Pressure ulcer among diabetes patients is the most devastating complication which is also costly. Also referred to as diabetic foot ulcer (DFU), it affects about 15 percent of the patients in their lifetime. The end result of this condition is always amputation on the lower limb of the patient. In some cases where there is no appropriate care, it can lead to death. Part of the cause of the foot ulcer is the pressure that the limbs undergo during weight-bearing activity. Currently, DFU is considered one of the most significant sources of morbidity and a leading cause of hospitalization in diabetes cases. There is, therefore, a need for proper interventions to reduce the occurrence cases and effectively manage the clinical problem. This paper seeks to review the literature and support the PICOT statement that compares nurses educating the patients and treatment of pressure ulcers.
There has been extensive research on the management of DFU and the implication it has to patient care. All this is done to try to find out what works best to manage the increasingly important topics in the care of diabetic patients. In studying the strategies for management, researchers always formulate different questions or hypotheses. Some determine the strategies for the management of diabetic foot ulcers in bids to reduce the complications and improve patient outcome (Yazdanpana et al., 2015). In this case, the authors formulate a stepwise management which begins with education and ending with surgery.
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The researchers also indicate that a multidisciplinary approach is included in the management of such complications. In another research by American Diabetes Association (2015), the main hypothesis was to investigate the relationship between microvascular complications and DFU. In this case, the study seeks to identify comorbid conditions that can be treated to manage diabetes and take care of the DFU in the long run. This means the diagnosis of other conditions such as diabetic kidney disease and neuropathy are included in the strategy. The research concentrated on diabetic kidney disease patients.
According to Crews et al. (2016), intervention measures that involve off-loading is a major concern. In their hypothesis to determine the level of adherence in off-loads, they create a question of how there is lack of effective observance. According to the study, the amount of DFU healing that occurs depends on the amount of adherence to the off-load treatment. The researchers focused on a population of 79 patients from UK (46) and the US (33). These were patients with type 2 diabetes and plantar DFU and were majorly white men in their mid-50s.
Another result that focused on intervention measures is the one carried out to find out the importance of skin care on the prevention of DFU in people with spinal cord injuries (Baron et al., 2016). Despite not concentrating on diabetes patients, the injuries on spinal cord have the same bed rest effects as diabetes. Thus it focused on a population of individuals with traumatic or non0traumatic spinal cord injuries. This study shows the disparity that exists between the self-management theories and the evidence-based practice. In this study, there is the call for the need of reviewing the intervention measures to manage pressure ulcers by providing skin care to the patients. This means that there should be interventions aimed at treating underlying conditions in order to maintain the DFU.
However, at the organization level, the interventions are not always operationalized to meet the requirements of the patients. This was revealed in a study by Soban et al. (2016) on a study aimed at investigating the presence and operational implementation of prevention DFU. The research involved email responses from 124 nurse leaders.
In some studies, there are propositions that the educational intervention should be an important aspect in the management of diabetic foot ulcer. In a research by Chiwanga & Njelekela (2015), the evidence of lack of knowledge on foot care as a prevention of DFU caused the high prevalence in the study population. This means that the high level of reported foot ulcers was due to the lack of knowledge on how to initiate self-care. The population included 404 patients with varying levels of risk factors to foot ulcers. The research notes that the academic levels of the patients influence the knowledge on the management of diabetic foot.
Another research that confers to the findings of this study found out that there is a knowledge gap in the nursing profession as means of management in a diabetic foot (Kumarasinghe et al., 2017). With a research question to identify the knowledge of nurses on diabetic foot ulcers and their approach towards patient care, the findings revealed a lack of research in the wound care interventions. In other words, the results suggest the disparity between the knowledge of care and the practice and how the lack of interest drives the inefficient services. The population studied involved 200 nurses in three teaching hospitals. This is in retrospect to the requirement of the PICOT statement that nurses should be in the forefront of the prevention and intervention of diabetic foot as was found out in a separate research (Hoviattalab et al., 2014).
The limitations of such studies involve the varying amounts and types of population and samples. Some studies concentrated on patients who had other risk factors which would lead to the development of foot ulcers. Also, the variation in the levels of the population makes it difficult to capture a uniform denominated result. For instance, studying patients of different countries make it difficult to form a conclusive result which reflects the practices of nursing in general. Different countries have varying practice codes and regulations.
In conclusion, the researchers have provided an insight into the gaps that exist in the knowledge and practice to manage DFU. As a result, there should be room for other research on why the past studies have only focused on the education intervention but not much done on treatment approaches. Thus, more studies should be carried out on the effectiveness of treatment and how to develop a framework to ensure patients are well taught about their care.
References
American Diabetes Association. (2016). 9. Microvascular complications and foot care: Diabetes care , 39 (Supplement 1), S72-S80.
Baron, J., Swaine, J., Presseau, J., Aspinall, A., Jaglal, S., White, B., & Grimshaw, J. (2016). Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol: Systematic reviews , 5 (1), 150.
Chiwanga, F. S., & Njelekela, M. A. (2015). Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania–a cross-sectional study: Journal of foot and ankle research , 8 (1), 20.
Crews, R. T., Shen, B. J., Campbell, L., Lamont, P. J., Boulton, A. J., Peyrot, M., ... & Vileikyte, L. (2016). Role and determinants of adherence to off-loading in diabetic foot ulcer healing: a prospective investigation: Diabetes care , 39 (8), 1371-1377.
Hoviattalab, K., Hashemizadeh, H., D'cruz, G., Halfens, R. J., & Dassen, T. (2015). Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals: Journal of clinical nursing , 24 (11-12), 1513-1524.
Kumarasinghe, S. A., Hettiarachchi, P., & Wasalathanthri, S. (2017). Nurses’ knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: a cross ‐ sectional institution based study: Journal of clinical nursing .
Soban, L. M., Kim, L., Yuan, A. H., & Miltner, R. S. (2017). Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey: Journal of nursing management , 25 (6), 457-467.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer: World journal of diabetes , 6 (1), 37.
