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A nursing metaparadigm perspective of diabetic foot ulcer care

28 March 2019
Volume 28 · Issue 6

Abstract

Diabetic foot ulcers (DFUs) are a serious complication of diabetes that impact on the patient, their social environment, overall health, and on nursing practice. Nursing scholars have integrated theories on practice to overcome these problems, but a lack of agreement in the available literature acts as a barrier to implementing these in practice. For that reason, using a nursing metaparadigm as a theoretical framework would assist nurses in managing care purposefully and proactively, thus possibly improving outcomes. There has been little discussion about the nursing metaparadigm in relation to DFU care. This article aims to identify why Fawcett's theory of the nursing metaparadigm is important as a fundamental part of DFU care. Understanding this will help to elucidate the phenomenon of DFUs. Moreover, identifying the elements of the DFU care framework is essential to improve reflective practice and intervention. This article discusses the concept of the nursing metaparadigm and its implications for practice in the care of patients with DFUs.

Diabetic foot ulcers (DFUs) are a serious consequence of diabetes, affecting patients' health outcomes and may lead to lower extremity amputation (Parekh et al, 2011). In recent years, the incidence of lower extremity amputation because of ulceration has increased; and robust epidemiological reports have found excess mortality in patients with diabetic foot syndrome (Chammas et al, 2016; Narres et al, 2017). The International Diabetes Federation stated that 9.1 to 26.1 million people with diabetes will suffer from DFUs each year (Armstrong and Boulton, 2017). DFUs are the most significant and devastating problem that patients with diabetes face (Priyadarshika and Sudharshani, 2018). Numerous studies have documented that DFUs commonly lead to such health issues as decreased patient quality of life, problems in the social environment, impacts on overall health, and an increased nursing workload (Aalaa et al, 2012; Fejfarová et al, 2014; Sekhar et al, 2015; Macioch et al, 2017). Patients exhibiting blood glucose levels of HbA1c ≥8 mmol/mol, peripheral arterial diseases (PAD), hypertriglyceridemia, hypertension, neuropathy, infection, neuroischemic foot, and with a history of smoking, are recognised as being at a high risk of DFUs and lower extremity amputation (Boyko et al, 2018).

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