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Bosun-Arije SF. Commentary: Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society. J Res Nurs 2023; 28:579-581. [PMID: 38162712 PMCID: PMC10756168 DOI: 10.1177/17449871231208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Stella F Bosun-Arije
- Senior Lecturer and Senior Fellow of Advance HE, Faculty of Health and Education, School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK
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Drovandi A, Crowley B, Alahakoon C, Seng L, Fernando ME, Ross D, Evans R, Golledge J. Perceptions of Australians with diabetes-related foot disease on requirements for effective secondary prevention. Aust J Rural Health 2023; 31:690-703. [PMID: 37092611 PMCID: PMC10947538 DOI: 10.1111/ajr.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Secondary prevention is essential in reducing recurrence of diabetes-related foot disease (DFD) but is frequently poorly implemented in clinical practice. OBJECTIVE To explore the perceptions of people with diabetes-related foot disease (DFD) on their self-perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. DESIGN Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi-structured interviews. Interviews were audio-recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. FINDINGS AND DISCUSSION Participants had high self-perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. CONCLUSION People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support.
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Affiliation(s)
- Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Biological Sciences, School of Biomedical SciencesUniversity of LeedsLeedsUK
| | - Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Chanika Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Malindu E. Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Faculty of Health and Medicine, School of Health SciencesUniversity of NewcastleNewcastleNew South WalesAustralia
- Department of Vascular and Endovascular Surgery, John Hunter HospitalHunter New England Local Health District, New South Wales HealthNewcastleNew South WalesAustralia
| | - Diane Ross
- Townsville Aboriginal and Islander Health ServicesTownsvilleQueenslandAustralia
| | - Rebecca Evans
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Ulcer and wound Healing consortium (UHEAL), Australian Institute of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
- Department of Vascular and Endovascular SurgeryTownsville University HospitalTownsvilleQueenslandAustralia
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Ferreira G, Bernardo AC, Carvalho A, Pereira MG. Relax to Heal? Perspectives of Patients with Diabetic Foot Ulcers and Health Professionals on Relaxation Sessions for Wound Healing. Adv Skin Wound Care 2023; 36:1-10. [PMID: 37017401 DOI: 10.1097/01.asw.0000922832.62539.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To explore patients' and healthcare professionals' (HPs') perspectives on the suitability/acceptability of a relaxation intervention, its effects on patients' well-being and diabetic foot ulcer (DFU) healing, and its incorporation into the multidisciplinary management of patients with diabetic foot. METHODS This qualitative study was nested within a three-arm pilot randomized controlled trial. Patients with a chronic DFU received four relaxation sessions. Investigators then interviewed patients, physicians, and nurses involved with diabetic foot consultations. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. RESULTS Five themes emerged from patient's interviews about the suitability/acceptability of the relaxation intervention: perceptions regarding the psychological intervention, distress, the relaxation technique, changes in the patient's life, and changes in DFU/contribution to healing. Three themes emerged from interviews with HPs: perceptions regarding relaxation, changes in the patient, and changes in DFU/healing. Regarding the feasibility of the relaxation intervention, three themes emerged for both patients and HPs: suggested modifications, stressors/difficulties, and impact of COVID-19 pandemic. The utility theme emerged only in HP interviews, with subthemes of patients' distress, psychological interventions, relaxation intervention, and integration of the psychologist in the team. CONCLUSIONS These findings provide evidence for the suitability/acceptability, feasibility, and utility of a relaxation intervention in diabetic foot consultations.
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Affiliation(s)
- Gabriela Ferreira
- At the Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal, Gabriela Ferreira, PhD, is Research Collaborator, Health & Family Research Group; and Ana Cristina Bernardo, MSc, is PhD Student in Psychology. André Carvalho, MD, PhD, is a Consultant in Endocrinology and Diabetes, at Centro Hospitalar Universitário do Porto. M. Graça Pereira, PhD, is the Coordinator of the Health, Well-being and Performance Research Lab, and the coordinator of the Health & Family Research Group in the Psychology Research Centre. She is also an Associate Professor with Habilitation in the School of Psychology, University of Minho
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Crowley B, Drovandi A, Seng L, Fernando ME, Ross D, Golledge J. Patient Perspectives on the Burden and Prevention of Diabetes-Related Foot Disease. Sci Diabetes Self Manag Care 2023; 49:217-228. [PMID: 37114642 DOI: 10.1177/26350106231170531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE The purpose of the study was to understand patient perspectives about the impact and prevention of diabetes-related foot disease (DFD). METHODS An online survey was distributed to patients with a history of DFD during 2020. The survey was designed alongside clinical specialists and DFD patients and utilized the health belief model. It asked about the impact of DFD on health, perceptions on preventive strategies, perceived need for additional support, and patient preferences for telehealth in DFD management. Quantitative data were summarized descriptively and compared between groups. Open-text responses were analyzed using conceptual content analysis. RESULTS Of 80 participants with a history of DFD, foot ulcers were the complication most often experienced, with over two-thirds having been admitted to hospital for a DFD-related issue and over one-third having a DFD-related amputation. Participants had ranging perceptions on the effect of DFD on health, from minimal to crippling. Those with previous severe DFD complications leading to hospital admission found a lack of mobility and independence the consequences of most concern. Using offloading footwear was perceived as very important for preventing DFD complications, although the use of offloading footwear was low, with participants citing issues relating to cost, comfort, appearance, and access to footwear as barriers to better adherence. Perceptions on telehealth were mixed, with many participants not having access to or being comfortable with the use of digital technologies. CONCLUSIONS Patients with DFD require additional supports for effective prevention, including offloading footwear.
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Affiliation(s)
- Benjamin Crowley
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, West Yorkshire, England
| | - Leonard Seng
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Malindu E Fernando
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Diane Ross
- Townsville Aboriginal and Islander Health Services, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Ulcer and Wound Healing Consortium, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
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Ma L, Chen J, Sun Y, Feng Y, Yuan L, Ran X. The perceptions of living with diabetic foot ulcers: A systematic review and meta-synthesis of qualitative studies. J Tissue Viability 2023; 32:39-50. [PMID: 36470779 DOI: 10.1016/j.jtv.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diabetic foot ulcers are associated with decreased quality of life in patients with diabetes and impose a heavy burden on patients, their families, and the health care system. For health providers, a deeper understanding of the perceptions of patients is significant. They can provide better management and direction to patients with diabetic foot ulcers, thus improving their quality of life. OBJECTIVES To synthesize the findings of qualitative studies to explore the perceptions of individuals living with diabetic foot ulcers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Published qualitative research articles were identified in PubMed, CINAHL, Embase, ISI Web of Science, Ovid, and Scopus from inception to January 2022, and bibliographical reports were reviewed. In addition, combing with the search for unpublished studies in the Google Scholar ProQuest Dissertations and Theses Database, we conducted a meta-synthesis. RESULTS Fourteen articles were eligible for inclusion, and the total number of included individuals was 226, with ages ranging from 28 to 84 years. The perceptions of individuals with diabetic foot ulcers synthesized four overarching themes and their subthemes: perceptions of diabetic foot ulcers (Realization, Reasons), living with diabetic foot ulcers (Change in life, Physical burdens, Emotional burdens, Economic burdens), coping with diabetic foot ulcers (Hospital attendance, Attitude toward amputation, Treatment, Management), and expectations (Expectation of health-personnel, Future expectation). CONCLUSIONS Individuals with diabetic foot ulcers suffer greatly in their physical, psychological, and social aspects. Comprehensive and individualized patient-centered care and appropriate families and social support for patients with diabetic foot ulcers should be provided.
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Affiliation(s)
- Lin Ma
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Yue Feng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Yuan
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Aagaard TV, Lindberg K, Brorson S, Madsen UR, Skou ST. A 12-Week Supervised Exercise Therapy Program for Patients with Diabetic Foot Ulcers: Program Development and Preliminary Feasibility. INT J LOW EXTR WOUND 2023:15347346221149786. [PMID: 36604981 DOI: 10.1177/15347346221149786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Exercise therapy helps improve glycaemic control and insulin sensitivity and may be relevant in treating patients with diabetic foot ulcers (DFUs). This study describes the development of a 12-week exercise therapy program for patients with DFUs and the preliminary feasibility of the program focusing on the program's inclusion, adherence, and safety. The development process is built on knowledge from a published systematic review on exercise for people with DFUs and a grounded theory study on the main concerns of people with DFUs regarding physical activity. The development involved doctors, wound care nurses, podiatrists, and feedback from patients and physical therapists using semi-structured interviews. The program was designed as a combination of aerobic and resistance training exercises. The aerobic exercise phase on the stationary bike of 30-minute duration was aimed at a moderate intensity. Resistance exercises were conducted with a 15-repetition maximum approach (four to five sets per trial) throughout the 12-week period. Three patients were included and received the exercise intervention. Except for recruitment and retention rates, acceptance levels were met for all other research progression criteria. Patients found the intervention relevant, wanted further guidance on continuing exercising, and would have liked the intervention closer to their home for example, a municipality setting. Although the exercise therapy program for patients with DFUs was developed in a thorough process with the inclusion of available evidence and the involvement of patients and other stakeholders conclusions on feasibility are limited due to the low recruitment rate. A reconsideration of the setting is needed in future exercise intervention studies.
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Affiliation(s)
- Thomas Vedste Aagaard
- Department of Physiotherapy and Occupational Therapy, 53163Holbaek Hospital, Holbaek, Denmark
- Department of Orthopaedic Surgery, 53163Holbaek Hospital, Holbaek, Denmark
- Department of Orthopaedic Surgery, Centre for Evidence-Based Orthopaedics, Zealand University Hospital, Koge, Denmark
| | - Kajsa Lindberg
- Health and Rehabilitation Centre Vanloese, Copenhagen Municipality, Copenhagen, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Centre for Evidence-Based Orthopaedics, Zealand University Hospital, Koge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Riis Madsen
- Department of Orthopaedic Surgery, 53163Holbaek Hospital, Holbaek, Denmark
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrez, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
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Terminologia especializada de enfermagem para a pessoa com úlcera do pé diabético. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Ong EKM, Fryer C, Graham K, Causby RS. Investigating the experience of receiving podiatry care in a tertiary care hospital clinic for people with diabetes related foot ulcers. J Foot Ankle Res 2022; 15:50. [PMID: 35778745 PMCID: PMC9248168 DOI: 10.1186/s13047-022-00556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes related foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetes related foot ulcers requires a multi-faceted, multi-disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of podiatric treatment for diabetes related foot ulcers to understand how people are engaged in their ulcer management. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetes related foot ulcers in a tertiary care outpatient setting. METHODS Ten participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetes related foot ulcer in a tertiary care setting. Participants with diabetes related foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi-structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer and understand how this experience impacts their regular lifestyle. Data were analysed using a thematic analysis method. RESULTS Four themes were identified that add an understanding of the lived experience of participants: 'Trusting the podiatrists with the right expertise', 'Personalised care', 'Happy with the service, but not always with prescribed care', and 'It's a long journey'. Participants described professional behaviour including high organisation and hygiene practices and demonstrated expertise as key factors influencing their trust of a podiatrist's care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants. CONCLUSIONS The findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual's lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person's experience of podiatric ulcer care differs amongst genders, cultural groups, and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.
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Affiliation(s)
- Emilee Kim Ming Ong
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia.
| | - Caroline Fryer
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Kristin Graham
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Ryan Scott Causby
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5001, Australia
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Lopes GSG, Rolim ILTP. DIABETIC FOOT SOCIAL REPRESENTATIONS ABOUT THE EXPERIENCES OF PEOPLE WITH DIABETES MELLITUS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to understand the social representations about the experiences of people with diabetic foot. Method: a qualitative study, based on the Theory of Social Representations, carried out with 28 participants, in reference services for the treatment of diabetic foot in São Luís, Maranhão, Brazil, from February to May 2019. Data collection took place through semi-structured interviews, a script to characterize the sociodemographic and clinical profile and a field diary. Content analysis was applied with the support of a qualitative data analysis software for categorization. Results: the results made it possible to identify two categories: experiencing diabetic foot, with the respective subcategories, and social responses to diabetic foot. The first category includes the following subcategories: cognitive aspects, psycho-affective aspects, social aspects and morality. The social representations of diabetic foot were based on a painful daily experience, with reference to functional loss, dependence on others and difficulty performing activities that were previously usual. Conclusion: the study made it possible to assert that diabetic foot is an object of social representation, showing how people build, connect and apply knowledge. The research constitutes a support tool for the care of people with diabetic foot, as it assists in the planning of interventions with impacts on the development of representations that generate positive health behaviors, from the perspective of foot self-monitoring.
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Kusnanto K, Alfaqih M, Padoli P, Arifin H. A Qualitative Study Inquiry among Patients with Diabetic Foot Ulcers: What have They Felt? Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Diabetic foot ulcers (DFU) caused physical and psychosocial problems and the risk of amputations and death.
AIM: The aim of the study was to overview the feelings of diabetes mellitus patients with DFU.
METHODS: A phenomenological qualitative study design was undertaken from January to April 2020. A total of 25 patients with DFU were determined through the purposive sampling technique. The study was conducted among the patients undertaking home-based wound care in Bojonegoro, Indonesia. The proposed discussion guidelines were used to collect the data through in-depth interviews. Colaizzi’s technique was used to analyze the data and it was managed by NVIVO.
RESULTS: We emerged two themes: Psychological and physiological response of patients with DFU and coping mechanisms in caring DFU. Among the patients with DFU, we determined their psychological responses and coping mechanisms as reported in this study.
CONCLUSIONS: Patients with DFU are expected to be able to control themselves psychologically. Health workers such as doctors and nurses can provide interventions by considering the psychological condition of patients with DFU. A good psychological condition can ensure that their blood sugar is regulated properly.
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