Preventing Diabetic Foot Ulcers: The Lived Experiences of Patients With Type 2 Diabetes and DFUs

Saturday, 16 November 2019: 3:15 PM

David Oni, PhD, MSN, RN
School of Nursing, Oregon Health and Science University, La Grande OR, OR, USA
Postma Julie, PhD RN
College of Nursing, Washington State University, Puyallup, WA, USA
Gail Oneal, PhD, MN, RN
College of Nursing, Washington State University, Spokane, WA, USA
Phyllis Eide, PhD, MN, MPH, RN
WSU College of Nursing, Spokane, WA, USA
Joshua Neumiller, DPharm, MScPharm, CDE
Pharmacotherapy, Washington State University College of Pharmacy, Spokane, WA, USA

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity and mortality globally. DFUs are often marked by poor healing, infection, re-ulceration, prolonged hospitalization, impaired quality of life, financial burden and death. Approximately 80,000 Americans lose their toes to DFU-related amputations annually. Research supports DFU prevention of through foot self-care practices. However, a gap exists between healthcare provider recommendations and actions taken by patients with DFUs. This study explored the lived experiences of patients with type 2 diabetes and DFUs regarding their foot self-care practices, so that recommendation can be provided for future clinical and educational intervention and practices.

Method: A descriptive phenomenological research study was conducted with a purposive sample of adults with type 2 diabetes and DFUs. Fifteen participants were recruited and interviewed from outpatient podiatry clinics in Washington State. Data were analyzed using Colaizzi’s approach to phenomenology.

Findings: Participants reported initially being passive about foot self-care. This was impacted by a lack of awareness between diabetes, foot self-care and DFU development. However, the sudden onset of DFUs was a wake-up call to adapt to a new reality. Adaptation included monitoring their feet, performing foot self-care, and learning about their disease process. However, ongoing challenges with DFUs and foot self-care continue to impair participants’ physical, social, and mental well-being. Some participants seek self-management strategies in a quest to make their feet comfortable and continue with their preferred lifestyle.

Conclusion: Study findings provide insights into how participants’ perception of foot self-care practices impacted their health behaviors. Early education to promote health literacy is important to help patients with type 2 diabetes understand their susceptibility to DFUs and the severity of DFUs. Tailored and long-term behavioral reinforcement may support daily foot self-care and reduce DFU development and re-ulceration.

Implications: Nurses should take the lead in developing programs to assist patients’ patients with diabetes and DFUs, families, and caregivers to overcome healthcare system and personal barriers to undertaking foot self-management and accessing care. Research is needed to identify the best methods of delivering patient-centered and behavioral-focused educational interventions to support patients’ initial and long-term adherence to foot self-care. Future foot care educational interventions and management should be tailored towards changing individual perceptions, priorities, and behaviors over the long-term. In view of these considerations, a holistic and multidisciplinary patient-centered approach focusing on changing patients’ behaviors may improve foot care behaviors and associated diabetes outcomes.

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