An international cruise conference on nursing problems.
Late August on board of some Russian river cruise ship took place an interesting conference. About 20 American &
Eugenia P. Ananieva
Experience of new
approach to nursing aid to the
patients with diabetic foot syndrome.
Diabetic foot syndrome
is an anatomo-functional disorder, leading to the development of ulcerous
striking foots, festering and necrotic complications, bone deformation and
destruction and after all to breaking the supporting functions of limb.
Persons with diabetes
are at significant risk for lower extremity amputations; such procedures are 15
times more common among persons with diabetes than among those without diabetes.
Yet if patients whose feet are particularly at risk are aggressively sought out
and treated, up to 50% of amputations can be prevented.
The amputation of the
lower extremity, especially in hip level, leads to the fast death of these
patients. 50% of operated patients dies during the first 3 years after
amputation and 50% of persons with diabetes who undergo a lower extremity
amputation have an amputation of the contra lateral leg within a few years. This
occurs not only because of peripheral neuropathy and peripheral vascular disease
but also because the remaining foot bears increased pressure and frequently
develops ulceration and infection. The risk is greater for patients over 40
years old who have had diabetes for more than 10 years. Have to remember that
about a half of patients after the first amputation loose the ability to move.
There is more than 11
thousand amputation of the shank due to diabetic foot syndrome. Really this
number is higher because there is not the registration by nosology.
So, the prevention of
diabetic foot syndrome development is very important. For the realization of
this special program the City Centers of Diabetes and Diabetic Foot were
established on the base of Chelyabinsk Medical Academy Clinic (the Diabetic Foot
Center) and on the base of Clinical Hospital № 1 (Diabetes Center).
rendering aid elderly sick complicated by diabetes must have both knowledge of
special care and clinical manifestations of glucose metabolism and its
complications, skill to render an emergency help and ensure an interaction with
relatives of sick and organs of social protection. It is most reasonable to
prepare such specialists from nurses, as far as they are put on shoe bases of
City Diabetes Center
works about 2 years and its activities consist of:
of endocrinologist, ophthalmologist, nephrologist etc;
The staff of this
center includes 2 nurses and 2 doctors. Coordinator of the school for patients
is chief nurse (nurse manager). The number of the patients in one group is 10.
People in the group are of same age, interest or education, if possible. The
study cycle is 16 hour in 4 days. The study day consists of the lectures with
breaks. Educators (endocrinologist, podiatrist, podiatric nurse) tell about
diet, special food item for suffers from diabetes which are produced by local
plants, about modern sugar reducing medicine and insulin therapy, about physical
activity and exercise, about podiatric care, about signs of worry (hyperglycemia
or its long-term complications). Educators help the patients understand and
accept the seriousness of his disease and the importance of daily self-care.
They assess, update, and reinforce their patient's self-care skills; for
example, insulin injection, planning meals, and foot care. Regular follow-up is
encouraged: feet and legs should be examined at each health care visit and
patient should have annual dilated-eye examinations.
service carries out foot care and diagnostic help. All patients with diabetes
should be given a complete foot examination at each visit (or at least four
times a year). Saving the diabetic foot and preventing amputation requires the
of feet at risk.
recurrence of foot ulcers.
Patient Education Principles:
patients on the importance of regular foot care.
about the relationship between neuropathy, peripheral vascular disease, and foot
to avoid risk factors associated with worsening of neuropathy.
not to smoke - particularly if they have peripheral vascular disease.
about special shoes for preventing or treating foot problems.
to a certified pedorthist if they have foot deformities or otherwise need
about the availability of podiatric services; encourage patients to use these
Furniture, computer and
technique with help of pharmaceutical company equipped school for patients. The
podiatrist service works at base of surgical outpatient department. There are
some problems in the work of Chelyabinsk City Diabetic center. First of all,
it's a physician priority in prophylactic field. As I said, we consider that
nurses have to prevent diabetes complication, to educate patients and
The second, there are
not enough visual aids for patients' education such as Blood Glucose Meters,
Non-invasive Blood Glucose Meters, Test Strips for Visual Reading, Syringes and
Injection Products, Urine Testing Products. We have not possibility to use any
software in spite of we have a computer at study. We have not any special
software product for diabetes patient, for example, Computerized Meal Planning,
Controlling Diabetes at the Keyboard, Computerizing Your Meter.
The third, patients
have podiatric care only at podiatrist room
at the polyclinic or, if it needs, at the in-patient surgical department.
They have not qualified help at own homes.
This problem we try to
decide at special Chelyabinsk City’s Diabetic Foot Center. We master by
practice a model of the complex
nurses' crews. The crew consists from
consultants (podiatrist, endocrinologist and others)
goals of this crew are:
Care at the pre- and post-hospital treatment
Education of patients
Monitoring for patients with Diabetic foot syndrome
Making doctors' prescription and procedures
Social and psychological help for patients
Interaction with social service
Conducting of medical documentation
Integration of activity with activity of the Diabetic foot center
The main problems are:
staff (there are only one crew - 2
nurses - for … patients)
material equipment (there is a shortage of dressing and antiseptics even)
Lack of special
educated nurses (at Chelyabinsk State Medical Academy have been worked up a
program of podiatric nurses and nurse managers education)
We consider that worthy
adapting principles of the care on Russian ground lead to the developing of
complex nurses' crews, which would be dispensary helpful for patients with
diabetic foot syndrome. We have many problems, especially financial and
material. But we have a wish to help our patients.
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Сестринское обозрение (Nursing Review)