Chapter 1

Chapter 1: Introduction to the Study
Introduction
Diabetic foot ulcer (DFU) is one of the complications of diabetes. Uncontrolled diabetes can cause complications such as neuropathy which is the leading cause of DFU, retinopathy which can cause blindness, and nephropathy that leads to renal failure and other cardiovascular complications (Mello, Pires, & Kede, 2017). There has been research on diabetic foot ulcers, but there is a gap between patient perception and behavior on the topic. There is a need for educational programs that will promote proper prevention of DFU through the collaboration of providers and patients. Patients are encouraged to be co-participants in their care where providers will evaluate them to make sure they have proper knowledge and education for self-management and self-care (Mello et al., 2017).
This DPI project assessed patients’ health, diabetic foot care, and other devices used for prevention of DFU. The research investigated the effectiveness of diabetic education and behavior on footwear and application of foot cream on preventing foot ulcers. It also investigated risk factors and preventive behaviors that can reduce the development of diabetic foot ulcers among patients with diabetes ages 18 and above (Healy, Naemi, ; Chockalingam, 2013). There is a significant relationship between vascular, neurological, orthopedic, and dermatological alteration with DFU (Smanioto, Haddad, ; Rossaneis, 2014). A mixed methodology of both qualitative and quantitative methods was used in this study. Qualitative methods included observation of patients’ knowledge of diabetic foot care and the knowledge of the disease process. Quantitative methods included examining the cause of diabetic foot ulcer and preventive behaviors, examining the relationship between uncontrolled blood sugars and the development of diabetic foot ulcers. Interviews with questionnaires included interviews with audiotape and videotape, direct, non-participant observation, participant observation, field notes, journals, and logs. Some of the questions included asking patients about stinging sensations on feet or legs, sensitive changes noted recently, numbness in legs, and leg pain at rest (Mello et al., 2017).
Background of the Project
Diabetic foot ulcer (DFU) is one of the complications of diabetes. Diabetes affects over 285 million people all over the world. Patients affected by complications of diabetes account for 15%, of which diabetic foot ulcer (DFU) is one of the most common complications. Patients with elevated foot planter are more prone to complications of DFU and infections (Reyzelman, Vartivarian, & Bazarov, 2013). A diabetic foot ulcer is defined as destruction of deep tissues of the skin, infection of the skin, and abnormalities caused to lower extremities (Takehara et al., 2015). According to Dallimore and Kaminski (2015), diabetic foot ulcer is a universal problem that occurs with uncontrolled blood sugars. Diabetic foot ulcers can have a long-term impact, including frequent hospitalization, loss of limb, infection, and decreased quality of life. Complications of uncontrolled diabetes and diabetic foot ulcer have lifelong consequences that include loss of jobs, economic restraint, and burden to families and hospitals. Patients with DFU complain of decreased sensation, neuropathy, tingling, and numbness. One of the gold standards for the treatment of DFU is total contact casting (TCC). Managing blood sugars will prevent complications such as DFU. Dyer (2013) supports technologies that promote self-monitoring of blood sugars at home. Patients who depend on insulin will help providers adjust their medication and give accurate coverage for their insulin.
Consequences of uncontrolled DM2 are more noted in African American patients than other ethnic groups. Most minorities are at risk for complications because of decreased knowledge of the disease, poverty, and no health insurance. Some of the complications include amputation, neuropathy, infections, blindness, and kidney failure (Dauvrin & Lorant, 2014). One of the reasons most patients frequently visit the emergency room is due to uncontrolled blood sugar levels. Treatments include diabetic drugs such as insulin (Nugent, Carson, Zammitt, Smith, & Wallston, 2015). Most research studies have implicated that the majority of patients have poor knowledge about the disease and complications that accompany the disease. However, with proper diabetic education and health care promotion, patients can decrease the formation of DFU, callosities, and callus.
Diabetes is a chronic disease that is estimated to have caused 1.6 million deaths in 2016; 425 million people live with diabetes. It is also estimated that by 2045, the number of new cases with diabetes will rise 629 million (World Health Organization, 2016). According to the World Health Organization (WHO), diabetes will be the seventh leading cause of death in 2030. With the increase in sedentary lifestyles, the number of people with diabetes is increasing in every country. In order to prevent complications associated to Type 2 diabetes (DM2), patients have to avoid the use of tobacco, foods high in saturated fats, eat healthy foods, be physically active, and maintain a healthy weight. One of the challenges with DM2 patients are methods used in obtaining the necessary skills to effectively manage their diabetes and keep their glucose level controlled (Nugent et al., 2015).
According to Dauvrin and Lorant (2014), complications from DM2 are seen more in African American patients than their white counterparts. Most minorities are at risk for complications because of insurance and poverty. Some of the complications include neuropathy, retinopathy, infections, and amputation. Some patients visit the emergency room because of non-compliance with care and uncontrolled blood sugars. Treatments include a change in behaviors and lifestyle. A patient’s willingness to follow the guidelines and pharmaceutical interventions is very important in controlling blood sugars. The main goal is to prevent micro and macro complications that usually accompany uncontrolled blood sugars.
Problem Statement
Diabetic foot ulcers are major complications of diabetes. DFU account for 5.2% of all deaths in the world. DFU accounts for 2–32% of all complications associated with diabetes. Patients with DFU end up with complications such as infections and lower extremity amputation. Unfortunately, some of these complications of DFU result in high costs of hospitalization and morbidity and mortality of patients (Mohamed et al., 2017). It is estimated that most patients with diabetic neuropathy, infections, and/or foot deformity end up with amputation and half of the patients have a second amputation in five years (Prajsnar et al., 2015). DFU has an economic burden on hospitals, it lowers patient’s self-esteem and decreases patient’s quality of life (Mohammed, Mikhael, Ahmed, Al-Tukmagi, ; Jasim, 2016). It is estimated that the cost of treating DFU in the U.S. is approximately $116 billion per year. In the UK, it is estimated to cost about between £639 and £662 per year (Healy et al., 2013).
Purpose of the Project
The purpose of the study was to analyze risk factors that contribute to DFUs’ implication of self-foot- care, educational programs and self-management behaviors in patients with DM2. Variables included patients with diabetes who are 18 years of age and above. Both males and females will participate. Patients were from the Detroit metropolitan area (Smanioto et al., 2014).
There is a significant relationship between vascular, neurological, orthopedic and dermatological alteration with DFU (Smanioto et al., 2014). There is not a significant relationship between neurological, orthopedic and dermatological alteration with DFU (Smanioto et al., 2014). There is no significant relationship between diabetic DFU and mobility and mortality (Nongmaithem et al., 2016). There is a significant relationship to DFU with perceived behavioral unhealthy lifestyle and DFU (Nugent et al., 2015). There is no relationship with DFU with diabetic foot care and self-care management (Nugent et al., 2015). There is a relation between group education and a decrease in DFU (Rise, Pellerud, Rygg, & Steinsbekk, 2013).
A mixed methodology of both qualitative and quantitative methods was used in this study. Qualitative methods included observation of patients’ knowledge of diabetic foot care and the knowledge of the disease process. Quantitative methods included examining the cause of diabetic foot ulcer and preventive behaviors, examining the relationship between uncontrolled blood sugars and the development of diabetic foot ulcers.
Research questions/Hypothesis
P: Among patients with diabetes, is there a relationship between diabetic foot ulcers and self-foot-care behaviors? I: how does the implementation of self-management programs C: compared to the traditional use of medication and other non- preventive programs O: impact the rate of increase in diabetic foot ulcers T: over a period of three months?
Q1: What is the relationship between DFU and self-foot-care?
Q2: Why is DFU the number one reason for lower extremity amputation?
Q3: Is there a relationship between lower extremity neuropathy and DFU?
Q4: Is there a relationship between self-care management and lower extremity DFU?
Q5: Is there a relationship between DFU and modified health behaviors in an adult with DM2?
Q6: Is there a relationship between education and lifestyle changes with DM2 patients?
Advancing Scientific Knowledge and Significance of the Project
In their studies of short-term educational programs, Monami et al. (2015) state that there is a need for educating patients about their disease process and for patients to fully participate in their care. Most patients are aware of the consequences of diabetes and of being non-complaint with their cares. Some of the risk factors that patients are aware of include high cholesterol, increased blood pressure, history of smoking, high glycemic levels, and callus. There is a gap in educating patients on foot hygiene and general foot care. There is a need to educate patients on foot care that includes checking

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