Management of a diabetic foot ulcer using larval therapy

Diabetic foot ulcers should be treated to maintain health status, improve quality of life, reduce the number of amputations and lower costs. Many centres that treat diabetic foot ulcers use a multidisciplinary team approach, which comprises medical staff, nurses, podiatrists and an orthotist. At the Manchester Diabetes Centre, larval therapy has been used for several years to debride sloughy diabetic foot ulcers. This case history demonstrates the adverse effects of diabetes on feet, and the multidisciplinary team's contribution to successful treatment and healing of a complex foot lesion.     

Foot wounds in diabetic patients. A comprehensive approach incorporating use of topical growth factors.

Managing nonhealing foot wounds in diabetic patients requires an understanding of the wounds' multiple contributing causes, including neuropathy, vascular occlusive disease, infection, and impaired wound healing. Proper attention to each cause may require consultations with vascular or orthopedic surgeons, diabetic education nurses, podiatrists, orthotists, and pedorthists. Wounds that fail to heal may respond to topical application of growth factors as part of a comprehensive clinical approach to the diabetic foot wound. An aggressive approach to diagnosis and treatment can result in improved wound healing and limb salvage.     

山西省长治地区护士对糖尿病足知识的认知情况调查分析

目的 调查分析山西省长治地区护士对糖尿病足知识的认知情况.方法 采用自行设计的调查评价表对由便利抽样所得的100名二级医院护士的糖尿病足知识进行调查与评价.结果 护理人员对糖尿病足知识的认识水平较低,参加继续教育的护理人员糖尿病足知识的掌握水平明显高于没有参加者.结论 山西省长治地区护理工作者对糖尿病足知识的认知度较低,需要引起护理管理者的重视,组织相应的继续教育及专科培训为糖尿病足的预防工作奠定良好的理论基础;护理工作者应该学习阅读文献,掌握最新知识,树立预防重于治疗的意识;在健康教育过程中应该扮演积极主动的角色.     

The experience of practice development: an exploratory telephone interview study

Practice development is a widely used term within British nursing. However, there is a lack of consistency and clarity in the way that the term is used. A small-scale qualitative telephone interview study was therefore conceived to explore practitioners' views of practice development. Qualitative telephone interviews were carried out with 26 nurses working in a range of settings and roles around the UK. Informants reported varying degrees of awareness of practice development roles and activities ranging from little awareness to being closely involved. Most informants seemed to place more emphasis on issues of personal development and educational aspects of practice development than is found in the literature. Practice development staff were seen as having a range of functions ranging from working with individual practitioners to the co-ordination of education and training within an organization. The credibility of practice development staff was closely related to their clinical experience and ability.     

Research utilization and attitudes towards research among psychiatric nurses in Northern Ireland

Evidence-based practice depends on a number of factors including practitioners' attitudes towards, and knowledge of, research, the availability and access to relevant research, adequate resources and managers' support. Yet little is known about these issues with regard to psychiatric nurses. The aim of this study was to survey psychiatric nurses on their attitudes to research, their perceptions of their use of research and other research-related activities. This paper reports data collected from a convenience sample of 236 nurses from the six main psychiatric hospitals and from the psychiatric wards of six general hospitals. The results show that, while they report positive attitudes towards research, their perception of their use of research in practice indicates that evidence-based practice is far from being realized. There is also some evidence to suggest that psychiatric nurses' reported extent of research utilization and frequency of reading research literature in this study are lower than those of general nurses. The implications of these and other findings are discussed.     

Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study.

OBJECTIVE: To assess the ability of a multidisciplinary approach to diabetic foot care to reduce the incidence of recurrent ulceration and amputations compared with standard care in a 2-year prospective study. RESEARCH DESIGN AND METHODS: A total of 145 patients with a past history of neuropathic foot ulcers but no evidence of peripheral vascular disease entered the study. Subjects were screened for their neuropathic and vascular status at baseline, and all received identical foot care education. The intervention group (n = 56) was followed by the multidisciplinary team of physicians, nurses, and podiatrists with regular podiatry and reeducation every 3 months and the provision of specialty footwear as required. The standard treatment group was followed in local clinics on a trimonthly basis and received identical screening and education at baseline. RESULTS: There were no significant differences at baseline in age (intervention 59.2+/-13.4, standard treatment 58.5+/-11.5 years), duration of diabetes (14.0+/-7.1 vs. 15.6+/-7.8 years), or neuropathic status (vibration perception threshold [VPT]: 31.1+/-12.1 vs. 33.9+/-11.3 V, neuropathy disability score [NDS]: 8.1+/-1.4 vs. 7.9+/-1.7). All patients had an ankle brachial pressure index (ABPI) of >0.9 and at least one palpable foot pulse. Significantly fewer recurrent ulcers were seen in the intervention group than in the standard treatment group during the 2-year period (30.4 vs. 58.4%, P < 0.001). CONCLUSIONS: This prospective study has demonstrated the effectiveness of a multidisciplinary approach to diabetic foot care together with the provision of specialty footwear in the long-term management of high-risk patients with a history of neuropathic foot ulcers.     

专科护士开展糖尿病足危险因素筛查与护理指导的效果及意义

目的探讨以糖尿病专科护士为主导的糖尿病足危险因素筛查与护理指导的效果。方法2006年1月-2007年4月由2名糖尿病专科护士对143例2型糖尿病患者进行糖尿病足危险因素筛查,发现115例患者存在多个糖尿病足危险因素,28例患者存在单个糖尿病足危险因素。危险因素包括：糖尿病知识缺乏,视力严重下降,吸烟,震动感觉减弱或消失,保护性感觉缺失,温觉减退,足部皮肤干燥、皲裂,有赤脚走路习惯等。根据筛查的结果,针对患者存在的糖尿病足危险因素,进行个体化、针对性的健康教育和足部护理指导。结果120例患者坚持每天检查足部,10例不能观察自己足的患者,均能定时请家人检查足部,10例有赤脚走路习惯的患者均改正其不良行为,40例吸烟患者中20例已戒烟,其余已减少吸烟量,37例肥胖患者均不同程度减轻了体质量,其中有8例体质量基本达标。随访6～12个月,均无发生足部新的损伤。全部患者掌握糖尿病足部护理知识,提高了遵医行为。结论糖尿病专科护士对糖尿病知识掌握全面,能够全面评估患者的个体情况及存在的问题,有针对性地设计并实施个体化的教育计划,提高患者的自我防护意识,有效地控制患者糖尿病足溃疡的发生。     

个体化健康指导用于42例糖尿病足高危患者的效果评价

目的 探讨个体化健康指导对糖尿病足高危患者预防足溃疡的知识、态度、行为的影响.方法 采用方便取样方法,自编预防糖尿病足知识、态度、行为(KAP)问卷对42例糖尿痛足高危患者进行调查.根据结果分析患者知识、行为的薄弱点,并实施个体化健康教育指导.指导后3个月内随访患者血糖、血脂等代谢指标的控制情况,足部损伤发生情况,并再次对患者进行KAP问卷调查.结果 教育前,患者糖尿病足知识、态度、行为得分的及格率分别是16.7%、64.3%、11.9%,教育指导3个月后为76.2%、95.2%,33.3%.3个月随访期间发生足部损伤2例,餐前血糖(FBG)、餐后血糖(PBG2h)、糖化血红蛋白(HbAlc)、高密度脂蛋白(HDL-CH)等代谢指标较教育指导前有所改善.结论 对糖尿病足高危患者采取个体化健康指导,能提高其对糖尿病足的预防知识、态度,改善日常足部护理行为.     

临床护士预防PICC导管相关感染的知信行现状及影响因素分析

目的：探讨临床护士对预防PICC导管相关感染的知信行现状,并分析其影响因素。方法：采用便利抽样法于2019年10月选取天津市5家医院215名临床护士,使用自行设计的知信行调查问卷进行调查,采用多重线性逐步回归分析其影响因素。结果：临床护士预防PICC导管相关感染的知信行总分为（90.86±5.23）分、知识（17.36±3.00）分、态度（24.13±1.83）分、行为（49.37±2.36）分;多重线性逐步回归分析结果显示,学历、是否为PICC专科护士、是否接受过PICC-CRI的知识培训是知识得分的主要影响因素（P<0.05）;是否为PICC专科护士、是否接受过中心静脉导管更换敷料的考核是影响预防态度的主要因素（P<0.05）。结论：临床护士预防PICC导管相关感染的知信行水平总体良好,其中预防PICC导管相关感染的态度和行为得分较高,但预防知识得分较低,建议加强相关理论知识的学习和培训,提高护士预防感染相关认知。     

Exploring the work of nurses who administer chemotherapy.

There is little research exploring nurses' experiences of, and attitudes towards, the chemotherapy administration process. There is also limited work investigating practitioners' educational preparation for this aspect of cancer nursing. The aim of this study was to describe nurses' experiences, attitudes and educational preparation for the chemotherapy administration process. A postal survey was conducted across 26 London hospitals providing cancer services. A survey questionnaire was sent to all 526 nurses who administered chemotherapy in these hospitals, of whom 257 replied (response rate 49%). Nearly all nurses (n=244, 95%) reported being frightened, scared and anxious when initially working with chemotherapy. Of these 221(86%) stated they became more confident with experience, when supported by knowledgeable role models and following chemotherapy education. Over 80% (n=206) of the sample had received some form of education, whilst 241 nurses (94%) thought they could benefit from more. Nurses reported they were often or always worried about extravasation (n=113, 44%), anaphylactic reactions (n=95, 37%), and other nurses' education and knowledge deficits (n=118, 46%). Overall, nurses' attitudes towards chemotherapy were neither negative nor positive. Findings highlight the value of formal educational preparation in chemotherapy prior to undertaking this aspect of nursing. Positive role models for novice practitioners would appear important and role models themselves require continued professional development. Wide variations in educational preparation and practice exist and a co-ordinated education and training strategy for chemotherapy practice is warranted to underpin safe and effective practice in this area.     

糖尿病联络护士的培训及效果分析

目的探讨糖尿病联络护士的培训方法及效果。方法对40名糖尿病联络护士进行糖尿病知识与技能的培训,由其负责培训本病区护理人员,并对糖尿病患者进行健康教育。比较培训前后对糖尿病相关知识与操作技能的掌握情况、糖尿病专科护理质量评分及非糖尿病专科患者对糖尿病健康教育的满意度。结果糖尿病联络护士在培训后糖尿病相关知识和操作技能成绩提高;糖尿病专科护理质量及非糖尿病专科患者对糖尿病健康教育的满意度均提高(P0.05)。结论糖尿病联络护士模式有利于护士综合护理能力提高,有利于提高糖尿病专科护理质量。     

The diabetic foot

Diabetic foot lesions most commonly result from a combination of neuropathy and vascular disease in the lower extremity, and may be the presenting feature of diabetes in the older patient. Insufficient attention previously has been given to the careful clinical assessment of the foot, which enables the physician to recognize those patients who are at particular risk of ulceration. The high-risk patient requires education and frequent follow up to reduce the risk of lesions developing. If ulceration develops, healing is likely to occur if the vascular supply is adequate, infection and the blood glucose are controlled, and pressures that may have caused the ulcer are relieved. The ischemic foot requires full vascular assessment, involving colleagues from vascular surgery. The key to a future reduction in the incidence of diabetic foot ulceration is the setting up of a foot care team in which the skills of nurses, podiatrists, orthotists, physicians, and surgeons are combined. The most important members of the team, however, are the patients, who must be convinced that regular foot care will reduce their chances of developing ulceration and other catastrophic consequences, such as amputation.     

Nurses' knowledge and perceptions related to foot care for older persons.

The purpose of this study was to examine nurses' knowledge and perceptions related to foot care of older persons. Nurses representing hospital, home health, and extended care settings were surveyed. Data were collected using a Foot Care Survey, with questions related to the nurse's role with foot care of older adults, importance of various components of patient teaching content, and knowledge about foot care. Only half of the sample reported having content related to the mechanics of foot care in their nursing program. Ninety-five percent of the sample indicated that there is an unmet need of the elderly for assistance with foot care and that provision of this service is a nursing function. There was disagreement between practice setting as to whether the nurse needs a physician's order to do foot care. Nurses employed in home health and extended care settings indicated more independence in performing these functions. The mean score on the knowledge portion of the tool was 9.47 (possible score = 10). The data suggest that nurses possess the knowledge but have not had the opportunity to acquire the associated foot care skills. Implications for nursing education and service were discussed.     

糖尿病患者足病预防护理知识与行为状况的调查研究

目的通过对糖尿病(DM)患者足病预防护理知识与行为状况的调查,寻找患者预防护理知识的薄弱环节.方法采用自行设计的调查评价表对352例 DM患者对DM足的预防护理知识与行为进行调查、测试与评价.结果近半数患者对DM足的认识不足;半数以上患者对预防DM足的日常足部护理知识缺乏、足部护理行为不良;半数患者对选择合适鞋袜的知识了解不足;2/3的DM患者未掌握正确修剪趾甲的方法;高危足患者预防DM足的护理知识明显缺乏.结论在DM教育中要特别重视DM足的预防护理教育,增强患者对DM足的认识和足部保护意识,加大对DM患者日常足部护理知识的教育力度,以使其建立健康的足部护理行为,减少DM足的发生.     

儿科ICU护士对每日唤醒患儿的知信行现状调查

目的 调查儿科ICU护士对每日唤醒的知信行情况,为临床培训提供参考。 方法 采用方便抽样法,于2021年7月对我国7所三级甲等儿童医院的298名儿科ICU护士进行问卷调查,调查工具为自行设计的一般资料调查表、每日唤醒知信行问卷。 结果 298名儿科ICU护士对每日唤醒的认知：知识得分为4（2,4）分,得分率为40%,157名（52.68%）护士表示不太了解或从未听说过每日唤醒。态度：认可度得分32（27,34）分,得分率为80%,217名（72.82%）护士愿意实施每日唤醒,258名（86.58%）护士想获得系统培训。实践行为：221名（74.16%）护士未接受过相关培训,159名（53.35%）护士从不或很少实施每日唤醒。 结论 儿科ICU护士对每日唤醒知识掌握较差,对每日唤醒的认可度较高,实践行为还有待加强,护理管理者应充分重视儿科ICU护士的培训需求,开展每日唤醒基础知识和实践技能的系统培训,提高护士每日唤醒实践水平。     

The principles of chronic wound assessment and measurement

The management of chronic diseases in the elderly population is a major challenge for professional nurses. Chronic wounds, such as pressure ulcers, diabetic foot ulcers, venous ulcers, and arterial ulcers are common problems among patients with chronic diseases. This article aims to improve the knowledge base of nurses who assess and identify the etiology of chronic wounds, in the hope that an improved pool of knowledge can be drawn upon and applied in clinical practice. The article discusses patient assessment, chronic wound assessment, assessment of healing, and wound classification systems that can provide a structured approach to the management of chronic wounds. It provides a rational and systematic approach to both assessment and management that is particularly useful in the management of non-healing wounds. It can be used as a source of reference for nurses in the organization of wound management plans and the provision of better care for patients.     

临床非内分泌科护士糖尿病知识的认知现状及培训需求调查

目的了解临床非内分泌科护士糖尿病知识的认知现状及培训需求,以期为今后开展非内分泌科护士糖尿病专科知识培训提供依据。方法采用便利抽样法选择2012年4月新疆某三级甲等综合性医院36个非内分泌科室的362名护士作为调查对象。采用自行设计的问卷对其进行糖尿病相关知识及培训需求调查。结果非内分泌科护士的糖尿病知识测试成绩为10～20分,平均(15.79±2.10)分。护士在糖尿病基本知识、饮食知识、运动知识、监测知识、药物知识、并发症及足护理等方面的全部答对率分别为30.1%、73.2%、46.4%、21.0%、28.5%、36.5%。不同学历、职称及工作时间的护士在糖尿病知识总评分上的差异有统计学意义(P<0.05或P<0.01)。95.3%的护士认为有必要进行糖尿病相关知识的统一培训,79.6%的护士希望培训后能提高对糖尿病患者的健康教育能力。结论临床非内分泌科护士对糖尿病知识的认知普遍不足,应对其进行系统、规范化的培训。     

临床护士预防医用黏胶相关性皮肤损伤知信行现状与影响因素分析

目的了解临床护士预防医用黏胶相关性皮肤损伤的知识、态度、行为现状并探讨其影响因素,为针对性制定预防医用黏胶相关性皮肤损伤培训项目提供科学依据。方法采用自行设计问卷,运用方便抽样法对浙江省不同地区2所三级乙等综合性医院的1 026名临床护士进行横断面调查,采用SPSS 22.0软件进行统计分析,描述一般资料,预防知识、态度、行为得分及正确率,分析其影响因素。结果临床护士预防"医用黏胶相关性皮肤损伤"知识、态度、行为总分为(70.73±5.95)分,处于中等水平;不同年龄、学历、工作年限、职称、职务、工作科室的护士,在预防医用黏胶相关性皮肤损伤知识方面差异有统计学意义(P0.05)。结论临床护士预防医用黏胶相关性皮肤损伤知信行水平亟待加强,护理管理者应建立和完善护士预防医用黏胶相关性皮肤损伤培训体系,强化临床护士的预防知识和预防行为。     

Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?

With 90% of people needing some inpatient hospital care in the final year of life, it is evident that the provision and awareness of palliative care, and education surrounding this, are widely needed. This study aims to evaluate a palliative care link nurse initiative (PCLN) in an NHS acute hospital, identifying key factors affecting link nurses' ability to influence palliative care practice. This qualitative study used semi-structured interviews and a focus group to show the anticipated and actual influence of link nurses on practice. Findings suggest that link nurses had increased knowledge and skills in palliative care due to education provided. Link nurses were seen to have an influence on the presence and quality of palliative care practice in hospital wards. Factors that could help link nurses to have greater influence are reported, as are difficulties in providing care and accessing training.