Nurses' role in diabetic foot prevention and care; a review

Diabetic foot workshop: Improving technical and educational skills for nurses

Diabetes mellitus as one of the most common metabolic disorders has some complications, one of the main ones is diabetic foot (DF). Appropriate care and education prevents 85% of diabetic foot amputations. An ideal management to prevent and treat diabetic foot necessitates a close collaboration between the health team members and the diabetic patient. Therefore, improving nurses' knowledge about DF care and advancement in the quality of care provided by the nurses could significantly improve diabetic foot prevention and management. Therefore, the aim of DF workshop was to improve technical and educational skills of the nurses to prevent and manage diabetic foot. Considering the vital role of the nurses in providing DF care, EMRI decided to conduct Diabetic foot workshop for them. The following five steps were designed for the 14 coordinating sessions in the workshop: Goals definition, deciding about attendees, location selection, creating agenda, and developing a follow-up plan. "Diabetic Foot Workshop for Nurses" provides appropriate training to DF nurses at the national level; and combining theory and practice in this workshop not only increases nurses' knowledge, but also improves their skills in the field of the diabetic foot. Providing education and care to patients by DF nurse specialists instead of general nurses could be an important output of this workshop, which may lead to DF prevention and amputation decrease in the long term.

Effect of local insulin injection on wound vascularization in patients with diabetic foot ulcer

The aim of the present study was to investigate the effect of local insulin injection on granulation tissue formation in the wounds of patients with diabetic foot ulcer. Thirty-two patients with diabetic foot ulcer were randomly divided into an insulin (n=18) and a control (n=14) group. In the diabetic foot ulcer wound, the insulin group were administered insulin and the control group were administered an equal volume of saline. Prior to injection and at 0.5, 1.0, 2.0 and 4.0 h after injection, the fingertip blood glucose levels were determined. The growth of granulation tissue was assessed continuously for 12 days. Wound tissue was harvested at 0, 5, 7 and 12 days for the detection of CD34 expression by immunohistochemistry. The microvessel density (MVD) was calculated. No significant difference in the fasting blood glucose level was found between the two groups at any time-point (P>0.05). Growth of granulation tissue in the insulin group was more marked from 7 days after local insulin injection (24.87±0.24) and was significantly different from that in the control group (18.66±0.45) (P<0.01). New vessels were observed in the insulin group 3 days after insulin injection; however, there was no significant difference in MVD compared with the control group (P>0.05). The MVD in the insulin group increased markedly from 5 days after treatment, and the difference between the two groups was significant (P<0.01). In conclusion, local injection of insulin into the base of a diabetic foot ulcer has a significant effect on systemic blood glucose and may promote wound healing by improving the growth of granulation tissue.

Prevent Wounds by Conducting a Comprehensive Foot Examination and Intervention

Lower extremity wounds and falls are on the rise with the demographics and projected aging population. Diabetes and heart disease supersede cancer deaths. A basic foot exam—performed routinely on patients identified as high risk allows time for early intervention and prevention. A Certified Foot and Nail Care Nurse (CFCN) who evaluates clients on a regular basis, conducts a comprehensive lower extremity exam for loss of protective sensation (LOPS) and compromised peripheral blood flow is more likely to provide needed care in a timely manner. Why a nurse? Because nurses who have the level of education, expertise through acquired training, and are board certified are competent to assess, educate, provide intervention, and refer. Utilizing CFCNs is cost-effective and efficient. CFCN is utilized as a member of the multidisciplinary team. Nurses are educators and education is an effective method for prevention. Nurses, as the most trusted health care provider, communicate, establish rapport, and develop sustaining relationships. Utilizing the Wound Ostomy Continence Nurses’ Credentialing Board (WOCNCB) CFCN raises the standard of care substantially and reduces overall costs to life, limbs, and dollars. This innovation in practice improves outcomes, patient satisfaction, and safety while reducing hospital admissions.

Nurses' knowledge of foot care in the context of home care: a cross-sectional correlational survey study

AIMS AND OBJECTIVES

This study aimed to explore nurses' knowledge of foot care and related factors in home care nursing.

BACKGROUND

Nurses caring for older people are increasingly confronted with clients who have multiple foot problems and need support with their foot health. The role of nurses in promoting foot health, caring for existing foot problems and supporting older people in foot self-care is especially important in the home care context. However, this entails up-to-date foot care knowledge and practices.

DESIGN

A cross-sectional correlational survey study design.

METHODS

Nurses' knowledge of foot care was evaluated using the Nurses' Foot Care Knowledge Test developed for this study. The data were analysed with descriptive and inferential statistics.

RESULTS

Nurses (registered nurses, public health nurses and licensed practical nurses) from public home care (n = 322, response rate 50%) participated the study. Nurses' knowledge in foot care varied. The knowledge scores were highest for skin and nail care and lowest for the identification and care of foot structural deformities. Longer working experience in the current work place and participation in continuing education explained higher Nurses' Foot Care Knowledge Test scores.

CONCLUSIONS

Nurses need more knowledge, and hence continuing education, in the foot care of older people to effectively prevent, recognise and care for foot problems and promote independent living in the community.

RELEVANCE TO CLINICAL PRACTICE

Nurses' have clinically relevant knowledge gaps. Therefore, foot care knowledge of nurses needs to be improved by continuing education in clinical settings. Adequate foot care knowledge among nurses is important to identify, prevent and care foot problems especially in older people.

Literature review on the management of diabetic foot ulcer

Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.

Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening

BACKGROUND

Diabetic Peripheral Neuropathy is one of the most prevalent complications of diabetes mellitus. The development and progression of such complications are responsible for much of the morbidity and mortality. The purpose of this study was to evaluate the effectiveness of Semmes-Weinstein monofilament ten gram in 3, 4, eight and ten points in the screening of diabetic peripheral neuropathy in patients with diabetes mellitus.

METHODS

In a descriptive correlational design, 150 patients with diabetes mellitus were selected using convenience sampling. All patients were evaluated for sensory neuropathy using ten gram Semmes-Weinstein Monofilaments and questionnaire on neuropathy symptoms. In the next phase, nerve conduction velocity was examined. The most common subjective symptoms were paresthesia of both feet, pain in feet, burning sensation in the extremities and numbness in the extremities.

RESULTS

The results showed that the sensitivity of Monofilament in three and four points were 35.9 to 53.8 present and 38.5 to 51.3 percent respectively. Specificity of Monofilament the same points, were 73.9 to 84.7 and 73 to 87.4 percent respectively. Monofilament sensitivity at eight and ten points were 38.5 to 61.5 and 64.1 to 30.8 percent respectively. Also, specificity of the same points were 77.5 to 95.5 and 64 to 89.2 percent respectively. It was revealed that the difference sensitivity and specificity of Monofilament in three and four points with sensitivity and specificity in eight and ten point is not statistically significant.

CONCLUSIONS

This study showed that Semmes-Weinstein monofilament can easily use as a simple and inexpensive device for screening. Since increasing the number of points it was not significantly difference. Therefore, we suggest that screening for diabetic peripheral neuropathy, especially in large populations to avoid wasting time on Monofilament application, areas like three or four points eight and ten points could be used.

A social network analysis on clinical education of diabetic foot

INTRODUCTION

Identification of Educational Influentials (EIs) in clinical settings helps considerably to knowledge transfer among health and medical practice providers. The aim of this study was identifying EIs in diabetic foot ulcers (DFU) by medical students (clerks, interns and residents) and providing their relational pattern in this subject.

METHODS

Subjects were medical students at clerk, intern and resident levels in a local educational hospital. A standard questionnaire with four domains (knowledge, communication, participation and professional ethics) was used for identifying EIs. Students introduced those people with these characteristics who referred them for DFU. Respective communication networks were drawn as intra-group (such as resident-resident) and inter-group (such as intern-resident) networks and quantitative criteria of density, in-degree and out-degree centrality and reciprocity were measured.

RESULTS

The network density of clerks-residents (0.024) and interns-residents (0.038) were higher than clerks-attends (0.015) and interns-attends (0.05); indicating that there were more consulting interactions in former networks than the latter. Degree centrality in residents-related networks (clerks-residents = 2.3; interns-residents = 2.6) were higher than attends-related ones (clerks-attends = 1.1; interns-attends = 1.7), while they were not statistically significant. However, In-degree centralization, which indicating a degree of variance of the whole network of ingoing relationships, in attends-related networks was greater than resident-related networks.

CONCLUSION

Resident were consulted with almost as same as attends on DFU. It showed that residents were playing a remarkable role in knowledge transfer and they can be considered as EIs in this clinical setting. It seemed that the availability was the main reason for this key role.