Evidence-Based Practice for Diabetic Foot Ulcers, Capstone Project Example
Words: 3259Capstone Project
The care and treatment of diabetic patients requires an effective understanding of the issues that many diabetics face in their daily lives. There are significant factors associated with the identification and development of evidence-based practice guidelines to support positive outcomes for patients. In particular, there is a substantial risk of foot ulcers and related damage as a result of diabetes, thereby mandating these guidelines. The ability to prevent diabetic foot ulcers is of primary concern; however, the treatment of existing ulcers to promote healing is also critical to the health and wellbeing of these patients. Therefore, proper care of the feet is essential in the preservation of health for patients with diabetes, including those facing neuropathy and those without this condition. The following discussion will address these concerns in greater detail and will consider the challenges associated with proper foot care for patients with diabetes. Evidence-based practice guidelines will be considered as a means of exploring different options that are available to these patients to preserve their general health. Finally, the opportunities available with patient education will be explored in order to establish new objectives for the treatment of diabetic foot ulcers and general foot care to preserve quality of life within this population group.
There are a number of factors to consider in the care and treatment of diabetic foot ulcers. In recent years, there has been an expanded interest in this subject area and its impact on diabetic patients. As a result, risk stratification guidelines have evolved that address the possible issues related to the development of diabetic foot ulcers to explore updated screening mechanisms to better serve this population (Monteiro-Soares et.al, 2011). Risk stratification mechanisms actively contribute to the potential success of evidence-based practice guidelines in order to achieve effective diagnostic and treatment outcomes for patients in this manner (Monteiro-Soares et.al, 2011).
Active education in the areas of diabetes and foot management is essential to the prevention of foot ulcers and other complications (McInnes et.al, 2011). In general, it is widely acknowledged that adequate foot self-care is not undertaken by the majority of patients with diabetes…To effectively educate diabetes patients, especially those at low risk of complications, on the importance of foot care, it is crucially important that healthcare professionals develop their understanding of the patient perspective “(McInnes et.al, 2011, pp. 162-163). Therefore, education regarding diabetes and general foot care appear to be noticeably absent in many circumstances, thereby creating a lapse in knowledge and understanding of the risks associated with foot ulcers (McInnes et.al, 2011). Furthermore, it is necessary to address the concerns associated with the increased risk of chronic foot ulcers, particularly in diabetics, with or without diagnosed neuropathy (Edwards et.al, 2013). The efforts made by experts must include adequate education and guidance in the prevention and management of diabetic foot ulcers for all patients (Edwards et.al, 2013). Many patients experience chronic ulcer development and require continuous treatment; as a result, they face a greater risk of serious damage to the feet that may result in permanent disability (Edwards et.al, 2013). These findings suggest that it is necessary to consider new alternatives to promote effective outcomes for patients with diabetes who face the risk of foot ulcers (Edwards et.al, 2013).
Patient education in an effort to prevent diabetic foot ulcers also requires an effective understanding of the challenges and limitations of existing patient knowledge and physician/nurse involvement in this area (Dorresteijn et.al, 2012). Therefore, educational opportunities must be frequent and specific so that patients are aware of these risks and their role in the prevention of diabetic foot ulcers as often as possible (Dorresteijn et.al, 2012). This includes greater nutritional and metabolic control, accompanied by routine examinations of the feet to determine if there is a risk of ulceration or infection so that treatment measures may be established as quickly as possible (Dorresteijn et.al, 2012). Therefore, it is the responsibility of physicians and nurses to work collaboratively with patients in order to identify areas of weakness and to determine how to best move forward with educational programs that will demonstrate effectiveness for this patient population over the long term (Dorresteijn et.al, 2012). In a similar context, it is observed that there are significant opportunities available to educate diabetic patients in a variety of areas that directly impact their health in order to ensure that their needs are met by using proactive measures rather than the necessity for treatment (Funnell et.al, 2009). It is expected that the continued growth and expansion of educational directives will play an important role in shaping outcomes and in supporting the development of new alternatives in education that will influence patient outcomes in a favorable manner (Funnell et.al, 2009).
Based upon prior evidence, it is noted that foot pressure, particularly in the plantar area, is a primary cause of plantar ulcers (Cavanagh and Bus, 2010). Therefore, it is important to utilize specialized resources, such as footwear, in order to reduce pressure and to prevent ulcers from reoccurring if they already exist, in addition to off-loading as a means of diabetic ulcer prevention (Cavanagh and Bus, 2010). In addition, it is important to identify areas where there are significant advantages to offloading and alleviating pressure to prevent additional damage or harm to the feet and any areas where ulcers are likely to be prevalent (Bus, 2012). Within this context, it is possible to treat patients with diabetic foot ulcers through the reduction of biomechanical dynamics that may lead to these ulcers to begin with (Bus, 2012). Evidence-based practice in this area of study continues to expand to other areas, including general wound care; however, these objectives play a similar role to those associated with diabetic foot ulcers and related treatments (Cavanagh and Bus, 2010). There are considerable efforts required from the knowledge and evidence-based perspectives to achieve effective outcomes in the prevention and treatment of these ulcers within the diabetic population (Cavanagh and Bus, 2010). The treatment of foot wounds as a result of diabetes or other conditions requires effective knowledge and experience from healthcare experts who are specialists in this area, along with an understanding of wound care as it is related to standardized protocols (Brolmann et.al, 2012).
It is important to recognize the value of evidence-based practice solutions in the prevention of diabetic foot ulcers. These objectives are critical in promoting a greater quality of life for patients with diabetes who face the risk of foot ulcers without proper foot care (Snyder et.al, 2009). These efforts are important because they provide further evidence in supporting expanded approaches to improve outcomes through organized interventions and treatment strategies, as well as basic objectives in foot care (Snyder et.al, 2009). It is expected that in evidence-based practice solutions, the ability to provide high quality foot care and education is necessary to reduce ulcer diagnoses and to improve healing when these wounds exist (Snyder et.al, 2009). It is imperative to make all efforts to reduce the pain associated with diabetic foot ulcers as best as possible, along with improved management of blood sugar levels and hypertension as necessary (Snyder et.al, 2009). These practices will support the ongoing development of new ideas and approaches to diabetic foot ulcers to reduce mortality rates and improve healing and long-term outcomes (Snyder et.al, 2009).
The treatment of diabetic foot ulcers must be addressed in relation to its frequency and severity within the diabetic population, as 15 percent of all patients within this group are likely to develop one or more diabetic ulcers at one point or another (Cheer et.al, 2009). The frequency of this diagnosis indicates that it is necessary to identify the underlying causes of this condition and its short and long-term impact on diabetic patient care and treatment (Cheer et.al, 2009). In this manner, it is imperative to develop and maintain guidelines that will be useful in reducing the risks associated with diabetic foot ulcers so that fewer patients are likely to be diagnosed with this condition (Cheer et.al, 2009). The assessment process for a diabetic foot ulcer requires detailed knowledge and understanding of this condition and its overall impact on patient wellbeing, using such practical assessment tools as the identification of the ulcer’s location, its size, and whether or not infection currently exists (Cheer et.al, 2009). These efforts are important because they demonstrate whether or not additional treatment is necessary and the projected length of recovery (Cheer et.al, 2009). Upon review of any identified lesions in the foot area, it is important to inspect for any signs of infection in order to determine the course of treatment that is most appropriate (Cheer et.al, 2009). At the same time, any signs of neuropathic pain within the foot area must also be addressed in order to ensure that patients are properly diagnosed and treated to alleviate pain and other related symptoms (Cheer et.al, 2009). Furthermore, the potential exists to identify other types of deformities within the foot that are further exacerbated by foot ulcers, all of which should be addressed separately and in great detail to ensure a proper diagnosis (Cheer et.al, 2009).
In terms of foot ulcers and related infections, it is important to identify specific factors that are associated with diabetic foot ulcers so that patient care and treatment are optimized at all times (Richard et.al, 2011). The diagnosis of infection is key in this process; however, it is often difficult to treat infection when it is sometimes difficult to diagnose (Richard et.al, 2011). Therefore, it is necessary to assess the existence of bacteria as a means of exploring available treatments, such as the appropriate antibiotics that will target infections (Richard et.al, 2011). Furthermore, the existence of other types of testing and assessment tools is necessary, such as the following: “New technologies such as DNA micro-array and multiplex real-time PCR offer a unique opportunity to analyze both the virulence and resistance potential of microorganisms. This method of miniaturized genotyping can rapidly and reliably detect the presence of genes encoding for various virulence and antibiotic resistance factors” (Richard et.al, 2011). The efforts made to determine if diabetic foot ulcers or infection are present require patients with these risks to be evaluated comprehensively, based upon existing practice methods to differentiate between different types of bacteria and the level of risk that is present (Richard et.al, 2011). Under these conditions, if antibiotics are necessary, the recognition that some types of bacteria may be resistant to antibiotics must also be addressed, including the increased risk of MRSA infection in some patients (Richard et.al, 2011). If antibiotics are prescribed, then wound assessment and care must be conducted on a regular basis in order to determine if healing is taking place, and if this is not the case, then alternate antibiotic therapies should be explored and prescribed to facilitate the proper level of healing within this diabetic patient population (Richard et.al, 2011).
Other alternatives must also be considered when developing evidence-based practice guidelines for the diagnosis, care, and treatment of diabetic foot ulcers. As mentioned previously, there are a variety of directives associated with the use of antibiotics that should be considered in the development of evidence-based practice solutions (Fincke et.al, 2010). To be specific, there are often significant variations in how patients are treated by their family practitioners and internists that are based upon customary guidelines, and many of these strategies are unsuccessful and/or cost effective (Fincke et.al, 2010). Therefore, it is necessary to address these concerns and to determine how to develop greater consistency in these protocols as a means of supporting treatments and other measures that are cost effective and successful in treating diabetic foot ulcers (Fincke et.al, 2010). Evidence-based practice solutions must convey the importance of consistency in approach and therapeutic interventions to ensure successful outcomes for this patient population (Fincke et.al, 2010).
Foot infections and ulceration are challenging to diabetic patients; therefore, they must be provided with effective care and treatment that will lead to a reduction of mortality rates and permanent damage, such as the necessity for amputations when infections spread (Powlson and Coll, 2010). It is important to recognize these concerns and to consider multi-disciplinary solutions as a key component of modern practice settings (Powlson and Coll, 2010). These efforts require expert knowledge and understanding of the causes of diabetic foot ulcers and the possible solutions that are available to reduce these risks (Powlson and Coll, 2010). When patients have been diagnosed with diabetic neuropathy, there is a greater risk of infection and ulceration due to limited feeling or sensations in the feet; therefore, increased pressure on the feet and other complications may trigger ulceration and infection (Powlson and Coll, 2010). As a result, it is necessary to establish a greater understanding of the specific variables and protocols that may be useful in supporting new directives in evidence-based practice for patients with diabetes who face these risks on a regular basis (Powlson and Coll, 2010).
For diabetic patients, it is also imperative to develop evidence-based practice solutions that will identify specific complications so that treatments are targeted and effective in promoting healing (Ndip et.al, 2012). From a neuropathic perspective, it is widely evident that trauma and other factors may lead to an increased risk of foot ulcers; therefore, it is likely that behavioral changes and interventions may be widely effective in reducing these risks over time for many patients (Ndip et.al, 2012). One area of practice to consider is surgical debridement in order to promote healing in this area through the improvement of tissue layers (Ndip et.al, 2012). These findings suggest that it is important to identify areas of practice where there are significant opportunities to promote debridement as a feasible alternative to encourage healing and recovery at a more rapid pace (Gordon et.al, 2012). Surgical debridement may also lead to other positive outcomes if this practice is encouraged on a regular basis for those patients who qualify for this procedure (Gordon et.al, 2012).
From a vascular health perspective, diabetic patients must continuously examine and take the steps that are necessary to protect their feet from possible ulceration and other complications. Therefore, it is imperative to evaluate common standards of care so that modifications are explored as necessary to ensure positive prevention and treatment outcomes (Kirsner, 2010). In this capacity, it is also necessary to determine how patient behaviors and education might be directed towards a more proactive model of prevention rather than treatment after a diagnosis is already made (Kirsner, 2010). In this context, it is important to identify areas where there are significant advantages for diabetic patients through continuous evaluation and behavioral change in examining the feet on a regular basis to prevent ulcers over the long term, even in cases where neuropathy is present (Kirsner, 2010). It is necessary to establish new directives that will accomplish these objectives in a manner that is consistent with positive results and improved health outcomes for patients who face diabetes on a daily basis (Kirsner, 2010).
Finally, the care and treatment of the diabetic condition is integral to the successful prevention of diabetic foot ulcers. This is best accomplished through a series of actions that are directed at behavioral change rather than other factors that will not necessarily be effective in supporting patient health and wellbeing (Wu et.al, 2007). In this capacity, physicians and nurses must play a significant role in shaping outcomes and in supporting the development of routine evaluations of current practice methods to determine if updates or other changes are required (Wu et.al, 2007). These efforts are imperative in the creation of new ideas and evidence-based practice methods that will facilitate positive results and optimal health within this patient population (Wu et.al, 2007).
Diabetic foot ulcers are a serious and often lasting complication of the diabetic condition. Therefore, it is important to recognize the necessity for evidence-based practice solutions and methods that will recognize the importance of optimal patient health and wellbeing. This is best accomplished through the creation of new solutions and updates to current protocols to ensure that patients with diabetes are taking the precautionary measures that are required to inspect their feet on a regular basis and to recognize any potential changes in their composition that may indicate ulceration. It is expected that alleviating pressure on the feet is one viable alternative in prevention; however, other factors also play a role and must be properly identified. These efforts will support the continuous emergence of evidence-based practice solutions that will identify areas of need and increased risk so that these methods are explored on a continuous basis. It is necessary for physicians, nurses, and other healthcare providers to consistently evaluate evidence-based practice alternatives so that there are sufficient opportunities for growth and change. Patients must also be provided with adequate education and frameworks that will work effectively to protect the feet from any types of unnecessary risk or harm. This is best accomplished by using a collaborative effort to ensure that patient care and wellbeing is satisfied in an effective and reasonable manner that supports these concerns and reflects favorably on diabetic patients.
Brolmann, F.E., Ubbink, D.T., Nelson, E.A., Munte, K., van der Horst, CMAM, and Vermeulen, (2012). Evidence-based decisions for local and systemic wound care. British Journal of Surgery, retrieved from http://www.dkmic.de/bibliothek/literatur/blog/Evidence-based%20decisions%20for%20local%20and%20systemic%20wound%20care.pdf
Bus, S.A. (2012). Priorities in offloading the diabetic foot. Diabetes/Metabolism Research and Reviews, 28(Suppl 1), 54-59.
Cavanagh, P.R., and Bus, S.A. (2010). Off-loading the diabetic foot ulcer for ulcer prevention and healing. Journal of Vascular Surgery, 52, 37S-43S.
Cheer, K., Shearman, C., and Jude, E.B. (2009). Managing complications of the diabetic foot. BMJ, 339, b4905.
Dorresteijin, JAN, Kriegsman, DMW, Assendelft, WJJ, and Valk, GD. (2012). Patient education for preventing diabetic foot ulceration (review). The Cochrane Collaboration, retrieved from http://www.bibliotecacochrane.com/pdf/CD001488.pdf
Edwards, H., Finlayson, K., Courtney, M., Graves, N., Gibb, M., and Parker, C. (2013). Health Service pathways for patients with chronic leg ulcers: identifying effective pathways for facilitation of evidence based wound care. BMC Health Services Research, 13(86), retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-13-86.pdf
Fincke, B.G., Miller, D.R., Christiansen, C.L., and Turpin, R.S. (2010). Variation in antibiotic treatment for diabetic patients with serious foot infections: a retrospective observational study. BMC Health Services Research, 10(193), retrieved from http://www.biomedcentral.com/1472-6963/10/193/
Funnell,M.M., Brown, T.L., Childs, B.P., Haas, L.B., Hosey, G.M., Jensen, B., Maryniuk , M., Peyrot, M., Piette, J.D., Reader, D., Siminerio, L.M., Weinger, K., and Weiss, M.A. (2009). National standards for diabetes self-management for education. Diabetes Care, 31(suppl 1), S87-S94.
Gordon, K.A., Lebrun, E.A., Tomic-Canic, M., and Kirsner, R.S. (2012). The role of Surgical debridement in healing of diabetic foot ulcers. SKINmed, 10, 24-26.
Kirsner, R.S. (2010). The standard of care for evaluation and treatment of diabetic foot ulcers. University of Michigan Medical School, 1-28.
McInnes, A., Jeffcoate, W., Vileikyte, L., Game, F., Lucas, K., Higson, N., Stuart, L., Church, A., Scanlan, J., and Anders, J. (2011). Consensus statement: foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabetic Medicine, 28, 162-167.
Monteiro-Soares, M., Boyko, E.J., Ribiero, J., Ribiero, I., and Dinis-Ribiero, M. (2011). Risk stratification systems for diabetic foot ulcers: a systematic review. Diabetologia, 54, 1190-1199.
Ndip, A., Ebah, L., and Mbako, A. (2012). Neuropathic diabetic foot ulcers – evidence –to-practice. International Journal of General Medicine, 5, 129-134.
Powlson, A.S., and Coll, A.P. (2010). The treatment of diabetic foot infections. Journal of Antimicrobial Chemotherapy, 65(suppl 3): iii3-iii9.
Richard, J.L., Sotto, A., and Lavigne, J.P. (2011). New insights in diabetic foot infection. World Journal of Diabetes, 2(2), 24-32.
Snyder, R.J., and Hanft, J.R. (2009). Diabetic foot ulcers – effects on quality of life, costs, and mortality and the role of standard wound care and advanced care therapies in healing: a review. Ostomy Wound Management, 55(11), 28-36.
Wu, S.C., Driver, V.R., Wrobel, J.S., and Armstrong, D.G. (2007). Foot ulcers in the diabetic patient, prevention and treatment. Vascular Health Risk Management, 3(1), 65-76.
Time is precious
don’t waste it!