Woudbe的dpreparation学习指导.docxVIP

Wound bed preparation:TIME in practiceCaroline Dowsett, Heather NewtonCaroline Dowsett is Nurse Consultant in Tissue Viability,Newham Primary Care Trust, London, and Heather Newtonis Nurse Consultant in Tissue Viability, Royal CornwallHospital Trust, CornwallWound bed preparation is now a well established concept and the TIME framework has beendeveloped as a practical tool to assist practitioners when assessing and managing patients withwounds. It is important, however, to remember to assess the whole patient; the wound bedpreparation ‘care cycle’ promotes the treatment of the ‘whole’ patient and not just the ‘hole’ in thepatient. This paper discusses the implementation of the wound bed preparation care cycle and theTIME framework, with a detailed focus on Tissue, Infection, Moisture and wound Edge (TIME).58 Wounds UKThe concept of wound bedpreparation has gainedinternational recognitionas a framework that can providea structured approach to woundmanagement. By definition woundbed preparation is ‘the managementof a wound in order to accelerateendogenous healing or to facilitatethe effectiveness of other therapeuticmeasures’ (Falanga, 2000; Schultz etal, 2003). The concept focuses theclinician on optimising conditions atthe wound bed so as to encouragenormal endogenous healing. It is anapproach that should be considered forall wounds that are not progressing tonormal wound healing.Wound healing is a complex seriesof events that are interlinked anddependent on one another. Acutewounds usually follow a well-definedprocess described as:?Coagulation?Inflammation?Cell proliferation and repair ofthe matrix?Epithelialisation and remodelling ofscar tissue.In the past this model of healing hasbeen applied to chronic wounds, butit is now known that chronic woundhealing is different from acute woundhealing. Chronic wounds become ‘stuck’in the inflammatory and proliferativestages of healing (Ennis and Menses,2000) which delays closure. Theepidermis fails to migrate at the woundm