Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani M. Nurses' role in diabetic foot prevention and care; a review. J Diabetes Metab Disord.. 2012; 11:(1)

Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLoS One.. 2019; 14:(6)

Ahmad A, Abujbara M, Jaddou H, Younes NA, Ajlouni K. Anxiety and depression among adult patients with diabetic foot: prevalence and associated factors. J Clin Med Res.. 2018; 10:(5)411-418

Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci.. 2015; 1353:(1)89-112

Baldacchino DR. Nursing competencies for spiritual care. J Clin Nurs.. 2006; 15:(7)885-896

Batcheller J, Davis J, Yoder-Wise PS. Hope for the future: intensifying spirituality in the workplace. Nurs Adm Q.. 2013; 37:(4)309-316

Bhuvaneswar CG, Epstein LA, Stern TA. Reactions to amputation: recognition and treatment. Prim Care Companion J Clin Psychiatry.. 2007; 9:(4)303-308

Britteon P, Cullum N, Sutton M. Association between psychological health and wound complications after surgery. Br J Surg.. 2017; 104:(6)769-776

Büssing A, Pilchowska I, Surzykiewicz J. Spiritual needs of Polish patients with chronic diseases. J Relig Health.. 2015; 54:(5)1524-1542

Butcher HK, Bulechek GM, McCloskey JM, Wagner CM. Nursing interventions classification (NIC), 7th edn. St Louis (MO): Mosby; 2019

Caldeira S, Carvalho EC, Vieira M. Spiritual distress-proposing a new definition and defining characteristics. Int J Nurs Knowl.. 2013; 24:(2)77-84

Casarez RL, Engebretson JC, Ostwald SK. Spiritual practices in self-management of diabetes in African Americans. Holist Nurs Pract.. 2010; 24:(4)227-237

Chan MF, Chung LY, Lee AS Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: results of a cluster analysis. Nurse Educ Today.. 2006; 26:(2)139-150

Cockell N, McSherry W. Spiritual care in nursing: an overview of published international research. J Nurs Manag.. 2012; 20:(8)958-969

Costa RHR, Cardoso NA, Procópio RJ, Navarro TP, Dardik A, de Loiola Cisneros L. Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia. Diabetes Metab Syndr. 2017; 11:S583-S587

Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med.. 2005; 20:(10)953-957

de Groot M, Golden SH, Wagner J. Psychological conditions in adults with diabetes. Am Psychol.. 2016; 71:(7)552-562

de Vera N. Perspectives on healing foot ulcers by Yaquis with diabetes. J Transcult Nurs.. 2003; 14:(1)39-47

Devarajooh C, Chinna K. Depression, distress and self-efficacy: The impact on diabetes self-care practices. PLoS One.. 2017; 12:(3)

Duke N, Wigley W. Literature review: the self-management of diet, exercise and medicine adherence of people with type 2 diabetes is influenced by their spiritual beliefs. J Diabetes Nurs.. 2016; 20:(5)184-190

El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care.. 2012; 6:(2)269-274

Ettun R, Schultz M, Bar-Sela G. Transforming pain into beauty: on art, healing, and care for the spirit. Evid Based Complement Alternat Med. 2014; 2014

Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care.. 2012; 35:(2)259-264

Frouzandeh N, Aein F, Noorian C. Introducing a spiritual care training course and determining its effectiveness on nursing students' self-efficacy in providing spiritual care for the patients. J Educ Health Promot. 2015; 4

George J, Mackinnon A, Kong DC, Stewart K. Development and validation of the Beliefs and Behaviour Questionnaire (BBQ). Patient Educ Couns. 2006; 64:(1-3)50-60

Glaser R., Kiecolt-Glaser J. K. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol. 2005; 5:(3)243-251

Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res.. 2010; 89:(3)219-229

Gupta PS, Anandarajah G. The role of spirituality in diabetes self-management in an urban, underserved population: a qualitative exploratory study. R I Med J. 2013; 97:(3)31-35

Halliday JA, Hendrieckx C, Busija L Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES–Australia. Diabetes Res Clin Pract. 2017; 132:27-35

Hebert RS, Jenckes MW, Ford DE, O'Connor DR, Cooper LA. Patient perspectives on spirituality and the patient-physician relationship. J Gen Intern Med.. 2001; 16:(10)685-692

Heidarzadeh M, Amohammadi M. Spiritual growth in patients with type II diabetes mellitus: A qualitative study. J Res Dev Nurs Midw. 2017; 14:(2)34-44

Hu J, Wallace DC, McCoy TP, Amirehsani KA. A family-based diabetes intervention for Hispanic adults and their family members. Diabetes Educ.. 2014; 40:(1)48-59

Imeni M, Sabouhi F, Abazari P, Iraj B. The effect of spiritual care on the body image of patients undergoing amputation due to type 2 diabetes: a randomized clinical trial. Iran J Nurs Midwifery Res.. 2018; 23:(4)322-326

International Council of Nurses. The ICN code of ethics for nurses. 2012. (accessed 23 July 2020)

Isaac KS, Hay JL, Lubetkin EI. Incorporating spirituality in primary care. J Relig Health.. 2016; 55:(3)1065-1077

Jacobsen JM. Nursing's role with amputee support groups. J Vasc Nurs.. 1998; 16:(2)31-34

Janssen EP, Köhler S, Stehouwer CD The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: the Maastricht study. J Am Geriatr Soc.. 2016; 64:(11)e201--e206

Jeyaraman K, Berhane T, Hamilton M, Chandra AP, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single centre in the Northern Territory of Australia. BMC Endocr Disord.. 2019; 19:(1)

Jiang X, Wang J, Lu Y, Jiang H, Li M. Self-efficacy-focused education in persons with diabetes: a systematic review and meta-analysis. Psychol Res Behav Manag. 2019; 12:67-79

Kalra B, Kalra S, Balhara YP. Psychological assessment and management in diabetes. J Pak Med Assoc.. 2013; 63:(12)1555-1557

Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab.. 2018; 22:(5)696-704

Kasiya MM, Mang'anda GD, Heyes S The challenge of diabetic foot care: Review of the literature and experience at Queen Elizabeth Central Hospital in Blantyre, Malawi. Malawi Med J.. 2017; 29:(2)218-223

Keukenkamp R, Merkx MJ, Busch-Westbroek TE, Bus SA. An explorative study on the efficacy and feasibility of the use of motivational interviewing to improve footwear adherence in persons with diabetes at high risk for foot ulceration. J Am Podiatr Med Assoc.. 2018; 108:(2)90-99

King MB, Koenig HG. Conceptualising spirituality for medical research and health service provision. BMC Health Serv Res. 2009; 9

Koenig H. The spiritual care team: enabling the practice of whole person medicine. Religions. 2014; 5:1161-1174

Lundberg PC, Kerdonfag P. Spiritual care provided by Thai nurses in intensive care units. J Clin Nurs. 2010; 19:(7–8)1121-1128

Marzen-Groller K, Bartman K. Building a successful support group for post-amputation patients. J Vasc Nurs.. 2005; 23:(2)42-45

Massey CN, Feig EH, Duque-Serrano L, Wexler D, Moskowitz JT, Huffman JC. Well-being interventions for individuals with diabetes: a systematic review. Diabetes Res Clin Pract. 2019; 147:118-133

McBrien B. Nurses' provision of spiritual care in the emergency setting—an Irish perspective. Int Emerg Nurs.. 2010; 18:(3)119-126

Messina R, Rucci P, Sturt J, Mancini T, Fantini MP. Assessing self-efficacy in type 2 diabetes management: validation of the Italian version of the Diabetes Management Self-Efficacy Scale (IT-DMSES). Health Qual Life Outcomes.. 2018; 16:(1)

Mishra SC, Chhatbar KC, Kashikar A, Mehndiratta A. Diabetic foot. BMJ. 2017; 359

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med.. 2009; 6:(7)

Nathan EP, Winkler SL. Amputees' Attitudes toward participation in amputee support groups and the role of virtual technology in supporting amputees: survey study. JMIR Rehabil Assist Technol.. 2019; 6:(2)

Nishio I, Chujo M. The acquisition of a new self-image in patients with type 1 diabetes: a qualitative study. Yonago Acta Med.. 2018; 61:(3)160-165

Nunes MA, Campos-Neto I, Ferraz LC, Lima CA, Rocha TO, Rocha TF. Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data. Sao Paulo Med J.. 2014; 132:(2)80-84

Nurhikmah L, Gayatri D, Nuraini T. Body image related to quality of life diabetic ulcer patients. Enferm Clin. 2019; 29:373-378

Ogrin R, Houghton PE, Thompson GW. Effective management of patients with diabetes foot ulcers: outcomes of an interprofessional diabetes foot ulcer team. Int Wound J.. 2015; 12:(4)377-386

Olorunfemi O, Ojewole F. Medication belief as correlate of medication adherence among patients with diabetes in Edo State, Nigeria. Nurs Open.. 2018; 6:(1)197-202

Parker M, Lee Roff L, Klemmack DL, Koenig HG, Baker P, Allman RM. Religiosity and mental health in southern, community-dwelling older adults. Aging Ment Health.. 2003; 7:(5)390-397

Penckofer S, Ferrans CE, Velsor-Friedrich B, Savoy S. The psychological impact of living with diabetes: women's day-to-day experiences. Diabetes Educ.. 2007; 33:(4)680-690

Polonsky WH, Fisher L, Earles J Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care.. 2005; 28:(3)626-631

Puchalski C, Ferrell B, Virani R Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med.. 2009; 12:(10)885-904

Rahmanian M, Hojat M, Fatemi NS, Mehran A, Parvizy S. The predictive role of spiritual intelligence in self-management in adolescents with type 1 diabetes. J Educ Health Promot. 2018; 7

Rao A, Sibbritt D, Phillips JL, Hickman LD. Prayer or spiritual healing as adjuncts to conventional care: a cross sectional analysis of prevalence and characteristics of use among women. BMJ Open.. 2015; 5:(6)

Rebolledo JA, Arellano R. Cultural differences and considerations when initiating insulin. Diabetes Spectr.. 2016; 29:(3)185-190

Riklikienė O, Spirgienė L, Kaselienė S, Luneckaitė Ž, Tomkevičiūtė J, Büssing A. Translation, cultural, and clinical validation of the lithuanian version of the spiritual needs questionnaire among hospitalized cancer patients. Medicina (Kaunas).. 2019; 55:(11)

Rivera-Hernandez M. Religiosity, social support and care associated with health in older Mexicans with diabetes. J Relig Health.. 2016; 55:(4)1394-1410

Salahshouri A, Zamani Alavijeh F, Mahaki B, Mostafavi F. Effectiveness of educational intervention based on psychological factors on achieving health outcomes in patients with type 2 diabetes. Diabetol Metab Syndr. 2018; 10

Salomé GM, Alves SG, Costa VF, Pereira VR, Ferreira LM. Feelings of powerlessness and hope for cure in patients with chronic lower-limb ulcers. J Wound Care. 2013a; 22:(6)300-304

Salomé GM, Pereira VR, Ferreira LM. Spirituality and subjective wellbeing in patients with lower-limb ulceration. J Wound Care. 2013b; 22:(5)230-236

Salomé GM, de Almeida SA, de Jesus Pereira MT The impact of venous leg ulcers on body image and self-esteem. Adv Skin Wound Care.. 2016; 29:(7)316-321

Salomé GM, de Almeida SA, Mendes B Association of sociodemographic factors with spirituality and hope in patients with diabetic foot ulcers. Adv Skin Wound Care.. 2017; 30:(1)34-39

Seaman S. The role of the nurse specialist in the care of patients with diabetic foot ulcers. Foot Ankle Int.. 2005; 26:(1)19-26

Shapiro JB, Vesco AT, Weil LEG, Evans MA, Hood KK, Weissberg-Benchell J. Psychometric Properties of the Problem Areas in Diabetes: Teen and Parent of Teen Versions. J Pediatr Psychol.. 2018; 43:(5)561-571

Singh DK, Ajinkya S. Spirituality and religion in modern medicine. Indian J Psychol Med.. 2012; 34:(4)399-402

Spiess KE, McLemore A, Zinyemba P, Ortiz N, Meyr AJ. Application of the five stages of grief to diabetic limb loss and amputation. J Foot Ankle Surg.. 2014; 53:(6)735-739

Sridhar GR. Diabetes, religion and spirituality. Int J Diabetes Dev Ctries.. 2013; 33:(1)5-7

Stansbury KL, Harley DA, King L, Nelson N, Speight G. African American clergy: what are their perceptions of pastoral care and pastoral counseling?. J Relig Health.. 2012; 51:(3)961-969

Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012; 12

Subrata SA, Phuphaibul R. Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice. Scand J Caring Sci.. 2019; 33:(2)298-310

Timmins F, Caldeira S. Understanding spirituality and spiritual care in nursing. Nurs Stand. 2017a; 31:(22)50-57

Timmins F, Caldeira S. Assessing the spiritual needs of patients. Nurs Stand. 2017b; 31:(29)47-53

Turns M. The diabetic foot: an overview for community nurses. Br J Community Nurs.. 2012; 17:(9)422-433

van Netten JJ, Bus SA, Apelqvist J Definitions and criteria for diabetic foot disease. Diabetes Metab Res Rev. 2020; 36

Veloza-Gómez M, Muñoz de Rodríguez L, Guevara-Armenta C, Mesa-Rodríguez S. The importance of spiritual care in nursing practice. J Holist Nurs.. 2017; 35:(2)118-131

Verghese A. Spirituality and mental health. Indian J Psychiatry.. 2008; 50:(4)233-237

Vincensi BB. Interconnections: spirituality, spiritual care, and patient-centered care. Asia Pac J Oncol Nurs.. 2019; 6:(2)104-110

Watkins YJ, Quinn LT, Ruggiero L, Quinn MT, Choi YK. Spiritual and religious beliefs and practices and social support's relationship to diabetes self-care activities in African Americans. Diabetes Educ.. 2013; 39:(2)231-239

Werfalli MM, Kalula SZ, Manning K, Levitt NS. Does social support effect knowledge and diabetes self-management practices in older persons with Type 2 diabetes attending primary care clinics in Cape Town, South Africa?. PLoS One.. 2020; 15:(3)

Willemse S, Smeets W, van Leeuwen E, Janssen L, Foudraine N. Spiritual care in the ICU: perspectives of Dutch intensivists, ICU Nurses, and Spiritual Caregivers. J Relig Health.. 2018; 57:(2)583-595

Williams JS, Walker RJ, Smalls BL, Hill R, Egede LE. Patient-centered care, glycemic control, diabetes self-care, and quality of life in adults with type 2 diabetes. Diabetes Technol Ther.. 2016; 18:(10)644-649

Williams MG, Voss A, Vahle B, Capp S. Clinical nursing education: using the FICA spiritual history tool to assess patients' spirituality. Nurse Educ.. 2016; 41:(4)E6-E9

Yang GM, Tan YY, Cheung YB Effect of a spiritual care training program for staff on patient outcomes. Palliat Support Care.. 2017; 15:(4)434-443

Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association [published correction appears in Diabetes Care. 2017;40(2):287] [published correction appears in Diabetes Care. 2017;40(5):726]. Diabetes Care.. 2016; 39:(12)2126-2140

Implementation of spiritual care in patients with diabetic foot ulcers: a literature review

13 August 2020
Volume 29 · Issue 15


Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.

The International Working Group on the Diabetic Foot (IWGDF) defines diabetic foot ulcers (DFU) as full-thickness wounds of the foot presenting with infection, and destruction of skin tissue as a consequence of neuropathy and/or peripheral artery disease in patients with diabetes (van Netten et al, 2020). DFU are associated with a number of complications, such as lower extremity amputation (LEA) and mortality (Costa et al, 2017). Studies have documented that DFU complications significantly impact on subjective wellbeing and spirituality, engendering feelings of powerlessness and loss of hope for recovery (Salomé et al, 2013a; 2013b). When spiritual health is at risk, patients may experience emotional problems that hinder desired outcomes (eg delayed wound healing) (Sridhar, 2013; Britteon et al, 2017). Psychological stress retards the initial inflammatory phase of the wound healing process and affects the hypothalamic-pituitary-adrenal, sympathetic-adrenal medullary axes (Glaser and Kiecolt-Glaser, 2005; Guo and Dipietro, 2010).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content