Development of nursing model for diabetic patients with foot ulcers with self-care management and case management in outpatient department SaKaeo Crown Prince Hospital

Abstract

        The objectives of this study were to 1) describe the situation and challenges in caring for diabetic patients with foot ulcers, 2) develop a nursing care model for diabetes patients, and 3) evaluate the development of a nursing care model for diabetic patients. The population consists of diabetic patients with foot ulcers and caregivers, outpatient nurses at Sa Kaeo Prince Hospital. The conceptual framework was the applied self-management theory of Kanfer and Gaelick-Buys. The methodology is research and development. The population consisted of patients with diabetes and their relatives, as well as registered nurses, totaling 7,441 people. The sample was divided into three groups: 1) ten registered nurses,  2) thirty‑five diabetic patients with foot ulcers, and 3) thirty‑five relatives/caregivers. The participants were selected using purposive sampling. The research tools included an interview protocol, a knowledge assessment, and a questionnaire. The Content Validity Index (CVI) of the instruments was 0.82, and the difficulty and discrimination indices were 0.34 and 0.82, respectively. The reliability of the entire instrument was 0.847. Statistical analyses included frequency, percentage, mean, standard deviation, paired sample t-test, and Wilcoxon sign rank test.
        The study results showed that 1) Nurses still lack the specific knowledge and skills required to care for diabetic patients with foot ulcers. 2) The nursing care model for patients with diabetes includes: 1) Screening, assessment, and classification of diabetic patients based on their risk levels for developing diabetic foot ulcers. 2) Management of diabetic foot ulcers to promote wound healing. 3) Self‑management for continued diabetic foot care at home. 4) Case management and coordination with a multidisciplinary healthcare team: after developing the nursing model for patients with diabetes and their relatives, the mean score of knowledge regarding foot care was significantly higher than before the model development at the .01 level. The diabetic patients and their relatives had significantly higher mean foot‑wound care behavior scores after the development of the nursing model than before, at the .01 level of statistical significance. The severity of diabetic foot ulcers showed significantly lower mean scores after the development of the nursing model than before, also at the .01 level of significance. The satisfaction of diabetic patients and their relatives with the nursing model was at a high level. Nurses adhered to the developed diabetic foot‑ulcer nursing model at 100%. After the development of the nursing model, the mean knowledge scores were significantly higher than before, at the .01 level. The overall mean skills in diabetic foot care were also significantly higher after the development of the nursing model, at the .01 level of significance. After the development of the nursing model, satisfaction was at the highest level, and no wound infections or readmissions were found.