Diabetic Foot Ulcers in People - Coursework Example

Chapter Five 5.0 Discussion The critical review of the systematic reviews, randomized controlled trials and other studies as well as literature search showed that diabetic foot ulcer is becoming a pandemic which mostly leads to amputation in people with type 2 diabetes and nurses need the required skills and education in order to effectively carry out foot ulcer assessment (Jenkins et al, 2011). Diabetic foot ulcers in people with type 2 diabetes represent a huge burden of care for healthcare providers. As evidence shows, most of the foot ulcers and amputations can be prevented with appropriate care and comprehensive and competent foot assessment is one way in which can help in preventing the amputations. This is because there are various risk factors for foot ulcers and amputations in people with diabetes and with proper assessment the risk factors can be identified and treated appropriately. Failure or delay in identifying the high risk foot ulcers is the greatest cause for amputation in people with diabetes. A minor condition like a deformed toe nail can result to a major problem and amputation (Blatchford et al, 2015). Effective foot assessment in people with type 2 diabetes involves; assessing the history of foot ulcers, sensation, structural and biomechanical abnormalities, circulation and patient understanding of self-care. This is supported by Crozier (2014) who explains that a comprehensive foot assessment by a competent healthcare provider is supposed to be performed for every patient who has diabetic foot ulceration in order to identify high-risk patients. The assessment should encompass a comprehensive history, physical examination, required diagnostic examinations in addition to identifying the risk factors that cause the ulceration (Metta et al, 2015). In addition, it is important to assess the etiology of the ulcer because it is important to explore factors that affect the healing of the ulcer and the bio-psychosocial status of the patient in order to give the patient holistic treatment. For instance study conducted by Etnyre et al (2011) found out that there were improved outcomes for diabetic foot ulcers in the patients who were assessed regularly to identify high risk people. In this study, RNs performed out foot assessments monthly. The regular foot assessment enabled nurses constantly monitor for any changes in the status of the foot. Basically, nurses are in a unique position to intervene through carrying out foot assessments and visualization in order to identify foot complications early and thus prevent further deterioration (Etnyre, 2011). Identifying people at high risk for diabetic foot ulcer involves reviewing medical history, interviewing patients and more importantly patient assessment. As the evidence shows, high risk people consists of individuals with history of prior foot ulcers, amputation, peripheral vascular disease, neuropathy or poor control of glucose (Aalaa, 2012). Comprehensive foot assessment involves: performing visual examination of high risk people as required to make sure that minor foot problems do not turn out to be serious; performing accurate visual assessment using monofilament test, as well as pulse assessment; validating required foot-care practices and educating patients regarding foot care; talking with patients regarding their foot care practices, problems as well as complaints with every visit; giving patients a chance to express their complains or concerns regarding their foot-related practices as well as offering recommendations on suitable foot care practices; encouraging patients to carry out daily washing, lubrication as well as foot examination; and finally promoting safe practices for patients, for instance advising patients not to walk barefoot, using proper-fitting shoes and seeking medical advice when required for any problems (Dorresteijn et al, 2010). As studies show, nurses are the healthcare providers who have active involvement in prevention and early identification of diabetes complications such as foot ulcers (Aalaa, 2012). Through foot assessment, nurses are able to detect any changes in skin and foot sensation, foot care and also educate patients regarding how to prevent diabetic foot, about foot care and how to prevent foot injury. Accordingly, nurses need to be educated on the most recent information and instructions on diabetic foot care and also how to carry foot assessments in order to provide the efficient services and promote the health of patients with diabetes. a nurse with the required education and skills on how to perform foot assessment will also use the skills and knowledge to refer the patients to specialists promptly as deemed suitable to prevent the foot problem from deteriorating (Lavery et al, 2012). Delay in referring worsening patients to the specialists is a major contributing factor for individuals with diabetes and foot problems to lead to amputations. This is because as mentioned before, a seemingly minor condition, like a deformed nail if not provided with the appropriate foot care and treatment can result to a major problem and amputation (Kuhnke et al, 2014). Therefore, it is important to educate, train and empower nurses on how to carry out foot assessment and work with individuals with diabetes. Nurses who are trained and educated on foot care are supposed to work closely with the patients with diabetic foot ulcers in order to address their complex lifestyle, self-care in addition to manifold treatment demands of individuals with diabetic foot ulcer (Aalaa, 2012). In addition, nurses have the ability to facilitate and positively impact outcomes of wound/ulcer healing through appropriate foot assessment and resulting promotion, collaboration and participating with inter-professional care teams to address the patient’s foot care problem. Through collaboration, nurses can work together with other specialists to support the needs of the individual with diabetes and diabetes complications such as diabetic foot ulcer. Moreover, nurses who are educated on how to perform foot care assessment follow the best practice guidelines and most recent evidence and this greatly improves the outcomes because there is no likelihood of making errors on omitting the required care (Blatchford et al, 2015). Studies also indicate that nurse who have the required education on foot care and foot assessment are able to identify ulcer etiology factors (Redmon et al, 2014). Identification of the ulcer etiology factors greatly impact the healing of the ulcer because once the etiology factors are identified during foot assessment they can be addressed and treated appropriately and this most definitely improves the outcome because the root cause problem of the foot ulcer is dealt with and treated. Factors that influence the healing of a foot ulcer can be systemic, local or even extrinsic (Turns, 2015). The systematic factors that cannot be modified include age and malignancy of the ulcer. However, other factors such as smoking, nutritional deficiencies, recurrent trauma, glycemic control as well as adherence greatly influence the healing of an ulcer are modifiable. Accordingly, a nurse who performs foot assessment should ensure all these factors are addressed since addressing them can promote ulcer healing. Similarly, reviewing the can identify and reveal the anti-inflammatory and cytotoxic medication that can interfere with the healing of the ulcer. As Redmon et al (2014) illustrate, the systemic factors that influence the healing of foot ulcers encompass autoimmune disorders, reduced blood supply, jaundice, obesity, renal failure, in addition to vasculopathy. In addition, there are some local factors that impact the healing of an ulcer and they consist of blood supply, denervation, edema, hematoma, local infection, mechanical stress, radiation plus suture material, as well as other causes like psychosocial/cognitive impairment, utilizing cytotoxic agents, and poor surgical outcome (Redmon et al, 2014). The extrinsic factors that influence the healing of foot ulcers consist of cultural beliefs, matters of quality of life, unsuitable footwear and offloading devices. This obviously indicates that nurses need training and education because for them to have all this knowledge they require extensive training for them to effectively perform a comprehensive foot assessment that covers all the required aspects of foot assessment. More importantly, studies show that nurse who perform foot assessment have the role of carrying out patient education. Dorresteijn et al (2010) explained that patient education is supposed to be founded on the evidence and should include signs and symptoms of problems allied to foot, significance of daily lubrication and foot examination, the significance of appropriately-fitting shoes, appropriate self-foot care and general safety. Patient education consists of many aspects (Dorresteijn et al, 2010). For instance, during foot assessment nurses should encourage patients to always put on white clean socks as this makes it easier for the patient to identify any drainage that might signify trauma and ulceration. Patient education should also include general safety aspects such as encouraging patient to avoid any physical trauma and encourage patients to avoid heated sources especially when they have neuropathy (Turns, 2015). In addition, since patient education is an important part of foot assessment, nurses need to educate patients on nail care to reduce the risk of accidental injuries and educate patients on appropriate nutrition and glucose control. Lastly, patients should be educated on neuropathy because sensory neuropathy causes decreased or absence of pain sensation on the feet. Therefore it is important to educate patients on modifiable practices that can enhance neuropathy such as avoiding smoking, reducing alcohol intake and avoiding crossing legs or ankles. Evidently, nurses need to undergo comprehensive training and education on how to educate patients about all the above discussed factors during foot care assessments. When nurses conduct effective and comprehensive foot care education during foot assessment, it is possible to avoid foot problems or worsening of foot ulcers and this most definitely prevents foot amputation (Aalaa et al, 2012). Chapter Six 6.0 Conclusions and Recommendations 6.1 Recommendations 1. Nurses require education and knowledge and skills in the following areas for them to be competent in assessment of individuals with type 2 diabetes’s risk for foot ulcers and offer the appropriate treatment, education and referrals as well. Basically, nurses should be skilled in performing assessment of the five risk factors for diabetic foot, namely; risk assessment algorithm; diabetes foot assessment; history or presence of earlier foot ulcers; sensation and structural and biomechanical deformities/abnormalities;circulation and self-care behavior and knowledge. Nurses also need knowledge in educating patients with type 2 diabetes and also knowledge regarding the sources of local referral for them to be making appropriate referrals for patients at high risk and other who need further medical attention (Jenkins et al, 2011). 2. Educational training institutions for nurses are supposed to integrate diabetic foot assessment as well as Nursing Best Practice Guidelines for decreasing foot problems for individuals with type 2 diabetes into basic nursing education syllabus. In addition, educational institutions should offer continuing education programs to nurses regarding diabetic foot assessment in order to update them with the current best practices for performing foot assessment. Nurses also should ensure that they regularly attend training workshops and seminars on how to perform diabetic foot assessment in order to equip them with the appropriate skills. The significance of nurses attending workshops and seminar training on foot assessment and having the subject incorporated in their curriculum is that nurse are in a key position to perform foot assessment and early intervention in decreasing foot complications for individuals with diabetes. For nurses to be able to prevent foot ulcers, they should be knowledgeable regarding the risk factors for foot ulcers, have the appropriate skills on how to use tools and equipment that support early assessment to facilitate implementation of preventative strategies and have knowledge regarding the local resources for referral. Additionally, as evidence shows, nurses should have the skills on performing patient education and responding to their individual needs (Dorresteijn et al, 2010). 3. Health institutions and hospitals need to develop a policy that recognizes and designates resources for supporting nursing’s role in foot assessment, education as well as referrals of patients for suitable foot care. It is the responsibility of health institutions and hospitals to advocate with policy makes and come up with policies that facilitate implementation of policies that support diabetic foot care and assessment 4. Health institutions/hospitals need to make sure that they avail educational resources for implementation to nurses for performing diabetic foot assessment. The resources include educational materials, foot assessment procedures and foot assessment tools such as monofilaments 5. There is need to implement nursing best practice guidelines in the healthcare institutions to guide nurses on how to successfully perform foot care assessment. Nurses should also attend best practice guideline education sessions and regularly self-asses their knowledge on how to perform foot assessment and use assessment tools such as monofilament (Lavery et al 2012) 6.2 Conclusion Diabetic foot ulcer is the most common complication in people with type 2 diabetes and thus it is important to allocate resources and time in preventing and diagnosing diabetic foot complications. Consequently, nurses as members of diabetic care team are required to play their role in diabetic foot care by preventing and detecting foot ulcers early enough to avoid worse complications such as amputation. For this, nurses should be educated and attend special training in using the most recent instructions of diabetic foot care and performing foot assessment to prevent and detect foot ulcers. Nurses should take part in updated and accredited continuing educational opportunities that support enhancement of diabetic foot care including foot assessment. To ensure that nurses acquire the required education and training on how to perform foot assessment, educational institutions incorporate foot care assessment in their curriculum to equip nurses them with the required skills. Health institutions also need to support nurses by availing the required resources to support nurses in their training. Equipping nurses with the required skills and knowledge through education will go a long way in reducing diabetic foot complications and the rate of amputations in people with type 2 diabetes. Reference List Aalaa M, Malazy T, Sanjari M, Peimani M & Mohajeri M, 2012, Nurses’ role in diabetic foot prevention and care; a review, J Diabetes Metab Disord, 11( 24). Blatchford L, Morey P & McConigley R, 2015, Identifying type 2 diabetes risk classification systems and recommendations for review of podatric care in an Australian Aboriginal health clinic, Journal of Foot and Ankle Research, 8(34). Crozier, L, 2014, Diabetic Foot-related Problems: Improving outcomes in the Dialysis Population using Foot Assessment Screening Tri-algorithm (FAST), Nephrology Nursing Journal, 41(4). Dorresteijn J, Kriegsman D, Assendelft W & Valk G, 2010, Patient education for preventing diabetic foot ulceration, Cochrane Database of Systematic Review, 5(1488). Etnyre A, Perla Z, Roehrick L & Farmer S, 2011, The role of certified foot and nail care nurse in the prevention of lower extremity amputation, J Wound Ostomy Continence Nurs, 38(3): 242-251. Kuhnke J, Bailey P, Woodbury G & Burrows M, 2014, The role of qualitative research in understanding diabetic foot ulcers and amputation, Advances in Skin & Wound Care, 27(4). Jenkins C, Myers P, Heidari K & Kelechi T, 2011, Efforts to Decrease Diabetes-Related Amputations in African Americans by the Racial and Ethnic Approaches to Community Health Charleston and Georgetown Diabetes Coalition, Fam Community Health Supplement 1, 34, No. 1S, pp. S63–S78. Lavery L, LaFontaine J, Higgins K , Lanctot D & Constantinides G, 2012, Shear-Reducing Insoles to Prevent Foot Ulceration in High-Risk Diabetic Patients, Advances in Skin & Wound Care, 25(11). 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