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Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0003-4395-2522
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0001-9065-6377
2013 (English)In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 10, no 2, p. 52-57Article in journal (Refereed) Published
Abstract [en]

Summary Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described. The objective of this study was to explore RNs’ professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus. Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years’ experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8). The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off-loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs’ formal education was some years back and they relied mostly on experience-based knowledge. It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Eur Diabetes Nursing 2013; 10(2): 52–57 Key words diabetes; diabetic foot ulcer; education; elderly; foot care; foot health; nursing; home care; pressure ulcer; prevention

Place, publisher, year, edition, pages
John Wiley & Sons, 2013. Vol. 10, no 2, p. 52-57
Keywords [en]
diabetes, diabetic foot ulcer, education, elderly, foot care, foot health, nursing, home care, pressure ulcer, prevention
National Category
Nursing
Identifiers
URN: urn:nbn:se:mau:diva-15269DOI: 10.1002/edn.227Scopus ID: 2-s2.0-84880351043Local ID: 15830OAI: oai:DiVA.org:mau-15269DiVA, id: diva2:1418790
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-12-12Bibliographically approved
In thesis
1. Prevention of foot ulcers in patients with diabetes mellitus
Open this publication in new window or tab >>Prevention of foot ulcers in patients with diabetes mellitus
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Amputation in patients with diabetes mellitus preceded by a foot ulcer is a serious complication. Patients with the highest risk of developing a foot ulcer are often found in home nursing settings. The overall aim was to focus on how registered nurses are working with prevention of foot ulcers in patients with diabetes mellitus in outpatient settings: - to identify factors related to short term outcome of foot ul-cers in patients treated in a multi-disciplinary system until healing was achieved. - to assess what was documented by registered nurses regarding diabetes care in a Swed-ish municipality’s home nursing service; to what extent nursing actions were planned for, performed and evaluated according to the goals of metabolic control, treatment and prevention of complications.- to explore registered nurses’ professional work with foot ulcer prevention in home nursing settings. - to explore whether participant driven group information has an impact on ulceration in a patient group with previ-ous diabetes foot ulcer. Study I used logistic regression analysis to identify factors related to outcome in a cohort of 2480 consecutive patients with diabetic foot ulcer at a multidisciplinary foot clinic. Results: Healed primarily: 65% (n=1617), 9% (n=250) after minor am-putation, 8% (n=193) after major amputation and 17% (n=420) died unhealed. Primary healing was related to co- morbidity, duration of diabetes, extent of periph-eral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity was related to amputation. In neuro-ischemic/ischemic ul-cers amputation was related to co morbidity, peripheral arterial disease and type of ulcer. Study II was a cross sectional assessment of all nursing records of patients with dia-betes (N=172) in a municipality’s home nursing setting and analyzed with manifest content analysis. Results: The overall standard of nursing records was insufficient. Evaluation of blood glucose was documented in 61% (n=105) of the records, weight was documented in 6% (n=10), blood pressure in 10% (n=17) and ongoing foot ul-cers were documented in 21% (n=36). Study III was a qualitative interview study of 15 registered nurses from four munici-palities, analyzed with manifest content analysis. Results: Registered nurses in home nursing settings worked mainly through health care assistants. The nurses used lead-ership and education as the main tools to enable the nursing process. They mainly relied on experience based competence. Study IV was a randomized controlled trial comparing participant driven education in group with standard information, in patients with diabetes and previous foot ul-cers. An interim analysis was made 6 months after intervention of 131 included pa-tients. Results: After 6 months follow up, 58% (n=57) of the 98 evaluated patients had not developed a new foot ulcer. There was no statistical difference between the two interventions. The most common reasons for ulceration were plantar stress ulcer and minor external trauma. Five patients had deceased and 10 had withdrawn con-sent to participate. Conclusion: Patients with diabetes and high risk of developing foot ulcer constitute a fragile group that needs special foot protective attention. This requires a well edu-cated staff in the home nursing organization. In the future patient education should target low risk patients.

Place, publisher, year, edition, pages
Malmö University, 2011
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383
Keywords
amputation, complications, diabetes mellitus, diabetic foot ulcers, documentation, education, healing, home care, neuropathy, nursing, nursing process, peripheral vascular disease, pressure ulcer, prevention, RCT
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-7351 (URN)12383 (Local ID)978-91-7104-412-9 (ISBN)12383 (Archive number)12383 (OAI)
Note

Paper III and IV in dissertation as manuscript, paper III with title "Prevention of foot ulcers in patients with diabetes in home nursing settings – an interview study among registered nurses"

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-04Bibliographically approved

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Annersten Gershater, MagdalenaAlm-Roijer, Carin

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