Background: Diabetes – one of the leading non-communicable diseases of our time is steadily increasing in prevalence with each year. The disease is linked to several complications that can have major consequences for both the individual and society at large. Diabetic foot ulcers are one of these complications. Aim: The aim of this study was to investigate preventive nursing measures that can be provided to patients at risk of diabetic foot ulcers. Method: This study was conducted as a literature review. The databases CINAHL and Medline were used to identify relevant articles. The database searches resulted in 11 articles that were included in the study and analyzed with the use of a thematic analysis approach. Results: Three overarching categories that nurses can work within to prevent diabetic foot ulcers were derived from the thematic analysis, namely: Care based on needs, Education and Importance of collaborations. Conclusion: Care based on needs, Education and Collaboration are areas in which the nurse can provide preventive care to patients with diabetes at risk of developing diabetic foot ulcers or to patients with already existing foot ulcers. Based on the studies key concepts, implications on the preventive areas relevance for nursing were drawn. Further studies are recommended to investigate how these nursing measures for preventing diabetic foot ulcers can be disseminated within the nursing profession. By spreading these nursing measures within the profession good conditions for minimizing the disease burden of diabetic foot ulcers can be established. / Bakgrund: Diabetes – en av vår tids främsta icke-smittsamma sjukdomar ökar stadigt i prevalens för varje år som går. Sjukdomen är kopplad till en rad komplikationer, bland annat diabetesfotsår, som kan innebära konsekvenser för individen och samhället i stort. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans preventiva omvårdnadsåtgärder kring fotsår hos patienter med diabetes. Metod: Studien genomfördes som en litteraturstudie. Databaserna CINAHL och Medline användes för att identifiera relevanta artiklar. Sökningarna i databaserna resulterade i 11 artiklar som inkluderades och analyserades med en tematisk analysmetod. Resultat: Den tematiska analysen resulterade i tre övergripande kategorier inom vilka sjuksköterskor kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som har eller riskerar att utveckla diabetesfotsår. Slutsats: Vård utifrån behov, Utbildning och Vikten av samarbeten är områden inom vilka sjuksköterskan kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som riskerar eller har utvecklat diabetesfotsår. Sett ur de centrala begreppens perspektiv kan slutsatsen att de identifierade omvårdnadsåtgärderna är relevanta för omvårdnad dras. Studiens resultat är således relevanta för sjuksköterskeprofessionen och vidare studier rekommenderas undersöka hur omvårdnadsåtgärderna kan spridas inom professionen. Om omvårdnadsåtgärderna kan spridas inom professionen och tillhandahållas patientgruppen finns goda förutsättningar att förebygga samt lindra den sjukdomsbörda som diabetesfotsår kan leda till.

Title: Effect of therapeutic physical program in patients with type 2 diabetes mellitus Objectives: The aim of my work was to examine the effect of 12 weeks therapeutic physical program on distribution of plantar pressure, muscle strength in plantar flexion, ankle range of motion and physical abilitity by patients with type 2 diabetes mellitus and diabetic foot syndrome. Methods: It was a quantitative research, randomized controlled trials. It was chosen 10 patients with type 2 diabetes mellitus and with diabetic foot syndrome. The patients were devided into 2 groups. In each group were four males and one female, aged from 54 to 73 years old. The first group included exercise patients and the second group nonexercise patients. The intervention took place 5 - 7 times a week and contained two types of training units. The first had 11 exercises, the second self mobilization of leg joint and walking. Basic anthropometric figures - height, weight, girth of waist and hipline (tailoring meter,weighing machine), ankle range of motion (goniometer), muscle strenght in plantar flexion (dynamometer), pressure distribution in stand (MobileMat), physical ability (Senior Fitness Test) were measured and compared in two groups after 12 weeks. The results were evaluated statistically in tables. Results: The...

Diabetic foot syndrome is a serious chronic complication of diabetes mellitus, caused by a number of factors such as neuropathy, angiopathy, infection, and above all, this syndrome is consequence of a poor diabetes compensation and cardiovascular risk factors. It is characterized by particularly impaired wound healing and a higher tendency to chronicity, which can often be a reason for disability of the patient. Nutrition plays a very important role in a patient hospitalized with diabetic foot syndrome, as adequate coverage of energy and nutritional needs is essential for successful treatment and healing of ulcers. The theoretical part of this diploma thesis first mentions diabetes mellitus, its basic characteristics and briefly describes the types of diabetes that are associated with diabetic foot syndrome. Acute and chronic complications of diabetes are also discussed, followed by a more extensive chapter on the diabetic foot syndrome itself. This is the very definition of the term, epidemiology, pathogenesis, classification, diagnosis, treatment and prevention of this syndrome. The last chapter deals briefly with general nutritional recommendations for diabetics and the nutritional status of patients in which they are most often found when they are admitted to hospital, which is malnutrition,...

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with diabetes as a routine organizational protocol for quality improvement in diabetic care in a primary care clinic. The question for this project was: How does the implementation of an evidence-based diabetic foot care protocol impact the health outcomes of diabetic patients in a primary care clinic? Orem’s self-care deficit nursing theory and the logic model for evidence-based practice were used to guide this DNP project. The research method for the quality improvement project was a review of the literature. The participants were staff and adults with diabetes at the primary care clinic. The results of the chart review showed that 80% of the charts included documented foot assessments and patient education, which was an improvement when compared to 40% pre-implementation of the foot care program. The program has improved the foot health knowledge and skills of clinicians and people with diabetes and has also helped to reduce the burden of healthcare costs related to the lower incidence of hospitalization for the treatment of wounds and amputation associated with complications of diabetes.

Abtrakt (EN) In spite of the fact that the diabetic foot syndrome is not considered a marginal complication of the patients with diabetes mellitus any more, its prevalence and incidence is not decreasing. The fact that early diagnosis and treatment or even prevention of foot ulcers is associated with a decrease in healthcare costs and, more importantly, with reducing patients' suffering, applies also in this case. The dissertation work originated in the Diabetologic Center of the Medical department I., University Hospital and Medical Faculty in Pilsen, Charles University in Prague, which has been dealing with diagnostic and therapeutic procedures in patients with diabetic foot syndrome for over 20 years. The examinations for diagnosis of the main etiologic factors, i.e. peripheral neuropathy and impaired perfusion, belong to already routine ordinary procedures here. My task was to move the diagnostics of this complication to earlier stages, even before the development of the ulcers, through diagnosing an impairment in skin microcirculation. The aim of the work was to evaluate reactivity of the skin microcirculation in patients with diabetes mellitus using laser doppler flowmetry and to introduce a new method - iontophoresis. Skin microcirculation assessment has become a center of interest of many studies...

Bakgrund: Diabetes Mellitus är en folksjukdom och ett samlingsnamn för flera olika typer av diabetes. En vanlig komplikation vid långvarig diabetes är fotsår, men vid god egenvård kan dessa fotsår till stor del förebyggas. Syfte: Undersöka personer med diabetes erfarenheter av egenvård relaterat till fotsår. Metod: Litteraturöversikten baserades på åtta vetenskapliga artiklar med kvalitativ design. Sökningen genomfördes i databaserna PubMed och Cinahl. Artiklarna kvalitetsgranskades, analyserades och sammanställdes. Resultat: Personer med diagnosen diabetes har i vissa fall bristande egenvård i relation till fotvård och fotsår. Analysen ledde fram till två huvudkategorier och sex subkategorier. Huvudkategorierna var; Hinder till att utföra egenvård samt Vikten av god kommunikation med vårdpersonal för att främja egenvård.  Konklusion: Personer med diabetes har i många fall bristande kunskap om fotsår. Detta leder till att de i många fall har svårt att utföra en god egenvård. Personanpassad och återkommande information från sjukvården har i många fall stärkt egenvården. / Background: Diabetes Mellitus is a public disease and a collective name for several different types of diabetes. A common complication of long-term diabetes is foot ulcers, but with good self-care, these foot ulcers can largely be prevented.  Aim: Investigate people with diabetes experiences of self-care related to foot ulcers. Methods: The literature review was based on eight scientific articles with a qualitative design. The search was performed through the databases PubMed and Cinahl. The articles were quality reviewed, analyzed and compiled. Results: People diagnosed with diabetes in some cases lack self-care in relation to foot care and foot ulcers. The analysis led to two main categories and six subcategories. The main categories were Obstacles to performing self-care and The importance of good communication with healthcare professionals to promote self-care. Conclusion: People with diabetes often lack knowledge about foot ulcers. In many cases this leads to them having difficulty in performing good self-care. Personalized and recurring information from healthcare has in many cases strengthened self-care.

Bakgrund: Förekomsten av diabetes typ 2 ökar både nationellt och internationellt. Många av dessa patienter utvecklar diabeteskomplikationer i form av diabetesneuropati som är en av de vanligaste bakomliggande orsakerna till diabetesfotsår. Samarbetet kring diabetesfotsår mellan olika professioner behöver öka för att få en bättre prognos för sårläkning och således bättre livskvalitet för dessa patienter. Diabetessjuksköterskor och distriktssköterskor är involverade i vården av patienter med diabetes och diabetesfotsår men hur samarbetet mellan dessa professioner ser ut är inte klarlagt. Syfte: Syftet med denna studie är att undersöka diabetessjuksköterskans och distriktssköterskans upplevelse av samarbete vid omvårdnad av diabetesfotsår hos patienter med typ 2 diabetes samt hur ett samarbete kan förbättra vården för patienter med diabetesfotsår.   Metod:  En kvalitativ intervjustudie med deduktiv ansats valdes för att bemöta studiens syfte. Sex semi-strukturerade intervjuer genomfördes och data analyserades enligt Granheim & Lundmans kvalitativa innehållsanalys. Resultat: Studien resulterade i fem olika kategorier; vikten av kommunikation, brist på rutiner, integrerat samarbete inom vården, utveckling och heterogen kompetens samt säkerhetskultur inom vården. Förbättring av samarbetet mellan diabetessjuksköterskor och distriktssköterskor kan leda till ökad kompetensen hos sjuksköterskorna samt till bättre livskvalitet för patienter med diabetesfotsår.  Slutsats: Samtliga deltagare har uttryckt vikten av ett bra samarbete och skapande av rutiner som kan leda till bättre förutsättningar för patienter med diabetesfotsår. Betydelsen av kompetensen och kunskapsutbyte var viktiga faktorer för ett välfungerande samarbete. / Background: The incidence of type 2 diabetes is increasing both nationally and internationally. Many of the patients develop diabetic complications in the form of diabetic neuropathy, which is one of the most common underlying causes of diabetic foot ulcers. Diabetes nurses and community health nurses are involved in the care of patients with diabetes and diabetic foot ulcers, but what the collaboration between these professions looks like is not clear. Objective: The purpose of this study is to investigate the diabetes nurse's and community health nurse's experience of collaboration in the care of diabetic foot ulcers in people with type 2 diabetes and how collaboration could improve care for patients with diabetic foot ulcers. Method: A qualitative interview study with an deductive approach was chosen to meet the purpose of the study. Six semi-structured interviews were conducted and the data were analyzed according to Granheim & Lundman's qualitative content analysis. Results: The study results in five different categories; the importance of communication, lack of routines, integrated collaboration in healthcare, development and heterogeneous competence and safety culture in healthcare. Improving of the collaboration between different professional groups can lead to an increase in the competence of the staff and to a better quality of life for the patients with diabetic foot ulcers. Conclusion: All participants emphasized on the importance of good collaboration and the creation of routines that can lead to better conditions for patients with diabetic foot ulcers. The importance of competence and knowledge exchange were important factors for a well-functioning collaboration.

Yes / To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji. Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis. Rotuma hospital, Fiji. HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included. There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients. HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.

Preventing diabetic foot ulcers among patients diagnosed with diabetes is an important element of care as diabetic foot ulcers present major medical, psychosocial and economic threats. In addition, about 20% of the diabetic foot ulcer cases will ultimately require amputation and cause greater mortality rates. The purpose of this literature review was to evaluate cellphone use to promote diabetic foot care practices among patients with diabetes. Six electronic databases were searched for articles which included text messaging and or phone interventions geared at improving foot care practices. A total of 14 articles dated 2009-2019 met the inclusion criteria and were included in the review. Cellphone use for text messaging and phone calls to advance diabetic foot care practices appears to be promising. Cellphone interventions among clients diagnosed with diabetes were found to have higher adherence with foot examinations, more frequent foot checks, and better overall performance score of diabetic foot ulcer preventive behaviors. This literature review supports cellphone use for text messaging and phone calls to improve diabetic foot care practices. Particularly among populations with health disparities and limited access to healthcare cellphone improves access to care, is uncomplicated and presents a cost-effective approach to improving diabetic foot care practices.

O conhecimento embasado nas melhores evidências científicas para a assistência de enfermagem às pessoas com feridas crônicas (FC) deve alicerçar o ensino da temática na formação do enfermeiro. Diante da relevância epidemiológica do problema, o docente de enfermagem se depara com o desafio de ensinar aos estudantes, o cuidado às pessoas com essa complicação, nos diversos contextos de atenção à saúde. A etapa da avaliação da FC é fundamental para identificar e descrever o processo de cicatrização e a seleção da terapia tópica, que o favoreça. A educação à distância (EAD) tem demonstrado ser uma estratégia efetiva para atualização do conhecimento. Diante disto, o objetivo deste estudo foi identificar o impacto da EAD, no conhecimento de docentes de enfermagem e enfermeiros vinculados ao ensino superior, acerca da avaliação de FC. Tratou-se de um estudo prospectivo, quase-experimental, com coleta de dados antes e após a intervenção. Após aprovação pelo Comitê de Ética em Pesquisa, foram convidados a participar da pesquisa, docentes e enfermeiros vinculados ao ensino, de instituições de ensino superior (IES) públicas e privadas, que ministrassem disciplinas teóricas e/ ou práticas, nos cursos de graduação em Enfermagem, de um município do interior do Estado de São Paulo. A amostra foi composta por 26 docentes e enfermeiros vinculados ao ensino, que participaram do curso de atualização \"Avaliação de Feridas Crônicas na Assistência de Enfermagem\" oferecido através do Ambiente Virtual de Aprendizagem (AVA) Moodle. Entre os participantes, a média de idade de 42,3 anos (DP 9,56), e todos eram do sexo feminino. O tempo médio de experiência no ensino foi de 11,16 anos (DP 8,02), 24 (92,3%) docentes afirmaram lecionar disciplinas teóricas e/ ou práticas, dos quais, 91,7% referiram atuar no cuidado de pessoas com FC, nos cenários de prática. A ferramenta mais utilizada para a busca de informações sobre \"feridas crônicas\" pela maioria dos participantes foi a internet. O aumento na porcentagem de acertos após a intervenção foi estatisticamente significante e o domínio que obteve maior número de acertos no pré e pós-teste foi \"Dimensionamento da ferida\", com melhor desempenho ao final do curso. A correlação entre o tempo de experiência na docência e o desempenho no teste de conhecimento foi negativa, e a associação entre a utilização de outras estratégias para busca de informações, tais como troca de experiência entre os pares, participação em eventos científicos acerca do tema, melhorou o desempenho dos participantes. A utilização da EAD, como ferramenta para a intervenção educativa, visando a divulgação de recomendações para a avaliação de feridas crônicas, impactou positivamente na aquisição de conhecimentos dos participantes. A adoção de tecnologias para o aprimoramento dos docentes de enfermagem trouxe implicações que podem favorecer o ensino e gerar mudanças na prática clínica de enfermagem / The knowledge based on the best scientific evidence of care to people with chronic wounds (CW) should be the basis of this theme teaching in nursing education. Considering the epidemiological relevance of this problem, nursing faculty are faced with the challenge of teaching students how to look after people with this complication in different contexts of health care. The assessment of CW is critical to identify and describe the healing process and the selection of the best topical therapy. The effectiveness of E-learning (EL) strategy to update knowledge has been demonstrated in other studies. Therefore, the aim of this study was to identify the impact of e-learning on CW assessment knowledge of teachers and nurses involved with higher education. A prospective and quasi-experimental study was conducted with data collection before and after the intervention. After the board of ethics approval, teachers and nurses were invited to participate in the research. These teachers and nurses involved in higher education institutions, both public and private, teach theoretical subjects and or practices in nursing undergraduate courses in the municipality in the state of Sao Paulo. The sample consisted of 26 teachers and nurses who attended the update course \"Assessment of Chronic Wounds in Nursing Care\" offered through the Virtual Learning Environment (VLE) Moodle. Among participants, we identified an average age of 42.3 years (SD=9.56), and regarding gender, all subjects were female. The average teaching experience was 11.16 years (SD=8.02), 24 (92.3%) teachers reported teaching theoretical subjects and/or practices, of which 91.7% reported working with CW care in practice scenarios. The most widely used tool to search for information about \"chronic wounds\" was the internet. The increase in the percentage of correct answers after the intervention was statistically significant and the item with highest number of correct answers in both pre and posttests was \"Dimensioning the wound\", with better performance at the end of the course. The correlation between times of teaching experience and performance on the knowledge test was negative, and the association between the use of other strategies to knowledge update (such as exchange of experience among peers, participation in scientific events on the theme) was found to improved performance of the participants. The use of EL as a tool for educational intervention focused on disseminating recommendations for CW assessment positively impacted the acquisition of knowledge among participants. Adopting technologies for the improvement of nursing faculty\'s abilities had outcomes that may support education and generate changes in the clinical nursing practice