TIMERS Wound Care: Strategies for Wound Bed Preparation

TIMERS wound care

Whether you’ve been in wound care for many years, or are a newcomer to the field, you have likely heard the terms TIME and maybe TIMERS.

The two words are acronyms pertaining to clinical categories related to comprehensive wound assessment, management and wound bed preparation for hard-to-heal wounds, said Donald Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery and clinical instructor with the Wound Care Education Institute (WCEI).

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Ileal Conduit Care and Nurses: A Review of Evidence-Based Practice

ileal conduit

In 2019, researchers in China released an important study on interventions with ileal conduit patients after having undergone surgery for bladder cancer.

It has since proven to be a wonderful resource for all providers who work with ileal conduit patients.

The study began in 2014 with the establishment of a “dedicated team” of ostomy specialists who provided standardized postoperative care.

Its purpose was to undercover the effects of a more involved, systematized program of postoperative care for patients with ileal conduits who were discharged from the hospital.

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Reduce Pressure Injuries When Prone Positioning COVID-19 Patients With ARDS

Prone positioning

As the COVID-19 pandemic endures, there is an increased awareness of the practice of placing patients in prone positioning versus supine positioning.

Prone positioning is important when patients are experiencing acute respiratory distress syndrome (ARDS), which is a risk for those who have the virus.

Prone therapy is not new, however.

“Critical-care nurses have known for many years that prone positioning patients with ARDS results in lower mortality rates and less incidence of lung injury,” said Kathleen M. Vollman, MSN, RN, CCNS, FCCM, FCNS, FAAN, clinical nurse specialist and consultant at Advancing Nursing, LLC.

Prone therapy was a nursing intervention first used personally by Vollman on an ARDS patient in 1981.

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Learn How to Determine What Wound Exudate Is Telling You

wound exudate

An integral part of a wound assessment includes analyzing the type and amount of wound exudate coming from the wound.

Knowing how to correctly make those observations and documenting accordingly is critical to a comprehensive assessment. Ultimately, we want a wound with an optimal level of moisture to support healing and not an overly moist or dry environment.

However, as wound care specialists or experts, we need to take it one step further and ask a few more questions.

  • Is this the type and amount of drainage I expect to see based on the wound’s current healing path? 
  • If it is not, why is the exudate presenting this way? 
  • How do we correct that? 

A good wound care clinician does more than just make observations and note them. They are continually critically thinking and asking “why” and seeking solutions. 

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Telewound Sessions: Best Practices When Conducting Virtual Appointments

Telewound

With the COVID-19 pandemic, telehealth and telewound services are in high demand.

For many wound care clinicians, providing telewound services may be a new addition to their practice.

We spoke with two telewound experts to help you learn more about best practices and possible glitches when conducting a telewound session.

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Your State Nurse Practice Act Can Dictate Wound Care Liability

state nurse practice act

I received a question about an RN who was practicing in a “wound center.” 

She received notice from her state board of nursing that a complaint had been filed concerning her treatment of a patient’s wound. 

According to the RN, a substitute physician saw her patient one week. He told the patient and a family member that Tegaderm should not have been used on the wound.

In addition, the substitute physician said there were two wounds — not one — and the second had not been treated.

The RN stressed the following:

  • There was only one wound
  • The substitute doctor was incorrect
  • The patient’s regular physician had been seeing the patient for some time and knew there was only one wound
  • She was upset about the complaint
  • Had to hire an attorney to represent her before the board
  • She believes the physician defamed her and should pay her attorney fees
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Determine If Live Online Training Is a Good Fit for Your Learning Style

A man logs onto his live online training course at his desk.

Are you thinking about taking our courses to earn wound care certification?

We personalize your learning by offering a variety of skin, wound and ostomy management classes in three formats:

  • Live onsite — in-person training
  • Online — you log in to learn at a convenient time for you
  • Live online training — all students log in at the same scheduled time for live, interactive classes and instruction

While some students know exactly which format best suits their learning style, you may wonder which structure fits your needs.

We spoke with Denise Richlen, PT, WCC, DWC, CLT, clinical instructor with WCEI, co-owner and COO of Infinitus, LLC and Wound Care Gurus, LLC in Santa Claus, Ind., to understand the different learning formats.

She shared which ones may be most suitable for various learners, and in particular, the benefits of live online learning.

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PPE: How to Reduce Your Chance of Pressure Injuries During COVID-19

PPE

Personal protective equipment (PPE) is critical to your safety while caring for patients during the COVID-19 pandemic.

But healthcare workers also should be aware of PPE guidelines to prevent side effects. For example, pressure injuries can occur from wearing the items meant to keep you protected.

Because of the nature of how the virus spreads, those caring for infected patients are required to wear masks in an effort to reduce risk of acquiring the virus.

Working an entire shift in this environment requires wearing a mask almost continually, which has led to the development of tissue damage from moisture and pressure.

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Ability of Patient to Provide Own Ostomy Care Called into Question

ostomy

As a wound care nurse, you teach your patients how to care for their wounds, including a colostomy.

You teach them as they observe treatments you provide, such as ostomy care, while they are at a clinic.

It also includes orally reciting your care as you carry out treatment and direct the patient. This empowers them to understand what is required for appropriate personal care. 

You also might write down instructions and diagrams about required treatment that patients can take home and reference.

The teach-back method of patient instruction incorporates both of these approaches. This is when you have the patient repeat back what you instruct and demonstrate the care you described.

Any patient teaching also requires that the patient comprehend your:

  • Demonstration of care
  • Verbal instructions
  • Ability to carry out the treatment
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Malignant Wounds: How to Identify and Treat Them

malignant wounds

Some wound care clinicians have experience caring for patients with malignant wounds.

But you may not be familiar with them at all. We recently spoke with a malignant wounds expert to learn more about them.

That expert is Joni Brinker, MSN/MHA, RN, WCC, an Ohio-based consultant and clinical nurse educator with Optum Hospice Pharmacy Services of Eden Prairie, Minn.

She is a returning speaker for our 2020 virtual Wild on Wounds (WOW) national conference in September. She offered the following explanation.

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