According to World Health Organization, nurses are one of the largest health groups in the world who are involved in different levels of health. To achieve these goals, nurses can play different roles.
There are seven main roles for nurses including: 1. Nurses combine science and art to provide health services and seek to eliminate physical, emotional, mental, social-cultural and spiritual patient needs. Since patients care is the first duty of nurses, so that they play an important role in the care of diabetes in developed countries, and diabetes nursing is divided into several categories, including nurse practitioner, clinical nurse specialist, diabetes nurse, generalist nurse and each of them has clear duties.
For example, nurse practitioner focuses on health promotion and disease prevention activities including patient education and consulting [ 49 ]. It is obvious that with the increasing prevalence of diabetes and its complications, there is undeniable need to train nurse specialist in this field. The diabetic foot is so important to such an extent that was considered as one of the main objectives of the Healthy People to reduce the incidence of foot ulceration and amputation in diabetic patients. It has been observed that nurses have an effective role in prevention of foot ulcers and lower limb amputation by educational interventions, screening high-risk people and providing health care [ 52 ].
It is necessary for all diabetic patients, especially patients at risk for foot ulcers, to be familiar with the basics of foot care. Several studies suggest that patient education about foot care is effective in prevention of diabetic foot ulcers [ 53 - 55 ]. Nurses can teach patients how to perform physical examination and take care of their feet on a daily basis [ 56 ]. For instance, nurses can encourage patients to carry out a series of simple rules in order to help prevent foot ulcers or recurrence, such as checking the shoes before wearing, keeping feet clean and continuing care of the skin and nails.
Training about choosing the right shoes is essential as well [ 57 ]. However, the nurse educators can evaluate patient requirements and design a particular educational program for each of patients and their families [ 33 ].
Step Up—Include Foot Care in Your Practice
Nurses can facilitate active participation of patients and family members in care and they can also teach patients about the importance of regular visits to the clinic, blood tests at specified intervals and the primary principle of diabetes care and prevention of its complication. Hence, patients with poor control of blood glucose should be given special attention for practicable educations [ 62 ]. Besides learning the suitable life style, patients should be trained according to the severity of diabetic foot problems [ 47 ]. Considering the above points, education of health care provider is a crucial issue.
In addition, most of the time, they lack the knowledge of effective treatments. In other words, along with patient education, diabetic foot team members and nurses as a key member of them must be trained. The main goal of it is to increase staff awareness of the diabetic foot ulcer risks and improve their skills in examination and treatment of diabetic foot [ 41 ].
Peripheral neuropathy, peripheral vascular disease and infection are three major factors for diabetic foot ulcer that can lead to gangrene and amputation [ 63 ]. Nurses who specialize in foot care are involved in the early stages of care and treatment [ 64 ]. The primary goal of screening is early detection of diabetic foot problems, identifying those at risk and planning to reduce the risk of ulcers [ 67 ].
Diabetic foot examination should be part of all visits. Nurses should ask patients to remove their shoes and socks [ 68 - 70 ], and then examine their feet in order to screen patients at high risk and report to other members of the multidisciplinary diabetic foot team [ 71 ]. In a diabetic foot specialty clinic, nurses may access vascular status with an ankle brachial index ABI and toe pressure.
Moreover, pedography system and thermometer are used to assess foot sole pressure and foot temperature [ 72 , 73 ] so the severity of foot problems and being at risk of diabetic ulcers will be identified. Another part of duties that a nurse provides to produce excellent diabetic foot care should be the complementary care such as selection an appropriate dressing according to the type of ulcers.
Selection dressing depending on the type of wound which is wet or dry is important since dressings, while keeping clean the wound and maintain the wound moisture, help to debridement and reduce the number of bacteria [ 74 , 75 ]. Regarding the variety of novel dressing, awareness and knowledge of nurses in this field needs to be improved.
Diabetic patients follow up at specified intervals is part of the care plan which should be considered first. Accordingly, all diabetics should be referred to the diabetes clinic in order to have been evaluated for diagnostic and comprehensive foot care every year [ 34 ]. Daily foot care for some diabetic patients, especially patients with limited vision due to diabetes and other chronic diseases are difficult because they could not be able to evaluate their feet.
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Peripheral vascular disease, decreased foot sensation in combination with delay wound healing cause difficulty in foot care. These complications should be evaluated by nurses in both clinic and home visit. This is vital especially for patients who have lost their foot. Nurses should encourage and teach patients to use assistive devices [ 76 - 78 ]. Accordingly, nurses should be identifying different types of devices and its applications so that introduce to the patients based on patient conditions to maintain their mobility.
The Benefits of Foot Care Certification
For example, duties of a diabetic foot nurse in this field include introduction, training and participation of patients in the make use of devices such as canes, walkers and wheelchair which completely remove the pressure on the limb along with the aids such as shoes, boots, the Scottish stone, full contact plaster, plaster walker are an effective methods for removing pressure of the foot [ 79 ].
Diabetic foot as the most common cause of hospitalization in diabetic patients is one of health system concerns. So that most of the time of diabetes healthcare providers is allocated to the prevention and diagnosis of diabetic foot complications. In this regard, nurses as members of the diabetes care team not only need to be play their role in health care, public education, health system management, patient care and improving the quality of life, but also must attend in special training to use the latest instructions of diabetic foot care in order that provides the effective services to facilitate promote diabetic patients health.
In our country, despite the increased number of diabetic patients, the training of specialist nurses such as diabetes or diabetic foot specialist nurses has not been considered effectively. It seems that developing short term training courses for nurses, use of diabetic foot clinical guidelines and algorithms in clinics and hospitals along with continues training about novel approaches in diabetic foot care could be temporarily increased the focus on diabetes and foot care.
Moreover the wide spectrum of programs includes the Master of Sciences in Nursing for developing diabetes specialist nurse and development of electronic health can be diminished this global problem. In this regard, Endocrinology and Metabolism Research Institution of Tehran University of Medical Sciences developed the clinical guideline of diabetic foot, translated the clinical care of diabetic foot, developed the diabetic foot section of the virtual clinic for diabetes education [ 80 ] designed diabetic foot website [ 81 ] and also has established the network of diabetic foot clinics in order to these educational resources used by diabetic foot care team including nurses.
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Q. How long have you been a nurse? What’s your nursing background/experience?
J Diabetes Metab Disord. Published online Nov Author information Article notes Copyright and License information Disclaimer. Corresponding author.
M Aalaa: ri. Received Oct 25; Accepted Oct This article has been cited by other articles in PMC. Abstract Diabetes as one of Non-communicable diseases has allocated a large proportion of cost, time and human resources of health systems. Keywords: Diabetes, Diabetic foot, Nurse. Background According to the report of World Health Organization WHO the number of diabetic patients in reached to million [ 1 ] and was predicted to increase million by Goals of nursing intervention in diabetic foot care Improvement of patient care and health services are one of the most important challenges for nurses.
Table 1 The basic principles of foot care in clinic and home visit.
Fraser Valley Foot Care – Office & In-home Visits
The best time for buying shoes is in the afternoon. Open in a separate window. Nurse cooperation in the diabetic foot treatment Another part of duties that a nurse provides to produce excellent diabetic foot care should be the complementary care such as selection an appropriate dressing according to the type of ulcers.
Nursing role in diabetic foot care at home Diabetic patients follow up at specified intervals is part of the care plan which should be considered first. Discussion Diabetic foot as the most common cause of hospitalization in diabetic patients is one of health system concerns. Global prevalence of diabetes, estimates for the year and projections for Diabetes Care. The relationship between Family support and diabetes control in type 2 diabetic patients.
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She has presented over seminars and programs throughout the world. A sought-after speaker, author, and consultant, she has been an invited lecturer at university-held, national and international programs and symposiums. She has written over articles for various peer-reviewed and clinical publications including chapters in the classic wound care reference texts, Chronic Wound Care 3rd and 4th and Wound Care Practice, as well as numerous other chapters in wound care and similar texts.
She is internationally recognized as an author, speaker, and consultant. She is also a Fellow in the American Academy of Nursing. Early in his year medical career, he recognized a need for science-based interventions in wound management. Recognizing a need for practical application, he then transitioned from research to advancing much-needed wound management strategies by providing education to numerous clinicians in the field.
He is a member of multiple professional organizations and editorial boards, a Diplomat of the American Academy of Wound Management and a founder as well as a Fellow of The American College of Certified Wound Specialist. This is important when assessing nail morphology and in teaching patients so that they understand that healthy nails take time to grow and changes will be seen over an extended time frame.
Preparation is elemental to success and this is never truer than with new endeavors. Foot care nursing is an area of expertise that is very narrow in scope and yet complex with information coming from nursing, podiatry, dermatology, and even surgery. The current knowledge base is large and is continuing to grow.
Success requires the proper combination of knowledge and experience. This preparation varies from one individual to the next and is dependant on a number of factors. The formal programs that are available offer similar content but each one varies slightly. The opportunities for continuing education also vary in content and the value of clinical time is dependent upon the setting, patients available, and the supervising healthcare provider.