Educating Nurses in the Care of Diabetic Foot Ulcers
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This study critically analyzes the importance and necessity of educating nurses in the care of diabetic foot ulcers. It explores the skills, potential, and education of nurses in providing care to patients with diabetic foot ulcers.
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Running head: EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
EDUCATING NURSES IN THE CARE OF DIABETIC FOOT ULCERS
Name of Student:
Name of University:
Authorās Note:
EDUCATING NURSES IN THE CARE OF DIABETIC FOOT ULCERS
Name of Student:
Name of University:
Authorās Note:
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1EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Literature review
The aim of the present study is to critically analyse the importance and necessity of
educating nurse in the care of diabetic foot ulcer. In today scenario of UK, diabetic foot ulcer is
the most lethal disease whose treatment is limited because of financial, economic, politic social
factors. As the mean of giving care, nurses of UK are the mainstream of alternative approach of
treatment of foot ulcer. The present research will focus on the skills, potential and education of
the nurse in providing care to the patient suffering from diabetic foot ulcer.
The problem of rising prevalence of diabetes is bringing a concomitant increase in its
consequence and complication among the person suffering with Diabetes. The most common
concern of diabetes is foot ulcer. Research by Lim, Ng and Thomas(2017) on prevention of foot
ulcer stated that incidence of diabetes among the people of UK is estimated to be 3.6 million and
expected to rise to 5 million in next 10 years. In UK the major health problem linking to single
reason for high hospitalization among the people suffering from diabetes is diabetic foot ulcer.He
further concluded by saying that preventative method for such disease is by patient education and
regular assessment of symptoms that can be the basis for management of foot ulcer.Ogurtsova
(2017) stated in his study that by 2040, the total rise in diabetic patient will increase by
10.4%.Walsh et al. (2016) investigated the prevalence of diabetic foot ulcer and death by using
hazard model from 414523 diabetic patient and founded that 5% of people with early foot ulcer
died within 1 year and 42.2% of people with chronic foot ulcer died within 5 years of period.
Therefore, it can be said that diabetic foot ulcer is recognized and linked to high risk of death and
should be taken as warning sign. Evidently, diabetic foot ulcer complication in latter stage is
linked with serious morbidity and lower the quality of life. It is noted from the research that more
than 75% of non-traumatic limb amputation is because of diabetic ulcer (Lombardo et al. 2014).
Literature review
The aim of the present study is to critically analyse the importance and necessity of
educating nurse in the care of diabetic foot ulcer. In today scenario of UK, diabetic foot ulcer is
the most lethal disease whose treatment is limited because of financial, economic, politic social
factors. As the mean of giving care, nurses of UK are the mainstream of alternative approach of
treatment of foot ulcer. The present research will focus on the skills, potential and education of
the nurse in providing care to the patient suffering from diabetic foot ulcer.
The problem of rising prevalence of diabetes is bringing a concomitant increase in its
consequence and complication among the person suffering with Diabetes. The most common
concern of diabetes is foot ulcer. Research by Lim, Ng and Thomas(2017) on prevention of foot
ulcer stated that incidence of diabetes among the people of UK is estimated to be 3.6 million and
expected to rise to 5 million in next 10 years. In UK the major health problem linking to single
reason for high hospitalization among the people suffering from diabetes is diabetic foot ulcer.He
further concluded by saying that preventative method for such disease is by patient education and
regular assessment of symptoms that can be the basis for management of foot ulcer.Ogurtsova
(2017) stated in his study that by 2040, the total rise in diabetic patient will increase by
10.4%.Walsh et al. (2016) investigated the prevalence of diabetic foot ulcer and death by using
hazard model from 414523 diabetic patient and founded that 5% of people with early foot ulcer
died within 1 year and 42.2% of people with chronic foot ulcer died within 5 years of period.
Therefore, it can be said that diabetic foot ulcer is recognized and linked to high risk of death and
should be taken as warning sign. Evidently, diabetic foot ulcer complication in latter stage is
linked with serious morbidity and lower the quality of life. It is noted from the research that more
than 75% of non-traumatic limb amputation is because of diabetic ulcer (Lombardo et al. 2014).
2EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Looking into the physiology of disease, the common cause of development for foot ulcer
are low glycaemic level, peripheral neuropathy, vascular disease and suppression of immune
system. Alavi et al (2014) said that about 85% of the foot ulcer is because of peripheral
neuropathy that alter the foot pressure. There are various deadly reasons that people are not
focusing in reduce its risk of occurrence. Negligence of patient are seen in the research
ofHemmati et al. (2017). People of United Kingdom have rich diet which result in high blood
glucose level. With rise in ignorance of proper care, peopleare facing the issue of diabetes at a
very high risk of foot ulcer. Therefore, Patient need to know about prevention and management
of diabetes as highlighted in the study of Coppola et al. (2016).
From the study of Armstrong, Boultonand Bus (2017) has mentioned in hisresearch that
northwestern United Kingdom has prevalence of the diabetic foot ulcer of 1.7% annual incidence
of 2.2%. the author has studied the diabetic foot ulcer and their reappearance in which he stated
that approx. 40% of the patients face the situation of recurrence in 1 year, 60% in 3 years after
ulcer get heals. Therefore, he concluded by saying that prevention of diabetic foot ulcer can be
by controlling diabetes in UK, educating nurse of UK to manage the illness and surgical
intervention by the health professional.
Hasan et al. (2016) tested the safety of intensive and less intensive glycemic control in
inhibiting diabetic foot ulcer. In the paper they stated that on the basis of United Kingdom
Prospective Diabetes Study, intensive control of glycemic has adequate effect on the frequency
of microvascular complication in diabetic foot ulcer patient. The author highlighted intensive
therapy given by nurse as another area to manage ulcer. Therefore, author concluded that giving
training to nurses and educating them will be the best way out for the disease.
Looking into the physiology of disease, the common cause of development for foot ulcer
are low glycaemic level, peripheral neuropathy, vascular disease and suppression of immune
system. Alavi et al (2014) said that about 85% of the foot ulcer is because of peripheral
neuropathy that alter the foot pressure. There are various deadly reasons that people are not
focusing in reduce its risk of occurrence. Negligence of patient are seen in the research
ofHemmati et al. (2017). People of United Kingdom have rich diet which result in high blood
glucose level. With rise in ignorance of proper care, peopleare facing the issue of diabetes at a
very high risk of foot ulcer. Therefore, Patient need to know about prevention and management
of diabetes as highlighted in the study of Coppola et al. (2016).
From the study of Armstrong, Boultonand Bus (2017) has mentioned in hisresearch that
northwestern United Kingdom has prevalence of the diabetic foot ulcer of 1.7% annual incidence
of 2.2%. the author has studied the diabetic foot ulcer and their reappearance in which he stated
that approx. 40% of the patients face the situation of recurrence in 1 year, 60% in 3 years after
ulcer get heals. Therefore, he concluded by saying that prevention of diabetic foot ulcer can be
by controlling diabetes in UK, educating nurse of UK to manage the illness and surgical
intervention by the health professional.
Hasan et al. (2016) tested the safety of intensive and less intensive glycemic control in
inhibiting diabetic foot ulcer. In the paper they stated that on the basis of United Kingdom
Prospective Diabetes Study, intensive control of glycemic has adequate effect on the frequency
of microvascular complication in diabetic foot ulcer patient. The author highlighted intensive
therapy given by nurse as another area to manage ulcer. Therefore, author concluded that giving
training to nurses and educating them will be the best way out for the disease.
3EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
However, with poor control of the disease the complication of it rising as the major
public health issue. They are become the leading reason for hospital admission, amputation and
high rate of mortality in patient suffering from diabetes. In the study of Ahmad (2016) seen that
foot ulcer in patient in addition high occurrence of pain and morbidity, is creating substantial
burden and low socio-economic outcome. Previously it is stated the cost for managing the care of
foot ulcer is high and its one of the major reason for its complication in health sector.
Guest,Fullerand Vowden (2018) estimated the care plan and health resource for
managing diabetic foot ulcer in clinical practice by National Health Service. He said that cost of
intervening unhealed ulcer is 4 times high than healed ulcer. He added that the cost may get
affected by the by combination of factor like high amputation rates, its morbidity and mortality,
poor control of diabetes.In order to manage the disease, it require huge investment and create
burden in the society. From the study of Kerr, Rayman and Jeffcoate (2014) it has been noted
that the procedure to manage the diabetic foot ulcer with help of resource and medication has
pose a high socio-economic burden. The author in his paper has estimated the total cost for 580
pound million to the National Health ServiceUnited Kingdom out of which 50% are spent in the
care of foot ulcer. Van Netten et al. 2016 conducted research through systematic literature review
regarding the prevention of ulcer in diabetic patients which is essential to reduce the burden of
the disease on patient as well as health resource. The author suggested that use of self-
management and nursing intervention for prevention of foot ulcer is strong enough to prevent the
disease. With the help of nursing assessment and education the patient will be able to self-
manage the disease efficiently.
From the annual report of Statista United Kingdom (2018) majority of the nurses with
285000, are working for National Health Service in 2018. Low number of nurse in UK is the
However, with poor control of the disease the complication of it rising as the major
public health issue. They are become the leading reason for hospital admission, amputation and
high rate of mortality in patient suffering from diabetes. In the study of Ahmad (2016) seen that
foot ulcer in patient in addition high occurrence of pain and morbidity, is creating substantial
burden and low socio-economic outcome. Previously it is stated the cost for managing the care of
foot ulcer is high and its one of the major reason for its complication in health sector.
Guest,Fullerand Vowden (2018) estimated the care plan and health resource for
managing diabetic foot ulcer in clinical practice by National Health Service. He said that cost of
intervening unhealed ulcer is 4 times high than healed ulcer. He added that the cost may get
affected by the by combination of factor like high amputation rates, its morbidity and mortality,
poor control of diabetes.In order to manage the disease, it require huge investment and create
burden in the society. From the study of Kerr, Rayman and Jeffcoate (2014) it has been noted
that the procedure to manage the diabetic foot ulcer with help of resource and medication has
pose a high socio-economic burden. The author in his paper has estimated the total cost for 580
pound million to the National Health ServiceUnited Kingdom out of which 50% are spent in the
care of foot ulcer. Van Netten et al. 2016 conducted research through systematic literature review
regarding the prevention of ulcer in diabetic patients which is essential to reduce the burden of
the disease on patient as well as health resource. The author suggested that use of self-
management and nursing intervention for prevention of foot ulcer is strong enough to prevent the
disease. With the help of nursing assessment and education the patient will be able to self-
manage the disease efficiently.
From the annual report of Statista United Kingdom (2018) majority of the nurses with
285000, are working for National Health Service in 2018. Low number of nurse in UK is the
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4EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
main problem of high number of patient of foot ulcer not getting efficient care. Therefore, to
make them available in United Kingdom, it is important to register them with NMC. MNC is
responsible for providing education and training to the nurse, hence this will help to analyses the
educated nurse in giving care to diabetic foot ulcer.
Therefore, many research has been conducted to find an alternative solution for it. In
study of Marqueset al. (2017) recognized that diabetic foot ulcer can be prevented and its
incidence can also be reduced by providing right guidance to the patient about podiatric care. He
conducted a research on patient having foot ulcer and giventhem proper teaching regarding how
to self-examine the feet care along with medication assistance. The author finds that out of 30
patients, 20 patients showed quick recovery from the disease. In the study of Stolt and Suhonen
(2019) found that early understanding of tissue that is undergoing the risk of ulceration through
intervention and assessment by the nurse and health care professional can help to eradicate the
disease easily and at low cost. The finding was supported by Meng et al (2014) where he showed
a considerable decrease in frequency of foot ulcer in patient suffering from diabetes who are at
high risk to encounter the infection after the rigorous and effective nursing education given to the
patients. The author added that risk of amputation can be reduced and prevented through proper
management and education provided by the nursing students and health care professionals.
However, until now United Kingdom are deficient in any long term and follow up data
about the nursing education and intervention. As seen from the research United Kingdom invest
huge capital in management of disease, Therefore, research need to conducted to educate nurse
about the disease risk, consequence, management and impact by giving them proper training in
regular basis. They also need to know the various management skill to help the patient further,
need to acknowledge ways of caring the patient with diabetic foot ulcer.
main problem of high number of patient of foot ulcer not getting efficient care. Therefore, to
make them available in United Kingdom, it is important to register them with NMC. MNC is
responsible for providing education and training to the nurse, hence this will help to analyses the
educated nurse in giving care to diabetic foot ulcer.
Therefore, many research has been conducted to find an alternative solution for it. In
study of Marqueset al. (2017) recognized that diabetic foot ulcer can be prevented and its
incidence can also be reduced by providing right guidance to the patient about podiatric care. He
conducted a research on patient having foot ulcer and giventhem proper teaching regarding how
to self-examine the feet care along with medication assistance. The author finds that out of 30
patients, 20 patients showed quick recovery from the disease. In the study of Stolt and Suhonen
(2019) found that early understanding of tissue that is undergoing the risk of ulceration through
intervention and assessment by the nurse and health care professional can help to eradicate the
disease easily and at low cost. The finding was supported by Meng et al (2014) where he showed
a considerable decrease in frequency of foot ulcer in patient suffering from diabetes who are at
high risk to encounter the infection after the rigorous and effective nursing education given to the
patients. The author added that risk of amputation can be reduced and prevented through proper
management and education provided by the nursing students and health care professionals.
However, until now United Kingdom are deficient in any long term and follow up data
about the nursing education and intervention. As seen from the research United Kingdom invest
huge capital in management of disease, Therefore, research need to conducted to educate nurse
about the disease risk, consequence, management and impact by giving them proper training in
regular basis. They also need to know the various management skill to help the patient further,
need to acknowledge ways of caring the patient with diabetic foot ulcer.
5EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
6EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Reference
Ahmad, J., 2016. The diabetic foot. Diabetes & Metabolic Syndrome: Clinical Research &
Reviews, 10(1), pp.48-60.
Alavi, A., Sibbald, R.G., Mayer, D., Goodman, L., Botros, M., Armstrong, D.G., Woo, K.,
Boeni, T., Ayello, E.A. and Kirsner, R.S., 2014. Diabetic foot ulcers: Part I. Pathophysiology and
prevention. Journal of the American Academy of Dermatology, 70(1), pp.1-e1.
Armstrong, D.G., Boulton, A.J. and Bus, S.A., 2017. Diabetic foot ulcers and their
recurrence. New England Journal of Medicine, 376(24), pp.2367-2375.
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A. and Gazzaruso, C., 2016. The role of patient
education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1),
pp.18-27.
Guest, J.F., Fuller, G.W. and Vowden, P., 2018. Diabetic foot ulcer management in clinical
practice in the UK: costs and outcomes. International wound journal, 15(1), pp.43-52.
Hasan, R., Firwana, B., Elraiyah, T., Domecq, J.P., Prutsky, G., Nabhan, M., Prokop, L.J.,
Henke, P., Tsapas, A., Montori, V.M. and Murad, M.H., 2016. A systematic review and meta-
analysis of glycemic control for the prevention of diabetic foot syndrome. Journal of vascular
surgery, 63(2), pp.22S-28S.
HemmatiMaslakpak, M., Parizad, N., Shahbaz, A. and Ghafourifard, M., 2017. Preventing and
managing diabetic foot ulcers: application of Oremās self-care model. Int J Diabetes Dev Ctries,
pp.1-8.
Reference
Ahmad, J., 2016. The diabetic foot. Diabetes & Metabolic Syndrome: Clinical Research &
Reviews, 10(1), pp.48-60.
Alavi, A., Sibbald, R.G., Mayer, D., Goodman, L., Botros, M., Armstrong, D.G., Woo, K.,
Boeni, T., Ayello, E.A. and Kirsner, R.S., 2014. Diabetic foot ulcers: Part I. Pathophysiology and
prevention. Journal of the American Academy of Dermatology, 70(1), pp.1-e1.
Armstrong, D.G., Boulton, A.J. and Bus, S.A., 2017. Diabetic foot ulcers and their
recurrence. New England Journal of Medicine, 376(24), pp.2367-2375.
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A. and Gazzaruso, C., 2016. The role of patient
education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1),
pp.18-27.
Guest, J.F., Fuller, G.W. and Vowden, P., 2018. Diabetic foot ulcer management in clinical
practice in the UK: costs and outcomes. International wound journal, 15(1), pp.43-52.
Hasan, R., Firwana, B., Elraiyah, T., Domecq, J.P., Prutsky, G., Nabhan, M., Prokop, L.J.,
Henke, P., Tsapas, A., Montori, V.M. and Murad, M.H., 2016. A systematic review and meta-
analysis of glycemic control for the prevention of diabetic foot syndrome. Journal of vascular
surgery, 63(2), pp.22S-28S.
HemmatiMaslakpak, M., Parizad, N., Shahbaz, A. and Ghafourifard, M., 2017. Preventing and
managing diabetic foot ulcers: application of Oremās self-care model. Int J Diabetes Dev Ctries,
pp.1-8.
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7EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Kerr, M., Rayman, G. and Jeffcoate, W.J., 2014. Cost of diabetic foot disease to the National
Health Service in England. Diabetic Medicine, 31(12), pp.1498-1504.
Lim, J.Z.M., Ng, N.S.L. and Thomas, C., 2017. Prevention and treatment of diabetic foot
ulcers. Journal of the Royal Society of Medicine, 110(3), pp.104-109.
Lombardo, F.L., Maggini, M., De Bellis, A., Seghieri, G. and Anichini, R., 2014. Lower
extremity amputations in persons with and without diabetes in Italy: 2001ā2010. PLoS One, 9(1),
p.e86405.
Marques, A.D.B., Texeira, A.K.S., Moreira, T.M.M., de Carvalho, R.E.F.L., de MeloFialho,
A.V. and Chaves, E.M.C., 2017. Nursing interventions for the prevention of foot ulcers in
patients with diabetes: an integrative review. International Archives of Medicine, 10.
Ogurtsova, K., da Rocha Fernandes, J.D., Huang, Y., Linnenkamp, U., Guariguata, L., Cho,
N.H., Cavan, D., Shaw, J.E. and Makaroff, L.E., 2017. IDF Diabetes Atlas: Global estimates for
the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice, 128,
pp.40-50.
Ren, M., Yang, C., Lin, D.Z., Xiao, H.S., Mai, L.F., Guo, Y.C. and Yan, L., 2014. Effect of
intensive nursing education on the prevention of diabetic foot ulceration among patients with
high-risk diabetic foot: a follow-up analysis. Diabetes technology & therapeutics, 16(9), pp.576-
581.
Statista United Kingdom, 2018. Number of nurses in the United Kingdom 2010-2018 | Statistic.
[online] Statista. Available at: https://www.statista.com/statistics/318922/number-of-nurses-in-
the-uk/ [Accessed 13 Apr. 2019].
Kerr, M., Rayman, G. and Jeffcoate, W.J., 2014. Cost of diabetic foot disease to the National
Health Service in England. Diabetic Medicine, 31(12), pp.1498-1504.
Lim, J.Z.M., Ng, N.S.L. and Thomas, C., 2017. Prevention and treatment of diabetic foot
ulcers. Journal of the Royal Society of Medicine, 110(3), pp.104-109.
Lombardo, F.L., Maggini, M., De Bellis, A., Seghieri, G. and Anichini, R., 2014. Lower
extremity amputations in persons with and without diabetes in Italy: 2001ā2010. PLoS One, 9(1),
p.e86405.
Marques, A.D.B., Texeira, A.K.S., Moreira, T.M.M., de Carvalho, R.E.F.L., de MeloFialho,
A.V. and Chaves, E.M.C., 2017. Nursing interventions for the prevention of foot ulcers in
patients with diabetes: an integrative review. International Archives of Medicine, 10.
Ogurtsova, K., da Rocha Fernandes, J.D., Huang, Y., Linnenkamp, U., Guariguata, L., Cho,
N.H., Cavan, D., Shaw, J.E. and Makaroff, L.E., 2017. IDF Diabetes Atlas: Global estimates for
the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice, 128,
pp.40-50.
Ren, M., Yang, C., Lin, D.Z., Xiao, H.S., Mai, L.F., Guo, Y.C. and Yan, L., 2014. Effect of
intensive nursing education on the prevention of diabetic foot ulceration among patients with
high-risk diabetic foot: a follow-up analysis. Diabetes technology & therapeutics, 16(9), pp.576-
581.
Statista United Kingdom, 2018. Number of nurses in the United Kingdom 2010-2018 | Statistic.
[online] Statista. Available at: https://www.statista.com/statistics/318922/number-of-nurses-in-
the-uk/ [Accessed 13 Apr. 2019].
8EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Stolt, M. and Suhonen, R., 2019. Supporting Individualised Nursing Care by Nursing
Interventions. In Individualized Care(pp. 187-194). Springer, Cham.
Van Netten, J.J., Price, P.E., Lavery, L.A., MonteiroāSoares, M., Rasmussen, A., Jubiz, Y., Bus,
S.A. and International Working Group on the Diabetic Foot (IWGDF), 2016. Prevention of foot
ulcers in the atārisk patient with diabetes: a systematic review. Diabetes/metabolism research
and reviews, 32, pp.84-98.
Walsh, J.W., Hoffstad, O.J., Sullivan, M.O. and Margolis, D.J., 2016. Association of diabetic
foot ulcer and death in a populationābased cohort from the United Kingdom. Diabetic
Medicine, 33(11), pp.1493-1498.
Stolt, M. and Suhonen, R., 2019. Supporting Individualised Nursing Care by Nursing
Interventions. In Individualized Care(pp. 187-194). Springer, Cham.
Van Netten, J.J., Price, P.E., Lavery, L.A., MonteiroāSoares, M., Rasmussen, A., Jubiz, Y., Bus,
S.A. and International Working Group on the Diabetic Foot (IWGDF), 2016. Prevention of foot
ulcers in the atārisk patient with diabetes: a systematic review. Diabetes/metabolism research
and reviews, 32, pp.84-98.
Walsh, J.W., Hoffstad, O.J., Sullivan, M.O. and Margolis, D.J., 2016. Association of diabetic
foot ulcer and death in a populationābased cohort from the United Kingdom. Diabetic
Medicine, 33(11), pp.1493-1498.
9EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
Appendix
Database Search term Hits Keywords Hits Inclusion/
exclusion criteria
Hits Remaining article
notes
CINAHL
plus
Diabetic
foot ulcer
453 Understandin
g Diabetic
Foot
Infection and
its
Management
34 Full text
Publication year
2000-2013.
346 Found: 1 Ahmad,
(2016)
2. Alavi et al.
(2014)
CINAHL
plus
Diabetic
foot ulcer
and United
kingdom
234 Diabetic Foot
Ulcers
65 Full text
Publication year
2000-2013
343 Found 1;
Armstrong,
Boulton and Bus
(2017)
Cochrane
library
Managemen
t-t of foot
ulcer
234 Type 2
diabetes
3443
6
Full text
Publication year
2000-2013
653 Found 1. Coppola
et al. (2016).
MEDLIN
E
Diabeteic
foot ulcer
management
757 United
Kingdom,
cost,
outcome
3578
3
Full text
Publication year
2000-2013
863
5
Found 1. Guest,
Fulleand Vowden
(2018).
EMBASE Diabetic
foot ulcer,
UK
435 Glycemic
control
4 Full text
Publication year
2000-2013
343 Found 1. Hasan et
al. (2016).
Europe Managemen 66 Self- 97 Full text 9 Found 1.
Appendix
Database Search term Hits Keywords Hits Inclusion/
exclusion criteria
Hits Remaining article
notes
CINAHL
plus
Diabetic
foot ulcer
453 Understandin
g Diabetic
Foot
Infection and
its
Management
34 Full text
Publication year
2000-2013.
346 Found: 1 Ahmad,
(2016)
2. Alavi et al.
(2014)
CINAHL
plus
Diabetic
foot ulcer
and United
kingdom
234 Diabetic Foot
Ulcers
65 Full text
Publication year
2000-2013
343 Found 1;
Armstrong,
Boulton and Bus
(2017)
Cochrane
library
Managemen
t-t of foot
ulcer
234 Type 2
diabetes
3443
6
Full text
Publication year
2000-2013
653 Found 1. Coppola
et al. (2016).
MEDLIN
E
Diabeteic
foot ulcer
management
757 United
Kingdom,
cost,
outcome
3578
3
Full text
Publication year
2000-2013
863
5
Found 1. Guest,
Fulleand Vowden
(2018).
EMBASE Diabetic
foot ulcer,
UK
435 Glycemic
control
4 Full text
Publication year
2000-2013
343 Found 1. Hasan et
al. (2016).
Europe Managemen 66 Self- 97 Full text 9 Found 1.
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10EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
PMC t, foot ulcer management
of foot ulcer Publication year
2000-2013
HemmatiMaslakp
ak et al. (2017).
PubMed National
service, foot
ulcer, cost
432
5
Cost,
diabetic foot
ulcer NHS
4543
6
Full text
Publication year
2000-2013
976
6
Found 1. Kerr,
Rayman,
and Jeffcoate
(2014).
ProQuest Treatment,
foot ulcer
23 Prevention,
diabetic foot
ulcer
5 Full text
Publication year
2000-2013
567 Found 1 Lim and
Thomas (2017)
CINAHL
plus
Amputation,
diabetic foot
ulcer
356
7
Extremity,
diabetes
6736
7
Full text
Publication year
2000-2013
355 Found 1
Lombardo et al.
(2014).
MEDLIN
E
Nursing,
education
foot ulcer
234 Diabetic foot
ulcer, UK
1899 Full text
Publication year
2000-2013
278 Found, 1.
Marques et al.
(2017)
2. Ren et al.
(2014)
3. Stolt and
Suhonen (2019)
MEDLIN
E
Global,
diabetes
464
5
UK 983 Full text
Publication year
2000-2013
564 Found 1.
Ogurtsova et al.
(2017).
EMBASE Number of 57 Statistic , UK 20 Full text 15 Found 1.
PMC t, foot ulcer management
of foot ulcer Publication year
2000-2013
HemmatiMaslakp
ak et al. (2017).
PubMed National
service, foot
ulcer, cost
432
5
Cost,
diabetic foot
ulcer NHS
4543
6
Full text
Publication year
2000-2013
976
6
Found 1. Kerr,
Rayman,
and Jeffcoate
(2014).
ProQuest Treatment,
foot ulcer
23 Prevention,
diabetic foot
ulcer
5 Full text
Publication year
2000-2013
567 Found 1 Lim and
Thomas (2017)
CINAHL
plus
Amputation,
diabetic foot
ulcer
356
7
Extremity,
diabetes
6736
7
Full text
Publication year
2000-2013
355 Found 1
Lombardo et al.
(2014).
MEDLIN
E
Nursing,
education
foot ulcer
234 Diabetic foot
ulcer, UK
1899 Full text
Publication year
2000-2013
278 Found, 1.
Marques et al.
(2017)
2. Ren et al.
(2014)
3. Stolt and
Suhonen (2019)
MEDLIN
E
Global,
diabetes
464
5
UK 983 Full text
Publication year
2000-2013
564 Found 1.
Ogurtsova et al.
(2017).
EMBASE Number of 57 Statistic , UK 20 Full text 15 Found 1.
11EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
nurses, UK nurses Publication year
2000-2013
Statistical United
Kingdom (2018).
Cochrane
library
Prevention
foot ulcer
128 Diabetes
food ulcer,
UK
67 Full text
Publication year
2000-2013
45 Found 1 Van
Netten et al.
(2016)
ProQuest Death, foot
ulcer,
population
467 UK, diabetic
food ulcer,
death
87 Full text
Publication year
2000-2013
8 Found 1 Walsh et
al. (2016)
nurses, UK nurses Publication year
2000-2013
Statistical United
Kingdom (2018).
Cochrane
library
Prevention
foot ulcer
128 Diabetes
food ulcer,
UK
67 Full text
Publication year
2000-2013
45 Found 1 Van
Netten et al.
(2016)
ProQuest Death, foot
ulcer,
population
467 UK, diabetic
food ulcer,
death
87 Full text
Publication year
2000-2013
8 Found 1 Walsh et
al. (2016)
Running head: EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
article year author country title aim design sampling
and size
findings reasons for
inclusion
1. 2016 Ahmad, J. Netherlands The diabetic
foot. Diabetes &
Metabolic
Syndrome:
Clinical Research
& Reviews
description of the
pathophysiology
and aspects using
which the
ulceration and its
effectiveness
could be
understood
descriptive
paper
descriptive
paper
descriptive
paper
accurate and
effective
description
2. 2014 Alavi, A., Sibbald,
R.G., Mayer, D.,
Goodman, L.,
Botros, M.,
Armstrong, D.G.,
Woo, K., Boeni,
America Diabetic foot
ulcers: Part I.
Pathophysiology
and prevention
description of
pathophysiology
descriptive
paper
descriptive
paper
descriptive
paper
accurate
description of the
pathophysiology
of the foot ulcer
article year author country title aim design sampling
and size
findings reasons for
inclusion
1. 2016 Ahmad, J. Netherlands The diabetic
foot. Diabetes &
Metabolic
Syndrome:
Clinical Research
& Reviews
description of the
pathophysiology
and aspects using
which the
ulceration and its
effectiveness
could be
understood
descriptive
paper
descriptive
paper
descriptive
paper
accurate and
effective
description
2. 2014 Alavi, A., Sibbald,
R.G., Mayer, D.,
Goodman, L.,
Botros, M.,
Armstrong, D.G.,
Woo, K., Boeni,
America Diabetic foot
ulcers: Part I.
Pathophysiology
and prevention
description of
pathophysiology
descriptive
paper
descriptive
paper
descriptive
paper
accurate
description of the
pathophysiology
of the foot ulcer
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1EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
T., Ayello, E.A.
and Kirsner, R.S.
3. 2017 Armstrong, D.G.,
Boulton, A.J. and
Bus, S.A.,
UK Diabetic foot
ulcers and their
recurrence
pathogenesis,
treatment, and
management of
diabetic foot
ulcers, including
prevention of
recurrence
review article review of
descriptive
paper
review of
descriptive
paper
it describes the
lower-extremity
complication in
patients and
hence, it was
included
4. 2016 Coppola, A.,
Sasso, L.,
Bagnasco, A.,
Giustina, A. and
Gazzaruso, C.
USA The role of patient
education in the
prevention and
management of
type 2 diabetes: an
overview
to understand the
effectiveness of
therapeutic
patient education
so that the
prevention of
type 2 diabetes
and recurrence of
ulcer could be
descriptive
paper
descriptive
paper
descriptive
paper
discusses most
relevant research
and data
T., Ayello, E.A.
and Kirsner, R.S.
3. 2017 Armstrong, D.G.,
Boulton, A.J. and
Bus, S.A.,
UK Diabetic foot
ulcers and their
recurrence
pathogenesis,
treatment, and
management of
diabetic foot
ulcers, including
prevention of
recurrence
review article review of
descriptive
paper
review of
descriptive
paper
it describes the
lower-extremity
complication in
patients and
hence, it was
included
4. 2016 Coppola, A.,
Sasso, L.,
Bagnasco, A.,
Giustina, A. and
Gazzaruso, C.
USA The role of patient
education in the
prevention and
management of
type 2 diabetes: an
overview
to understand the
effectiveness of
therapeutic
patient education
so that the
prevention of
type 2 diabetes
and recurrence of
ulcer could be
descriptive
paper
descriptive
paper
descriptive
paper
discusses most
relevant research
and data
2EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
prevented
5 2016 Hasan, R.,
Firwana, B.,
Elraiyah, T.,
Domecq, J.P.,
Prutsky, G.,
Nabhan, M.,
Prokop, L.J.,
Henke, P., Tsapas,
A., Montori, V.M.
and Murad, M.H.
UK A systematic
review and meta-
analysis of
glycemic control
for the prevention
of diabetic foot
syndrome
to develop the
relative efficacy
and safety of the
process with
usage of RCTs so
that usage of
intensive
glycemic control
in prevention of
diabetic foot
ulcers could be
developed
systematic
review
Included
10897
patients with
type 2
diabetes so
that
effectiveness
of the
interventions
could be
understood.
glycemic
index and its
control helped
to reduce the
prevention of
the diabetic
foot ulcer
increased level of
evidence due to
the RCTs were
included in the
study
6. 2014 Lombardo, F.L.,
Maggini, M., De
Bellis, A.,
Seghieri, G. and
Anichini, R.
Italy Lower extremity
amputations in
persons with and
without diabetes
in Italy: 2001ā
to determine the
hospitalization
process so that
lower extremity
amputations
systematic
analysis
11639
patients were
included in
the study
ulceration was
associated with
amputations
and patients
with diabetes
the study
provided detail of
progressive
reduction of
hospitalization so
prevented
5 2016 Hasan, R.,
Firwana, B.,
Elraiyah, T.,
Domecq, J.P.,
Prutsky, G.,
Nabhan, M.,
Prokop, L.J.,
Henke, P., Tsapas,
A., Montori, V.M.
and Murad, M.H.
UK A systematic
review and meta-
analysis of
glycemic control
for the prevention
of diabetic foot
syndrome
to develop the
relative efficacy
and safety of the
process with
usage of RCTs so
that usage of
intensive
glycemic control
in prevention of
diabetic foot
ulcers could be
developed
systematic
review
Included
10897
patients with
type 2
diabetes so
that
effectiveness
of the
interventions
could be
understood.
glycemic
index and its
control helped
to reduce the
prevention of
the diabetic
foot ulcer
increased level of
evidence due to
the RCTs were
included in the
study
6. 2014 Lombardo, F.L.,
Maggini, M., De
Bellis, A.,
Seghieri, G. and
Anichini, R.
Italy Lower extremity
amputations in
persons with and
without diabetes
in Italy: 2001ā
to determine the
hospitalization
process so that
lower extremity
amputations
systematic
analysis
11639
patients were
included in
the study
ulceration was
associated with
amputations
and patients
with diabetes
the study
provided detail of
progressive
reduction of
hospitalization so
3EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
2010 (LEAs) and
amputee rates in
persons with and
without diabetes
in Italy could be
understood
were
associated
amputations
that amputee
rates could be
understood.
7. 2017 Marques, A.D.B.,
Texeira, A.K.S.,
Moreira, T.M.M.,
de Carvalho,
R.E.F.L., de
MeloFialho, A.V.
and Chaves,
E.M.C.
UK Nursing
interventions for
the prevention of
foot ulcers in
patients with
diabetes: an
integrative review
To determine the
available
resources so that
the interventions
to prevent the
ulcers and
diabetic foot
could be
understood.
integrative
review with
databases
BDENF,
LILACS,
IBECS,
CINAHL,
PubMed and in
the virtual
library
15 articles
included in
the study so
that the
preventive
measures
could be
understood
health
education
could be one of
the effective
measures using
which the
diabetic foot
and the
amputation
episodes could
the papers
included in this
paper had level 1
evidence, hence it
was included
2010 (LEAs) and
amputee rates in
persons with and
without diabetes
in Italy could be
understood
were
associated
amputations
that amputee
rates could be
understood.
7. 2017 Marques, A.D.B.,
Texeira, A.K.S.,
Moreira, T.M.M.,
de Carvalho,
R.E.F.L., de
MeloFialho, A.V.
and Chaves,
E.M.C.
UK Nursing
interventions for
the prevention of
foot ulcers in
patients with
diabetes: an
integrative review
To determine the
available
resources so that
the interventions
to prevent the
ulcers and
diabetic foot
could be
understood.
integrative
review with
databases
BDENF,
LILACS,
IBECS,
CINAHL,
PubMed and in
the virtual
library
15 articles
included in
the study so
that the
preventive
measures
could be
understood
health
education
could be one of
the effective
measures using
which the
diabetic foot
and the
amputation
episodes could
the papers
included in this
paper had level 1
evidence, hence it
was included
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4EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
SCIELO
without time
restriction
be eliminated
8. 2014 Ren, M., Yang,
C., Lin, D.Z.,
Xiao, H.S., Mai,
L.F., Guo, Y.C.
and Yan, L.
UK Effect of intensive
nursing education
on the prevention
of diabetic foot
ulceration among
patients with
high-risk diabetic
foot: a follow-up
analysis
to discuss the
effect of intensive
nursing education
on the prevention
of diabetic foot
ulceration among
patients at high
risk for diabetic
foot
individualized
education
study were
included in the
paper
185 patients
were included
in the study
who were at
high risk of
diabetic foot
ulcer
there were
highly
statistically
significant
improvements
in the intensive
treatment
group
compared with
the control
group
the paper
included aspects
due to which the
effectiveness of
the paper
included
9. 2016 Van Netten, J.J.,
Price, P.E.,
Lavery, L.A.,
MonteiroāSoares,
UK Prevention of foot
ulcers in the atā
risk patient with
diabetes: a
to investigate the
effectiveness of
interventions to
prevent first and
systematic
review
research
articles were
included from
PubMed,
interventions
and self
management
aspects helps
It was included as
Surgical
interventions can
be effective in
SCIELO
without time
restriction
be eliminated
8. 2014 Ren, M., Yang,
C., Lin, D.Z.,
Xiao, H.S., Mai,
L.F., Guo, Y.C.
and Yan, L.
UK Effect of intensive
nursing education
on the prevention
of diabetic foot
ulceration among
patients with
high-risk diabetic
foot: a follow-up
analysis
to discuss the
effect of intensive
nursing education
on the prevention
of diabetic foot
ulceration among
patients at high
risk for diabetic
foot
individualized
education
study were
included in the
paper
185 patients
were included
in the study
who were at
high risk of
diabetic foot
ulcer
there were
highly
statistically
significant
improvements
in the intensive
treatment
group
compared with
the control
group
the paper
included aspects
due to which the
effectiveness of
the paper
included
9. 2016 Van Netten, J.J.,
Price, P.E.,
Lavery, L.A.,
MonteiroāSoares,
UK Prevention of foot
ulcers in the atā
risk patient with
diabetes: a
to investigate the
effectiveness of
interventions to
prevent first and
systematic
review
research
articles were
included from
PubMed,
interventions
and self
management
aspects helps
It was included as
Surgical
interventions can
be effective in
5EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
M., Rasmussen,
A., Jubiz, Y., Bus,
S.A. and
International
Working Group
on the Diabetic
Foot
systematic review recurrent foot
ulcers in persons
with diabetes
EMBASE,
CINAHL and
the Cochrane
database and
in the
process, 30
controlled
and 44 non-
controlled
studies were
included, 19
articles were
randomized
control trials
to prevent
Diabetic foot
ulcer
selected patients,
but the evidence
base is small.
Hence it was
included
M., Rasmussen,
A., Jubiz, Y., Bus,
S.A. and
International
Working Group
on the Diabetic
Foot
systematic review recurrent foot
ulcers in persons
with diabetes
EMBASE,
CINAHL and
the Cochrane
database and
in the
process, 30
controlled
and 44 non-
controlled
studies were
included, 19
articles were
randomized
control trials
to prevent
Diabetic foot
ulcer
selected patients,
but the evidence
base is small.
Hence it was
included
6EDUCATING NURSE IN THE CARE OF DIABETIC FOOT ULCER
10. 2016 Walsh, J.W.,
Hoffstad, O.J.,
Sullivan, M.O.
and Margolis, D.J.
UK Association of
diabetic foot ulcer
and death in a
populationābased
cohort from the
United Kingdom
To understand the
effects of
diabetes induced
complications so
that diabetic foot
ulcer and
associated death
could be
understood.
population
based cohort
study
414523
patients with
diabetes
enrolled in
practice were
included
It was found
that diabetic
foot ulcer is
associated with
increased
mortality rate
among patient
with diabetes.
it was included
because the paper
provided
evidence that
increased rate of
diabetic foot
ulcer is
associated with
increased
mortality rate
10. 2016 Walsh, J.W.,
Hoffstad, O.J.,
Sullivan, M.O.
and Margolis, D.J.
UK Association of
diabetic foot ulcer
and death in a
populationābased
cohort from the
United Kingdom
To understand the
effects of
diabetes induced
complications so
that diabetic foot
ulcer and
associated death
could be
understood.
population
based cohort
study
414523
patients with
diabetes
enrolled in
practice were
included
It was found
that diabetic
foot ulcer is
associated with
increased
mortality rate
among patient
with diabetes.
it was included
because the paper
provided
evidence that
increased rate of
diabetic foot
ulcer is
associated with
increased
mortality rate
1 out of 19
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