Factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer.

AIMS: To explore the factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer. BACKGROUND: The 30-day readmission rate of patients with diabetes-related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self-monitoring blood glucose promotes optimal glycaemic control. DESIGN: A comparative descriptive study. METHODS: In this study, 200 participants, who had been hospitalized due to diabetes-related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self-efficacy and knowledge) and pre-hospitalization self-monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self-monitoring blood glucose behaviour delivery was collected again. RESULTS: Five variables explained 47% of the variance in the delivery of self-monitoring of blood glucose at home. The delivery of hospital-to-home transitional self-monitoring blood glucose behaviour was more likely for individuals with higher pre-discharge self-efficacy, higher post-discharge self-efficacy, more attention to pre-hospitalization glycaemic status and post-discharge insulin usage and those without an insensitive foot. CONCLUSION: Self-monitoring blood-glucose behaviour should be promoted among post-discharge patients with diabetes-related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan.

Psychometric evaluation of the Farsi version of the diabetes foot self-care bahavior scale.

BACKGROUND: Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran. METHODS: In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach's alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC). RESULTS: In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575-0.925; P < 0.001), respectively. CONCLUSIONS: The Farsi version of DFSBS (F-DFSBS) has good validity and reliability, and due to its appropriate psychometric properties, this tool can be used in future studies.

Factors associated with foot ulcer self-management behaviours among hospitalised patients with diabetes.

AIMS AND OBJECTIVES: To determine prehospitalised diabetes-related foot ulcer (DFU) self-management behaviours and explore the factors associated with these behaviours. BACKGROUND: Although there are many studies that explore DFU prevention and treatment, to our knowledge, there are no quantitative studies of DFU self-management behaviours. DESIGN: Cross-sectional design. METHODS: From June 2015-June 2016, 199 hospitalised patients with DFU were given a survey questionnaire at a medical centre in northern Taiwan. DFU self-management behaviours, diabetes foot self-care behaviours, beliefs in regard to barriers to DFU self-management behaviours, and knowledge regarding warning signs of DFU deterioration were assessed by well-designed measurement tools. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to ensure quality reporting during this observational study (see Supporting Information Appendix S1). RESULTS: The results revealed that 62.8% of participants never monitored their blood glucose level when they had foot ulcers, and 63.8% never sought treatment for their wounds when their wounds were not painful. After controlling for demographic and medical variables, stepwise multiple regression analysis revealed that the following eight significant variables were associated with DFU self-management behaviours: two DFU self-management barrier beliefs, foot self-care behaviour, no treatment for diabetes, poor financial status, employment, knowledge regarding the warning signs of DFU deterioration, and number of DFU hospitalisations. CONCLUSIONS: Diabetes-related foot ulcer self-management behaviours were insufficient. Some modifiable factors and high-risk groups for insufficient DFU self-management behaviour were identified. RELEVANCE TO CLINICAL PRACTICE: Diabetes-related foot ulcer self-management behaviours should be promoted. Interventions that modify the risk factors that were identified in this study can be designed to promote the performance of DFU self-management behaviours.

Knowledge of the Warning Signs of Foot Ulcer Deterioration Among Patients With Diabetes.

BACKGROUND: Seeking treatment in a timely manner may prevent lower limb amputation subsequent to diabetic foot ulcers. Knowledge regarding the warning signs is one importantfactor that is related to the timely treatment seeking of patients with diabetic foot ulcers. However, there is no previousresearch on which aspects of such knowledge that patients with diabetes are lacking. PURPOSE: The aims of this study were to test the psychometric properties of a questionnaire that was designed to assess the knowledge of the warning signs of diabetic foot ulcer deterioration and to determine the knowledge of these warning signs among patients with a history of diabetic foot ulcers. METHODS: A cross-sectional study design was used. Patients with a history of diabetic foot ulcers were recruited using convenience sampling (N = 385). Data were analyzed using Spearman's rank correlation and the Mann-Whitney U test. RESULTS: The questionnaire showed good known-group validity, satisfied internal consistency (Kuder-Richardson Formula 20 = .82), and exhibited acceptable 2-week test-retest reliability (Spearman's rho coefficient = .75). More than 30% of the participants were unaware of the warning signs of peripheral vascular insufficiency and severe infection. Of the participants, 75.8% felt that the time to seek medical treatment of diabetic foot ulcers was when they experienced wound deterioration. Those who held this opinion had significantly less knowledge regarding the warning signs of diabetic foot ulcer deterioration than did those who had not. Other factors that were significantly associated with less knowledge included being older, having less education, not having an existing foot ulcer, having no foot ulcer treatment history, and never having received education regarding foot ulcers. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The questionnaire showed adequate validity and reliability and thus may be used by healthcare practitioners and researchers to assess the knowledge of at-risk patients regarding the warning signs of diabetic foot ulcer deterioration. Patient education regarding the importance of timely treatment seeking and warning signs should be promoted.

There is nothing wrong with being a nurse: The experiences of male nursing students in Taiwan.

AIM: Male nurses are reported to experience role strain. Fear of gender stereotyping can be stressful and frustrating for male nursing students, which could make them feel isolated and excluded. The aim of this qualitative study was to investigate how male nursing students in Taiwan perceive the barriers to their experience as nursing students and how they manage these barriers in their study environment and social life. METHODS: A qualitative research approach was used in this study. Data were collected during 2014 from 24 male nursing students from three nursing educational institutes in Taiwan who participated in order to share their experiences by using a semistructured interview. All the interviews were recorded, transcribed verbatim, and analyzed by thematic analysis. RESULTS: The main theme that described the experiences of the male nursing students in Taiwan was: "There is nothing wrong with being a male nurse." Contrary to other studies, role strain for the participants was minimal. The students experienced some barriers because of being a male nursing student, both at school and in their social life. Most of these students tended to manage the barriers by developing positive thinking and coping strategies. CONCLUSION: Nursing educators are encouraged to use the findings from this study to provide appropriate support for male nursing students.

Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes.

OBJECTIVES: Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes. METHOD: A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed. RESULTS: The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group. CONCLUSIONS: The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength.

Effectiveness of individualised intervention on older residents with constipation in nursing home: a randomised controlled trial.

AIMS AND OBJECTIVES: To develop and examine the effectiveness of individualised intervention to reduce constipation among older adults in nursing homes. BACKGROUND: In long-term care facilities, approximately 60-80% of the residents have symptoms of constipation. Constipation may lead to haemorrhoids, faecal impaction, ulcers, intestinal bleeding and can also lead to a decrease in quality of life. Although a high prevalence of constipation in older adults can be seen, there is a lack of empirical evidence for delivering interventions based on individual risk factors of constipation. Many factors cause constipation but the risk factors are different for each individual. DESIGN: A prospective, randomised control trial conducted in northern Taiwan. METHODS: Nursing home residents (n = 43) were randomly assigned to either the control group or the experimental group. The control group received no extra care from the researcher while the experimental group received an individualised intervention and an eight-week follow-up. Participants were assessed using the Bristol Stool Form Scale, the Patient Assessment of Constipation Symptoms, types and dosages of laxative, and bowel sound observations. Data were taken at baseline, four weeks as well as eight weeks after the intervention. RESULTS: The participants in the experimental group had a significantly higher increase in the frequency of defecation (group effect, p = 0·029) and in bowel sounds (interaction effect, p = 0·010) compared to those in the control group. However, the two groups did not differ significantly in symptoms and the severity of the constipation symptoms, Bristol Stool Form and use of laxatives. CONCLUSIONS: The results of this trial suggest that the individualised intervention may be appropriate for decreasing constipation among nursing home residents and encourage further study and confirmation. RELEVANCE TO CLINICAL PRACTICE: Using individualised intervention to enhance the self-care ability related to constipation among older adults is recommended.

Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial.

BACKGROUND: Depression is a major health problem for community-dwelling elderly adults. Since limited resources are available to decrease the high prevalence of depressive symptoms among the elderly adults, improved support for them can be provided if we can determine which intervention is superior in ridding depressive symptoms. OBJECTIVE: To compare the effectiveness of the physical fitness exercise program and the cognitive behavior therapy program on primary (depressive symptoms) and secondary outcomes (6-min walk distance, quality of life, and social support) for community-dwelling elderly adults with depressive symptoms. DESIGN AND SETTINGS: A prospective randomized control trial was conducted in three communities in northern Taiwan. PARTICIPANTS: The elderly adults in the three communities were invited to participate by mail, phone calls, and posters. There were a total of 57 participants who had depressive symptoms and all without impaired cognition that participated in this trial. None of the participants withdrew during the 9 months of follow-up for this study. METHODS: Fifty-seven participants were randomly assigned to one of the three groups: the physical fitness exercise program group, the cognitive behavior therapy (CBT) group, or the control group. The primary (Geriatric Depression Scale-15, GDS-15), and secondary outcomes (6-min walk distance, SF-36, and Inventory of Socially Supportive Behaviors scales, ISSB) were collected immediately (T2), at 3 months (T3), and at 6 months after the interventions (T4). RESULTS: After the interventions, the CBT group participants demonstrated significantly lower symptoms of depression (p=0.009) at T2 and perceived more social support from those around them (p<0.001, <0.001 and =0.004, respectively) at three time-point comparisons than the control group. Moreover, after intervention, participants in the physical fitness exercise program group had decreased GDS-15 scores at three time-point comparisons (p=0.003, 0.012 and 0.037, respectively), had a substantially greater 6-min walk distance (p=0.023), a better quality of life (p<0.001), and a better perceived social support at T2 (p<0.001). CONCLUSIONS: Immediately after a 12-week intervention, there were significant decreases in depressive symptoms and more perceived social support amongst those in the CBT group. When considering the effectiveness in the decrease of depressive symptoms longer term, the increase in the 6-min walk distance and raising the patients' quality of life, physical fitness exercise program may be a better intervention for elderly adults with depressive symptoms.

The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: a prospective study.

BACKGROUND: Although foot self-care behavior is viewed as beneficial for the prevention of diabetic foot ulceration, the effect of foot self-care behavior on the development of diabetic foot ulcer has received little empirical investigation. OBJECTIVE: To explore the relationship between foot self-care practice and the development of diabetic foot ulcers among diabetic neuropathy patients in northern Taiwan. METHODS: A longitudinal study was conducted at one medical center and one teaching hospital in northern Taiwan. PARTICIPANTS: A total of 295 diabetic patients who lacked sensitivity to a monofilament were recruited. Five subjects did not provide follow-up data; thus, only the data of 290 subjects were analyzed. The mean age was 67.0 years, and 72.1% had six or fewer years of education. METHODS: Data were collected by a modified version of the physical assessment portion of the Michigan Neuropathy Screening Instrument and the Diabetes Foot Self-Care Behavior Scale. Cox regression was used to analyze the predictive power of foot self-care behaviors. RESULTS: A total of 29.3% (n=85) of diabetic neuropathy patients developed a diabetic foot ulcer by the one-year follow-up. The total score on the Diabetes Foot Self-Care Behavior Scale was significantly associated with the risk of developing foot ulcers (HR=1.04, 95% CI=1.01-1.07, p=0.004). After controlling for the demographic variables and the number of diabetic foot ulcer hospitalizations, however, the effect was non-significant (HR=1.03, 95% CI=1.00-1.06, p=0.061). Among the foot self-care behaviors, lotion-applying behavior was the only variable that significantly predicted the occurrence of diabetic foot ulcer, even after controlling for demographic variables and diabetic foot ulcer predictors (neuropathy severity, number of diabetic foot ulcer hospitalizations, insulin treatment, and peripheral vascular disease; HR=1.19, 95% CI=1.04-1.36, p=0.012). CONCLUSIONS: Among patients with diabetic neuropathy, foot self-care practice may be insufficient to prevent the occurrence of diabetic foot ulcer. Instead, lotion-applying behavior predicted the occurrence of diabetic foot ulcers in diabetic patients with neuropathy. Further studies are needed to explore the mechanism of lotion-applying behavior as it relates to the occurrence of diabetic foot ulcer.

Development and validation of a diabetes foot self-care behavior scale.

BACKGROUND: Foot self-care practice is one of the most important self-management behaviors to prevent the occurrence of diabetic foot ulcers. A tool that measures all aspects of daily foot care routines and demonstrates good reliability and validity is essential to pinpointing specific foot ulcer problems and evaluating intervention outcomes. There is currently no such tool available. PURPOSE: This study developed a diabetes foot self-care behavior scale (DFSBS) and tested its psychometric properties. METHODS: The researchers reviewed the literature to generate the initial item pool. After expert confirmation of final draft scale content validity, we used convenience sampling to recruit 295 patients with diabetes and peripheral neuropathy who completed the scale. We analyzed results to determine the scale''s psychometric properties, including construct validity, internal consistency, and test-retest reliability. RESULTS: The final scale consisted of a one-factor structure with seven items. The analysis of the scale indicated the DFSBS score as significantly correlated with the foot care subscale score of the Chinese version of the summary of diabetes self-care activity questionnaire (rho = .87, p < .001) and the Chinese version of the diabetes self-care scale (γ = .45, p < .001). Importantly, the DFSBS was found to differentiate between participants with and without a history of foot ulcers (Mann-Whitney Z = -3.09, p < .01). Internal consistency was acceptable (Cronbach''s alpha = .73), and intraclass correlation coefficient for test-retest reliability over a 2-week period was .92. CONCLUSION/IMPLICATIONS FOR PRACTICE: This study provides evidence of the DFSBS validity and reliability. Clinicians may use the DFSBS to screen patients'' foot self-care behavior, and researchers can use it to elucidate foot self-care issues.

Impact of action cues, self-efficacy and perceived barriers on daily foot exam practice in type 2 diabetes mellitus patients with peripheral neuropathy.

AIMS AND OBJECTIVES: To identify the effects of health belief model factors on daily foot-exam practice among diabetes mellitus patients with peripheral neuropathy. BACKGROUND: Daily foot exams are one of the most important self-care behaviours that prevent the occurrence of diabetic foot ulcers and subsequent amputation. Although daily foot exams were under-practiced in patients with peripheral neuropathy, few studies have explored modifiable social-psychological factors related to daily foot exams. DESIGN: A cross-sectional survey was used to collect the data. METHODS: A total of 277 patients with diabetes and peripheral neuropathy were recruited from two hospitals in northern Taiwan. The Family APGAR and Diabetic Foot Ulcer Health Belief Scale (DFUHBS) were used to measure family support and health belief factors respectively. Data on foot-exam practice, perceived self-efficacy and action cues were collected through the use of structured questionnaires. The data were analysed using logistic regression. RESULT: The regression model revealed that select action cues (recommendations from family, friends, or health professionals), perceived self-efficacy and perceived barriers interactively influenced the participants' daily foot-exam practice. CONCLUSION: Factors related to daily foot-exam practice were identified. Specifically, action cues played a significant role in motivating daily foot-exam practice in this group. RELEVANCE TO CLINICAL PRACTICE: This study recognises modifiable factors that influence the daily foot-exam practice of patients with diabetes and peripheral neuropathy. Using the findings of this study, health professionals can design interventions that aim to modify the above factors as a means to promote daily foot-exam practice.

[Nursing management of wound care pain].

Wound care is an important step in promoting wound healing, but it may cause wound care pain. This article aims to explore factors influencing wound care pain and the effectiveness of various interventions to alleviate it. Five major factors that influence wound care pain include inappropriate dressing change techniques, inflammation response, emotion, cognition, and social-cultural factors. Nurses should apply appropriate dressings and dressing change techniques to relieve wound care pain. Music therapy and aromatherapy can alleviate wound pain after dressing change. But distraction techniques should be used in conjunction with consideration of the needs of the individual subject.

[Dressing and wound care pain].

Wound care is an important step for promoting wound healing. Nevertheless it is also a major source of pain for patients with wounds. The results of a survey showed that not only burn patients but also non-burn ones suffered from wound care pain which occurred in inpatients and outpatients. One of the significant factors causing wound care pain was that the dressing adhered to the wound bed. Although some agencies claimed that particular dressings with low adhesion can result in painless removal, the actual effects needed to be verified. Results of clinical trials revealed that for relieving wound care pain of certain kinds of wound, it was recommended to use particular dressings, such as banana leaf dressing, boiled potato peel bandage, Acticoat, Mepital or Mefix.