Diabetes is one of a killer disease that has been reported worldwide, Diabetic Foot Ulcers (DFU) being the most lethal form of the disease. DFU is caused by changes in the bone formation of the foot as a result of peripheral neuropathy or peripheral atherosclerotic disease among diabetic patients. This paper will address reflective narrative that will integrate leadership and current practices in the management of diabetic foot ulcers.
New practice approaches have been developed to provide the best management of diabetic foot ulcers. Education awareness programs among patients with diabetes have been the target point in preventing diabetes from developing to DFU. The nurses offer training to inpatients with diabetes in self-care, and how to follow the self-care requirement. Also, patients are also guided by conducting exercises to promote movement of blood in their whole body (Shahwan, 2015). Additionally, the investigation of the relationship between microvascular complications and DFU has provided a new outlook to identify the conditions that can be treated and help to manage DFU in the long run. The diagnosis of conditions such as neuropathy and diabetic kidney disease can be included in this approach. Antitherapeutic therapy in the foot ware through the administration of antibiotics if Cellulitis is present and assessing the foot regularly to identify the likelihood of the patient to contract DFU has also enhanced DFU management (Shahwan, 2015). These new approaches are mainly based on preventive approaches rather than curative approaches.
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The intra-professional collaboration that exists among interprofessional care aims at improving diagnostic and improving wound healing outcomes over community care services. Studies have indicated that the patients who visited a podiatrist in combination with other lower specialist were unlikely to undergo amputation compared to patients who didn’t have multiple care providers (Ogrin, Houghton, &Thompson, 2015) . Patients receive more coordinated care when multiple care providers attend them. Studies have indicated that it is an organization of care and training teams that influence the rate of healing rather than the setting of care itself (Ogrin, Houghton, &Thompson, 2015) . Wide team support which includes diabetes education, case management, nursing, hospitalists, endocrinology, infectious disease, and social work should follow DFU patient in their complete period of ulceration to ensure the maximum outcome.
The health care delivery and clinical systems on DFU has improved significantly over the past era. There has been a clear understanding and good practices on factors that lead to limb loss and increasing relevant information on management of various aspects of DFU care. The overall loss of limb has decreased due to coordinated care and frequent interdisciplinary collaboration between health specialty providers. About 60% of foot ulcers present clinical signs of infections such as cellulitis, fasciitis, and osteomyelitis which has increased the health cost, thus it is important for clinicians to early identify and treat the infections as the first step in managing DFU (Serena et al., 2017) . Treatment of these infections ranges from oral antibiotics, minor amputations, and administration of a wide spectrum intravenous antibiotics.
The ethical consideration in the management of DFU has raised different perceptions. Studies to determine the perception of people with DFU and underlying factors leading to ulceration and amputation have indicated lack of understanding on effects of diabetes, self-management, and failure to seek early treatment on foot related complications (Piaggesi et al., 2016) . Insufficient public awareness on DFU management has raised concerns on the knowledge nurses have in their practice on DFU management. Late healthcare result to amputation of lower limb leading to loss of mobility, depression and anxiety, loss of independence among the patients.
DFU has become a public health concern in both developed and developing the world. DFU is a major cause of hospitalization and a leading cause of cause of limb amputation among people with diabetes. DFU decrease life quality and are costly to treat. As the population continues to grow there is an increased prevalence of diabetes (Meenakshisundaram et al., 2015) . DFU has resulted in economic burden due to the treatment cost and surgical amputation cost. The government is forced to allocate a large amount of money in the management of DFU. Good health practices are required and early diagnosis to prevent diabetes from developing to DFU.
Technology has been improvised in the management of DFU. Spark wave therapy has been introduced in the treatment of DFU which has promoted positive results. This technique applies shock wave energy which has a positive effect in accelerating wound healing (Loske, 2016) . Molecular techniques have such as tissue engineering; bioengineering skin grafts are employed in the management of DFU. The molecular techniques have a limitation of high sensitivity in applying skin clones and are expensive to maintain.
The healthcare policy emphasize the need for more research and understand the effectiveness of conducting education programs to the patient with a diabetic condition. The patients with DFU should also be advised of their nutrition practice beside homecare management on foot pressure ulcers. Policies to lower the cost of DFU treatment should be outlined (Skrepnek et al., 2017) .
The US government has allocated lumpsum of money and resources on the management and treatment of DFU. Approximately $11 billion cost has been estimated for those with DFU related with neuropathy annually (Barshes et al., 2016). Reform in the health care system has been designed to encourage preventive care, improve access to health care, and health provider reimbursement depending on patient outcome has improved the system care on a patient with diabetes and DFU. The resources in healthcare systems are fixed, and requests for additional funds for quality improvement is based on the priority within the healthcare system. Nurses and all healthcare providers must provide awareness and effective care to limit the cost incurred when DFU has accelerated to late stages.
The information on health disparities is evidence in DFU treatment and management. Research confers that there is a knowledge gap in the nursing profession and management of diabetic foot ulcers (Kumarasinghe et al.,2017). In research to identify knowledge of nurses on DFU and their approach towards patient care, the findings indicated lack of enough knowledge in wound care intervention (Kumarasinghe et al.,2017). This indicate knowledge disparity on patient care and how inefficient services are delivered due to lack of interest. There is also a disparity on self-management and evidence-based practices. Therefore, new measures for managing DFU should be put as a priority for the patient rather than doing it when it’s too late when amputation is the last option.
Nurses and other healthcare providers should focus on providing education to patients who have diabetes on healthy practices. Intra-professional collaboration should be recommended in every unit for maximum outcome. The government should increase expenditure on DFU to provide a subsidized treatment for all patient. Despite the healthcare providers and the government effort, the patients should also be responsible for their health and seek medical attention at the right time.
References
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Kumarasinghe, S. A., Hettiarachchi, P., & Wasalathanthri, S. (2017). Nurses' knowledge of diabetic foot ulcer disease and their attitudes towards patients affected: A cross ‐ sectional institution ‐ based study. Journal of clinical nursing , 27 (1-2), e203-e212.
Loske, A. M. (2016). Medical and biomedical applications of shock waves . Cham, Switzerland: Springer.
Meenakshisundaram, C., Rao, U. A., Rajendran, P., Mohan, V., & Vasudevan, R. (2015). Characterization of Pseudomonas aeruginosa and its Association with Diabetic Foot Ulcer Isolated from a Tertiary Care Hospital in Tamilnadu, India. Int. J. Curr. Microbiol. App. Sci , 4 (7), 122-126.
Ogrin, R., Houghton, P. E., & Thompson, G. W. (2015). Effective management of patients with diabetic foot ulcers: outcomes of an interprofessional diabetes foot ulcer team. International wound journal , 12 (4), 377-386.
Piaggesi, A., Goretti, C., Iacopi, E., Clerici, G., Romagnoli, F., Toscanella, F., & Vermigli, C. (2016). Comparison of removable and irremovable walking boot to total contact casting in offloading the neuropathic diabetic foot ulceration. Foot & ankle international , 37 (8), 855-861.
Serena, T. E., Fife, C. E., Eckert, K. A., Yaakov, R. A., & Carter, M. J. (2017). A new approach to clinical research: Integrating clinical care, quality reporting, and research using a wound care network ‐ based learning healthcare system. Wound Repair and Regeneration , 25 (3), 354-365.
Shahwan, S. (2015). Management and Prevention of Diabetic Pressure Ulcers with Neuropathy. General Medicine: Open Access , 2015 .
Skrepnek, G. H., Mills, J. L., Lavery, L. A., & Armstrong, D. G. (2017). Health care service and outcomes among an estimated 6.7 million ambulatory care diabetic foot cases in the US. Diabetes Care , 40 (7), 936-942.
