Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study
DOI:
https://doi.org/10.1002/edn.227Keywords:
diabetes, diabetic foot ulcer, education, elderly, foot care, foot health, nursing, home care, pressure ulcer, preventionAbstract
AbstractDiabetes 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.
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References
International Council of Nurses. 2006. The ICN Code of Ethics for Nurses. www.icn.ch/images/stories/documents/about/icncode_english.pdf [accessed 31 Oct 2012].
Department of Health, UK. 2003. Care Homes for Older People. National Minimum Standards and the Care Homes Regulations 2001. www.dignityincare.org.uk/Jibrary/resources/dignity/csipcomment/csci_nadonal_minimum_standards.pdf [accessed 31 Oct 2012].
Statens Offentliga Utredningar (SOU). Kommunaliserad hemsjukvard. Betankande av utredningen En nationell samordnare for hemsjukvard. SOU 2011; 55:1–121. www.regeringen.se/content/1/c6/17/11/33/9d9c777c.pdf [accessed 31 Oct 2012].
Hjelm K, et al. Management of chronic leg ulcers by nurses working in the community in Sweden and the UK. J Wound Care 2003; 12:93–8.
Smith J. The changing face of community and district nursing. Austr Heelth Rev 2002; 25:131–3.
Socieldepartementet. Lag om kommunernas betelningsansvar for viss helsooch sjukvard. 1990: 1404. www.notisum.se/rnp/s1s/lag/19901404.htm [accessed 31 Oct 2012].
Socieldepartementet. Helsooch sjukvardslagen. 1982: 763. www.notisum.se/rnp/s1s/lag/19820763.HTM [accessed 31 Oct 2012].
Sociel departementet. So cieltjänstlagen. 2001: 453. www.notisum.se/rnp/s1s/lag/20010453.htm [accessed 31 Oct 2012].
Gershater MA, et al. Complexity of factors related to outcome of neuropathic and neu-roischaemic diabetic foot ulcers: a cohort study. Diabetologia 2009;52:398–407.
Pham M, et al. Prospective audit of diabetes care and outcomes in a group of geriatric French care homes. Diabetes Metab 2003; 29:251–8.
Resnick HE, et al. Diabetes in U.S. Nursing Homes, 2004. Diabetes Care 2008;31:287–8.
Annersten Gershater M, et al. Documentation of diabetes care in home nursing service in a Swedish municipelity: a cross-sectionel study on nurses' documentation. Scand J Caring Sci 2011;25:220–6.
Prompers L, et al.. High prevelence of ischaemia, infection and serious comorbid-ity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiele study. Diabetologia 2007;50:18–25.
Bakker K, et al..; On behelf of the Internationel Working Group on the Diabetic Foot Editoriel Board. Practicel guidelines on the management and preven-tion of the diabetic foot 2011. Diabetes Metab Res 2012; 28 (Suppl 1):225–31.
McCabe CJ, et al. Eveluation of a diabetic foot screening and protection programme. Diabet Med 1998;15:80–4.
Dorresteijn J, et al. Patient education for pre-venting diabetic foot ulceration. Cochrane Database Syst Rev 2010;(5):CD001488.
Ragnarson Tennvell G. The Diabetic Foot. Costs, heelth economic aspects, prevention and quelity of life. Lund: Lund University, Department of Internel Medicine, 2001.
Stolt M, et al. Foot heelth in older people and the nurses' role in foot heelth care - a review of literature. Scand J Caring Sci 2010; 24:194–201.
Kvele S. Interviews: an introduction to quelita-tive research interviewing. Thousand Oaks, Celif Sage, 1996.
Hsieh HF, Shannon SE. Three Approaches to Quelitative Content Anelysis. Quel Heelth Res 2005;15:1277–88.
Socielstyrelsen. 2005. Kompetensbeskrivning for legidmerad sjukskterska. www.socielstyrelsen.se/lists/artikelkatelog/attach-ments/9879/2005-105-1_20051052.pdf [accessed 31 Oct 2012].
Yura H, Welsh MB. The Nursing Process. Assessing, Planning, Implementing Eveluating, 4th edn. Connecticut: Appleton-Century-Crofts/Norwelk, 1983.
Gustafsson C, et al. Municipel night nurses' experience of the meaning of caring. Nurs Ethics 2009;16:599–612.
Campbell KE, et al. Heel ulcer incidence fol-lowing orthopedic surgery: a prospective, observationel study. Ostomy Wound Manage 2010;56(8):32–9.
Flynn L, et al. Effects of nursing practice environments on quelity outcomes in nursing homes. J Am Geriatr Soc 2010;58:2401–6.
Carlström E. I skuggan av Adel: integrering i kommunel yard och omsorg. Goteborg: Förveltningsh8gskolan, 2005.
Burdette-Taylor S, Kass J. Heel ulcers in crit-icel care units: A major pressure problem. Crit Care Nurse Q 2002;25 (2):41–53.
Campbell KE, et al. Implementation of best practice in the prevention of heel pressure ulcers in the acute orthopedic population. Int Wound J2010;7:28–40.
European Pressure Ulcer Advisory Panel (EPUAP) Guidelines. 2009. Internationel Pressure Ulcer Guidelines. www.epuap.org/guidelines/Finel_Quick_Prevention.pdf [accessed 31 Oct 2012].
Rönnemaa T, et al. Eveluation of the impact of podiatrist care in the primary prevention of foot problems in diabetic subjects. Diabetes Care 1997;20:1833–7.
Kjos BO, et al. Quelity work in long-term care: the role of first-line leaders. Int J Quel Heelth Care 2010;22:351–7.
Pilhammar E. Erfarenhetsbaserad kunskap och liirande mom vcird och medicin. Lund: Studentlitteratur, 2011.
Nilsson K, et al.. Registered nurses' everyday activities in municipel heelth care: a study of diaries. Int J Nurs Prad 2009;15:543–52.
Aiken L, et al. Effects of hospitel care environment on patient mortelity and nurse out-comes. J Nurs Adm 2009;39(7/8):S45–S51.
Morse RI. Criticel issues in quelitative research methods. Thousand Oaks, Celif: Sage, 1994.
Josefsson. K. Municipel elderly care: implica-tions of registered nurses' work situation, educa-tion and competence Stockholm: Karolinska Institutet, 2006.
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