The Integrative Literature Review
Diabetic foot ulcers represent a significant problem for healthcare professionals worldwide due to their high prevalence and potential for serious complications. Effective management of diabetic foot ulcers is essential to prevent infections and lower extremity amputations, as well as to improve patient’s overall quality of life. The role of glycemic control in the healing of foot ulcers has been the subject of interest and debate in the medical community. Nurses provide wound assessment, wound management, monitoring and evaluation, and comprehensive education and support for patients and their families. Educating patients with diabetic foot ulcers is extremely important as it empowers them to take an active role in the healing process and implement self-care techniques that can significantly impact wound healing outcomes. Through a comprehensive analysis of peer-reviewed articles, observational studies, and systematic reviews, this literature review will synthesize key findings and identify any gaps in knowledge related to best nursing practices in the management of diabetic foot ulcers.
Nurse-Led Wound Care: A Multifaceted Approach
Nurse-led wound care for diabetic foot ulcers is a multifaceted, evidence-based approach. Hailu et al. (2018) conducted a study in Ethiopia demonstrating the positive effects of nurse-led diabetes self-management education on clinical parameters. Their findings highlight that nurse-led interventions significantly improved glycemic control in patients with diabetes, with reductions ranging from 0.03% to 2.0%, contributing to better wound healing outcomes. Tassiou, A. (2021) states that regular annual foot examinations significantly contribute to the reduction of foot ulcers and lower limb amputations in diabetic patients. Therefore, nurses can encourage patients with diabetes to schedule regular follow-up visits to effectively monitor their foot health. In assessing nurses’ knowledge of diabetic foot care, Kaya and Karaca (2018) identified gaps in nurses’ understanding of evidence-based wound care protocols. This finding highlights the need for continuing professional development to provide nurses with the latest knowledge and skills necessary to provide optimal care for patients with diabetic foot ulcers. By addressing these knowledge gaps, nurses can ensure that their wound care practices are consistent with current evidence-based guidelines, ultimately improving patient outcomes. A synthesis of these studies suggests that nurse-led wound care for diabetic foot ulcers is a critical and comprehensive approach that includes patient education, glycemic control, wound assessment, and evaluation. Tassiou (2021) emphasizes that a multidisciplinary approach to nurse-led care improves clinical parameters and glycemic control, reducing the risk of diabetic foot ulcers and related complications. Hence, the research highlights the key role of nurses in improving clinical parameters, increasing patient education, and assessing their level of knowledge to optimize the management of diabetic wounds.
Impact of Nurse-Led Care on Glycemic Control and Healing
Several studies have investigated the impact of nurse-led care on glycemic control and diabetic foot ulcer healing. The study findings of Hailu et al. (2018) indicate that both the intervention and comparison groups experienced significant reductions in mean HbA1c levels, with no significant difference in the proportion of participants achieving target HbA1c. However, the intervention group demonstrated favorable improvements in adjusted end-line fasting blood sugar and blood pressure levels, suggesting the potential benefits of nurse-led care in enhancing glycemic control and blood pressure management among diabetic patients (Hailu et al., 2018). Lane et al. (2020) assessed a total of 12,312 adult subjects with 12,604 diabetic foot ulcers, predominantly in older diabetic adults with slight male predominance. Nurse-led interventions encompassed various wound management strategies, including infection control, glycemic/metabolic control, surgical debridement, revascularization, minor amputation, offloading, dressings, topical agents, and nonsurgical debridement. However, significant heterogeneity was observed in wound severity, wound management approaches, and outcome definitions among the studies, which may influence the generalizability and interpretation of the findings. Despite this variability, the collective evidence suggests that nurse-led care plays a crucial role in addressing the complex needs of diabetic foot ulcers and optimizing patient outcomes. In contrast, the review by Holloway et al. (2023) indicated that in 23 of the studies, nurse-led care resulted in a clinically significant reduction of HbA1c (>0.5%), with the extent of reduction ranging from 0.03% to 2.0%. Holloway et al. (2023) investigated that the use of information technology, including phones, in diabetes care and education showed promising results with HbA1c reduction ranging from 0.1% to 1.4% in various studies, highlighting its potential in enhancing patient self-management and adherence to medication, diet, and exercise. At the same time, the study by Guerrero (2018) shows a positive impact on diabetic foot ulcer healing time when comparing an intervention group receiving telemedicine follow-up care in the community to a control group receiving standard of care (SOC). These results underscore the potential of technology as a relevant and effective alternative to traditional wound care approaches, offering new possibilities for improving diabetic foot ulcer management and patient outcomes. Furthermore, Dissanayake et al. (2020) conducted research on glycaemic control with intensive insulin therapy in diabetic foot ulcers, as 31% of participants met the potential RCT entry criteria, fasting capillary blood glucose values showed a significant mean decrease of -3.7 mmol/L and an impressive 83% of ulcers had healed within 24 weeks. These results suggest the potential efficacy of intensive insulin therapy in managing diabetic foot ulcers and warrant further investigation in a larger-scale RCT. Comparing the results of these studies, it is evident that nurse-led care can have a positive impact on glycemic control and diabetic foot ulcer healing. Hailu et al. (2018) and Lane et al. (2020) demonstrated significant. Improvements in glycemic control with nurse-led interventions, reducing the risk of diabetic foot ulcers. On the other hand, Holloway et al. (2023) highlighted the need for more standardized protocols to ensure consistent outcomes. Additionally, Dissanayake et al. (2020) provided preliminary evidence supporting intensive glycemic control in promoting diabetic foot ulcer healing. Despite some variations in results, the overall evidence indicates that nurse-led care positively influences glycemic control and diabetic foot ulcer outcomes. The synthesis of these studies supports the implementation of nurse-led interventions in diabetic care settings, given their potential to enhance patient outcomes and reduce the burden of diabetic foot complications.
Nurses as Educators of Diabetic Foot Patients
Nurses play a pivotal role as educators in the management of diabetic foot ulcers. Patient education and counseling are fundamental components of nurse-led wound care, contributing to patient empowerment and active engagement in their healing journey. Studies have shown that well-informed patients are more likely to adhere to treatment plans, including wound care protocols, leading to better outcomes in wound healing (Guerrero, 2018; Hailu et al., 2018). Kaya and Karaca (2018) conducted an evaluation of nurses’ knowledge levels of diabetic foot care management, highlighting the significance of continuous professional development for nurses in this field. Their study revealed that despite the critical role nurses play in wound care, there are potential gaps in their knowledge regarding evidence-based diabetic foot care practices. This finding underscores the need for ongoing educational initiatives to equip nurses with the latest best practices and advancements in wound care management.
In contrast, Hailu et al. (2018) demonstrated the positive impact of nurse-led diabetes self-management education on clinical parameters in Ethiopia. The study reported improvements in glycemic control and other clinical outcomes among patients receiving. Nurse-led education. These results further emphasize the essential role of nurses in educating patients with diabetic foot ulcers, as effective patient education contributes to better glycemic control, which is critical for wound healing (Hailu et al., 2018). Furthermore, Tassiou (2021) highlights nurses’ crucial role as educators for diabetic foot patients. Nurse-led educational efforts significantly influence patient behavior and self-care practices, which in turn affect wound healing outcomes. Patients who receive comprehensive education from nurses are better equipped to manage their foot ulcers, leading to enhanced wound recovery and prevention of complications.
These studies show the criticality of nurse-led education in the management of diabetic foot ulcers. Nurses can empower patients to take an active role in their wound care and overall health. The integration of technology, as mentioned by Hailu et al. (2018) and Tassiou (2021), can further enhance patient education and follow-up care. As patient adherence and education are key factors affecting wound healing outcomes, investing in targeted educational interventions for nurses and patients can yield significant improvements in diabetic foot ulcer management and overall patient well-being.
Consequently, nurse-led care has a significant role in the management of diabetic foot ulcers and emphasizes the importance of patient education and counseling to achieve positive wound-healing outcomes. Nurse-led care and education are important components of an effective multifaceted approach to diabetic foot ulcer management. Nurse-led interventions involving wound assessment, wound management, monitoring and evaluation, and patient and family education have shown promise in improving clinical parameters and reducing the incidence of diabetic foot ulcers. By enabling patients to effectively control their blood sugar levels, nurses make a significant contribution to improving wound healing and reducing complications. The literature review highlights that nurse-led care enables patients to effectively control their blood sugar levels, promoting improved wound healing and reduced complications. In addition, technologies such as information technology and telemedicine have been integrated into nursing practice to deliver and support diabetes care, further improving patient engagement and outcomes. Continuing professional development for nurses is vital because by improving their expertise in evidence-based wound care protocols, nurses can optimize patient care and address any knowledge gaps.
Dissanayake, A., Vandal, A. C., Boyle, V., Park, D., Milne, B., Grech, R., & Ng, A. (2020). Does intensive glycaemic control promote healing in diabetic foot ulcers? – A feasibility study. BMJ Open, 10, e029009. doi:10.1136/ bmjopen-2019-029009
Guerrero, J. G. (2018). Best and effective practices of wound care and healing among patients with diabetes mellitus. Clinical Journal of Nursing Care and Practice, 2, 025-031. https://doi.org/10.29328/journal.cjncp.1001009
Hailu, F. B., Hjortdahl, P., & Moen, A. (2018). Nurse-led diabetes self-management education improves clinical parameters in Ethiopia. Frontiers in Public Health, 6, 302. doi: 10.3389/fpubh.2018.00302
Holloway, D., James, S., Ekinci, E., & Craft, J. (2023). A systematic review of the effectiveness of nurse-led care in reducing glycated hemoglobin in adults with type 1 or 2 diabetes. International Journal of Nursing Practice, e13135. https://onlinelibrary.wiley.com/doi/full/10.1111/ijn.13135
Kaya, Z., & Karaca, A. (2018). Evaluation of nurses’ knowledge levels of diabetic foot care management. Nursing Research and Practice, 2018, 1-12. https://doi.org/10.1155/2018/8549567
Lane, K. L., Abusamaan, M. S., Voss, B. F., Thurber, E. G., Al-Hajri, N., Gopakumar, S., Le, T., Gill, S., Blanck, J., Prichett, L., Hicks, C. W., Sherman, R. L., Abularrage, C. J., & Mathioudakis, N. N. (2020). Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies. Journal of Diabetes and its Complications, 34(10), 107638. https://doi.org/10.1016/j.jdiacomp.2020.107638
Tassiou, A. (2021). Nurses as educators of diabetic foot patients. Journal of Research and Practice on the Musculoskeletal System, 5(1), 25-28. doi:10.22540/JRPMS-05-025
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Perform a literature review using a minimum of seven (7) peer-reviewed articles and books, as well as non-research literature such as evidence-based guidelines, toolkits, standardized procedures, etc.
2. Review of areas in relationship to medicine, nursing, public health, etc. 3. The review should be critical and synthesized rather than just being a catalog of
studies. 4. Summarize the key findings of the research and its relevancy to your project that
point out the scientific status of the phenomenon under question. Such a statement includes:
5. What we know and how well we know it. 6. What we do not know. 7. Describe any gaps in knowledge that you found and the effects this may have on
advanced practice nursing as it relates to your project topic.
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