The guideline “Assessment and management of foot ulcers for people with diabetes” comprises various recommendations for the selection and utilization of evidence related to the examination, staff education, improvement of appropriate organizational culture, and policy-making in the area of prevention and treatment of foot ulcers in patients with diabetes. The guideline is indented for the use of advanced practice nurses. It is meant to encourage them to implement high-quality evidence to address the given health problem in individuals aged 15 and more years.
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In the document, six major levels of evidence are identified. To achieve better results, it is suggested to match each area of performance with the recommended level of evidence. For instance, Ib-level evidence (obtained from a randomized control trial) should be used for the ongoing monitoring of the healing process, and IV-level evidence (expert committee reports) − for policy development.
Important recommendations are provided in the section “Description of the implementation strategy.” To increase the EBP success, the hospital’s personnel should evaluate the environment and identify major issues and gaps in knowledge, as well as resources needed for improvement. The workforce should be mobilized to search for and implement the evidence. Moreover, constant monitoring of the progress and the evaluation of outcomes may define the sustainability of results.
The expected favorable outcomes of the evidence-based practice include the reduced incidence of amputation, duration of ulceration, and the overall number of diabetes-related complications. By improving the interventions using different levels of evidence, it will be possible to enhance patients’ quality of life.
Prevention of Foot Ulcer Development in Patients with Diabetes
Patient education can be regarded as one of the most effective preventive practices. To identify what specific educational techniques should nurses use to prevent foot ulcer development in high-risk patients, the articles containing the III-level evidence were selected. The given level refers to the data provided in “well-designed non-experimental descriptive studies,” and is recommended for the facilitation of patient-centered learning (Agency for Healthcare Research and Quality, 2013).
The first of the selected articles is the literature review conducted by Aalaa, Malazy, Sanjari, Peimani, and Mohajeri-Tehrani (2012). The researchers emphasize the significance of nurses’ role in the prevention of diabetes-related complications. Nurses should promote patients’ awareness of basic foot care principles (i.e., wound dressing, cleaning, etc.) and encourage them to practice these principles daily. Additionally, Aalaa et al. (2012) note that patients may largely benefit if nurses provide information about relevant risk factors. They state that such modifiable factor as hyperglycemia contributes to the progression of diabetic neuropathy. Therefore, regular blood sugar control is critical to the prevention of foot ulcer development and improvement of the overall quality of life.
The evidence in the second study by Iraj, Khorvash, Ebneshahidi, and Askari (2013) is collected by using the literature review as well. The authors conduct a comprehensive overview of the pathophysiological processes leading to foot ulcer development in patients with diabetes and, based on this, outline the patient education recommendations. The major risk factors identified by the researchers include neuropathy, peripheral artery disease, deformity, and minor traumas that progressed as a result of metabolic complications and vascular complications. The given factors are modifiable.
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Thus, during the education course, nurses should address the issues related to “lifestyle modification, blood pressure control, lipid management, glycemic control, and smoking cessation” (Iraj et al., 2013). The specific practical recommendations include the regular feet washing and drying with the focus one the inter-digital spaces between the toes, decrease the exposure to high temperatures, the selection of appropriate shoes, and their daily examination aimed to prevent the extra pressure effects due to the presence of external objects inside the shoes.
The collected evidence shows that the level of awareness of existing prevention measures and health risks defines the overall level of patient morbidity. For this reason, patient education aimed to encourage individuals to engage in healthier lifestyles and use various diabetes-specific self-management activities may foster favorable behavioral changes in the target population.
Aalaa, M., Malazy, O. T., Sanjari, M., Peimani, M., & Mohajeri-Tehrani, M. (2012). Nurses’ role in diabetic foot prevention and care: A review. Journal of Diabetes and Metabolic Disorders, 11, 24.
Agency for Healthcare Research and Quality. (2013). Assessment and management of foot ulcers for people with diabetes. Web.
Iraj, B., Khorvash, F., Ebneshahidi, A., & Askari, G. (2013). Prevention of diabetic foot ulcer. International Journal of Preventive Medicine, 4(3), 373–376.