Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study

Abstract

Diabetes mellitus and foot ulcer increase the risk of amputation, and prevention of foot ulcers are therefore important. Patients with diabetes and other concomitant diseases are often cared for in a home nursing service and the registered nurses (RNs) have the opportunity to practise preventive care to avoid foot ulcers. How prevention of foot ulcer is performed in home nursing settings has not been previously described. The objective of this study was to explore RNs' professional work with foot ulcer prevention in home nursing settings for patients with diabetes mellitus. Qualitative interviews were analysed, using manifest content analysis. The setting was four municipalities in Sweden (large and small cities, and rural areas). Fifteen RNs actively working in a home nursing service with more than two years' experience were recruited. The participants were all women, had worked as RNs for 3–41 years (median 25), and in home nursing for 2–18 years (median 8). The results showed that the RNs work through leadership, coordination, education and evaluation. Health care assistants perform most of the nursing actions to prevent foot ulcers such as assessment of feet, off‐loading, nutrition and hygiene. The RNs have medical and nursing responsibility but without the formal tools to execute this fully. The RNs' formal education was some years back and they relied mostly on experience‐based knowledge. It was concluded that patient assessment and nursing actions to prevent foot ulcers are mostly performed by health care assistants. The RNs need to be given formal responsibility in their role as leaders and educators, and need more education in pedagogy and leadership. Copyright © 2013 FEND. Published by John Wiley & Sons, Ltd.

What implies registered nurses’ leadership close to older adults in municipal home health care? A systematic review

“…RNs' leadership close to older adults in municipal home health care implies that RNs must be able to trust themselves and the nursing staff and their competence in assessment and information concerning older adults' condition. RNs must be able to depend on the nursing staffs' 'eyes and ears' and trust all their senses [22][23][24]. In addition, RNs possess personal characteristics such self-control, which includes RNs' ability to control and manage their own emotions [25,26].…”

“…… mutual trust was therefore necessary, as the health care assistants constituted the eyes, ears, nose and hands of the registered nurses … [22], p., 53]…”

“…RNs' leadership close to older adults in municipal home health care implies continuous learning in an effort to obtain knowledge in several ways [22,26]. Learning implies maintaining RNs' competence, obtaining new knowledge and adapting to new technologies [26,29].…”

“…Learning implies maintaining RNs' competence, obtaining new knowledge and adapting to new technologies [26,29]. Learning can be achieved by reflecting on issues with colleagues [27] and through research published in scientific databases and nursing magazines [22]. This can often be performed during RNs' leisure time [29].…”

“…Having competence through knowledge and ability means that RNs' leadership necessitates acquiring knowledge from several different disciplines and contexts, possessing specific medical knowledge and having knowledge in relation to teaching [24]. RNs' leadership close to older adults involves teaching [22,26], such as educating nursing staff, older adults and next of kin [22,24]. Teaching is a positive part of RNs' leadership roles [24].…”