be tried. When the tumour does not respond to these treatments the patient will be left with a chronic complex wound with local wound management as the only option. It is at this time that the community nurse usually becomes involved with the patient. This article discusses the assessment of patients with fungating wounds in the community, taking into consideration the immense psychological distress that they can cause. It highlights factors that need to be taken into consideration when assessing these complex wounds. Many of them are heavily exuding, malodorous and bleed easily. Strategies that focus on managing these symptoms are explored and recommendations for clinical practice are made.
Bandages↗
The management of surgical wounds in a community setting.
Many patients are now having minor surgical procedures carried out in the community and those patients who undergo surgery in hospital are likely to be discharged earlier due to increasing pressure on hospital beds. This article discusses the management of surgical wounds healing by both primary and secondary closure, in the community setting. Understanding the complex process of wound healing is essential if nurses are to recognize abnormalities and select appropriate treatments for patients. The stages of wound healing will be discussed in detail, including the patient's presentation. Factors that influence this process within the patient (e.g. age, nutrition, medication and pain) and those at the wound bed (e.g. exudate, tissue type and infection) will be highlighted. Choosing the correct type of surgical wound dressing for the type of wound can contribute to wound healing, patient comfort and the cost-effectiveness of treatment. Factors that need to be taken into consideration when choosing a dressing will be outlined and suggestions made for the type of dressings that would be most appropriate. The importance of accurate and detailed documentation will be highlighted as part of this process.
Bandages↗
TIME principles of chronic wound bed preparation and treatment.
Managing chronic wounds has progressed from merely assessing the wound to understanding the underlying cellular abnormalities and associated clinical problems. The concept of wound bed preparation offers a systematic approach to removing barriers to healing such as tissue (non-viable), infection/inflammation, moisture (imbalance) and edge (non-advancing or undermining). The principles of wound bed preparation as outlined in the tissue, infection, moisture, edge (TIME) table are explained in this article, with examples and recommended treatment interventions. The TIME table is recommended for use at the bedside when assessing patients with wounds.
Anti-Bacterial Agents↗
The role of the nurse in wound bed preparation.
This article explores the role of the nurse in wound bed preparation. Wounds cannot be tended to in isolation--many patient factors will influence healing. The nurse needs to have an understanding of the process of wound healing and have undertaken a full patient assessment before focusing on the patient's wound. Recognising and managing problems at the wound bed, for example necrotic tissue and excess exudate, can result in a better prepared wound bed and optimal healing. If the concept is to be valuable to nurses, they need to be part of the debate that defines wound bed preparation, how it is being implemented in clinical practice and how patients can benefit. This debate needs to include all nurses involved in wound care.
Bacterial Infections↗
The use of silver-based dressings in wound care.
Chronic wounds such as leg ulcers and pressure ulcers are often slow to heal. One of the causes of delayed wound healing is the presence of micro-organisms in the wound. A strategy for the prevention and treatment of wound colonisation or infection, which is receiving renewed attention, is the use of silver-based dressings. Silver has been used as an antimicrobial agent for centuries. It is effective against a broad range of bacteria (including methicillin and vancomycin-resistant strains), yeast, fungi and viruses. A number of new silver-based dressings, some of which act by the sustained release of silver ions to the wound bed, have recently become available, but there are wide variations in the amount of data supporting the use of individual products. This article reviews the evidence base for silver-containing dressings to help practitioners select the most appropriate product for the type of wound being treated.
Aged↗
Assessment and management of patients with leg ulcers.
This article discusses the assessment and management of patients with leg ulcers, focusing on venous, arterial and mixed aetiology ulcers. Successful care planning should be based on working in partnership with patients in terms of offering choices that meet their clinical, quality-of-life and psychosocial needs.
Bandages↗
Managing leg ulceration in patients with sickle cell disorder.
Leg ulceration is a complication associated with sickle cell disorders. Caroline Dowsett outlines why this problem occurs and describes the management of a patient with sickle cell disorder who presented with an infected leg ulcer. She concludes that there is a need for more research into the management of these complex wounds.
Adult↗
Assessing mixed venous and arterial leg ulcers.
Caroline Dowsett outlines the key points in the assessment and management of mixed venous and arterial leg ulcers so that readers can consider their own practice against expert opinion.
Arteries↗