Diabetes: Causes, Complications & Foot Wounds - Essay Sample

Introduction

Diabetes is a condition brought about by either inadequate production of insulin or the inability of the body to utilize this hormone. The result is an increase in blood sugar levels. Diabetes has a myriad of complications, including chronic wounds. These wounds are commonly referred to as diabetic foot since they are usually located in the extremities, especially the feet. These wounds develop due to various factors. Increased blood sugar levels cause constriction of blood vessels, reducing blood flow to the extremities. A decrease in blood supply impairs wound healing. Diabetes also causes peripheral neuropathy, a complication that involves a compromise of the peripheral nerves (Forbes & Cooper, 2016). These patients are prone to injuries due to the decreased sensations and subsequent chronic wounds. Another factor contributing to the causation of diabetic foot is immune system deficiency secondary to high blood glucose levels, impairing the body's natural healing process (Medscape, 2019). This factor slows down the healing of wounds, increasing the rate of infection. The number and exacerbations of diabetes-related wounds can be controlled through modifications in some areas of the health care setting. This paper will use the Plan-To-Do-Act Model to test for implementation of changes that can reduce the occurrence of chronic diabetic wounds.

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Literature

The article written by Forbes and Cooper offers comprehensive and evidence-based information on the process of development of diabetic complications. It further outlines the pathways through which these complications develop. It also explores the various steps in these pathways that can be potential targets for therapeutic intervention. Medscape 2019 further outlines and illustrates the complications of Diabetes, including diabetic foot and other complications. Nurses play a critical role in the management of diabetic patients in the hospital setting (Lippincott Nursing Center, 2019). This article further analyzes on the types of diabetes and nursing interventions for the management of the same. The article outlines specific roles that every nurse should play when dealing with these patients. Vissarion et al. 2015 emphasize the critical role played by education on the management of Diabetes. Education programs, directed towards equipping patients and their families with the knowledge about this disease has dramatically improved patient outcomes. These people are educated on self-care and management of the disease through ways such as lifestyle modifications.

Plan-Do-Study-Act

The PDSA is a handy tool for testing, implementing, and documenting change in an organization. This tool can be applied in testing various ways of controlling the occurrences and exacerbations of diabetic wounds in a healthcare setting.

Step I: Plan

In health care today, the wound care journey suffers shortcomings which range from nurses that are not adequately educated on wound care and infection control, to inadequate knowledge of sterilization of wounds and equipment. The goal of this test is to decrease the occurrences of these wounds tremendously. This will be carried out through:

Implementing timers for a turning schedule. This will involve installing timers at the nurses' stations. These timers go off every two hours, prompting the nurses to turn the patients. This will help control pressure ulcers on immobile patients. Hospitalized patients that are not totally confined to the bed will be encouraged to ambulate and will be assisted to do so.

Infection control. This measure will be implemented through regular cleaning and debriding of wounds, proper dressing, and adherence to the appropriate antibiotic therapy.

Better nutrition for diabetic patients. This will help boost the immune system of the patients, hence improving the body's natural wound healing process.

Mobility for other patients will also be emphasized. This will involve urging these patients to walk around and engage themselves in physical exercise. This will improve circulation to the extremities and maintain patency of the peripheral blood vessels. Mobility will, therefore, promote rapid wound healing of existing ulcers as well as contribute to the prevention of developing new wounds.

Hygiene, both on the part of the nurses and the patient, is vital in the wellbeing and recovery.

Psychosocial support is necessary for these patients. They need this support to accept that Diabetes is a chronic disease, and drastic modifications in their lifestyle are mandatory to keep the complications at bay.

Comfort measures (pain control) through timely and appropriate wound care and administration of analgesics.

Make a class that is required of all nurses on the floor to attend and educate nurses on Diabetes and its effect on wound healing. Teach them how to properly manage Diabetes and how to properly teach patients on diabetes management. It is important to also educate these patients on the advantages of long term diabetic control in a bid to avert the complications of Diabetes (Vissarion et al, 2015).

Increasing the staff of the various hospital units handling diabetic patients. This will enable nurses to allocate more time per patient, improving the quality of care that each patient receives. Increasing the nursing staff will also reduce the occurrence of medical errors since the team will not be under pressure to handle many patients.

Data will be gathered. This data will include patient details and their progressive response to the above interventions. It is expected that patients with chronic wounds will generally improve. Their wounds will start healing with reduced development of new wounds.

Step II: Do

This is the stage of implementation of this change. All the measures discussed above are implemented while keeping records. These records will include the day to day progress of the patients, the types and frequency of nursing interventions as well as the patient response to these interventions. Record the number of complications resulting from Diabetes and compare to complications before class and timer implementation. The challenges experienced are also recorded.

Step III: Study

The records taken in the step above are thoroughly analyzed. Data that was collected before the implementation of change is compared to the data collected after the change. It is then essential to conclude whether the change satisfied the goal of the whole process. Was there a tremendous reduction in the occurrence of wounds secondary to Diabetes?

Step IV: Act

If the test process resulted in a successful reduction in the occurrence of diabetic wounds, then the change is implemented in the day to day patient care routine. Shortcomings of the change are documented, and possible improvements recommended. If a different approach from the one achieved is preferred, then the plan-Do-Study-Act is started again, to test the new plan.

Desired Outcomes

After the rolling out of this test for change, it is expected that the patients will improve tremendously. The nurses will be equipped with proper wound care techniques and practices. They will clean, debride and dress wounds appropriately (Lippincott Nursing Center, 2019). Through the implementation of this knowledge, patients will chronic wounds are expected to improve tremendously. The patients will have minimal or no wound infections. There will be reduced occurrences of new wounds in hospitalized patients due to frequent turning and ambulation. The patients will be adequately equipped with knowledge of Diabetes and its complications. They will be driven towards a personal glycemic control through dietary, pharmacological and lifestyle modifications. These patients will improve their diets and increase their levels of physical activity (Vissarion et al, 2015). The cumulative effect of all these changes is expected to be better glycemic control and eventual elimination of the complications of Diabetes Mellitus.

Conclusion

Diabetes is a condition brought about by either inadequate production of insulin or the inability of the body to utilize this hormone. This results in increased blood sugar levels. Lack of long term glycemic control leads to complications such as peripheral neuropathy, peripheral vascular disease causing vasoconstriction and a compromised immune system. Cumulatively, these factors contribute to the development of chronic ulcers in the extremities, most frequently in the feet. This is further compounded by frequent infections and slowed wound healing. Using the Plan-Do-Study-Act model, changes that improve patient outcomes can be tested and implemented. Changes in the health setup such education of nurses on proper wound care practices, increasing the mobility of hospitalized patients through frequent turning can tremendously decrease the occurrence and complications of these wounds. Other measures that can be adopted include psychosocial support, proper nutrition and adequate pain control. The desired outcomes include reduced incidents and exacerbations of chronic diabetic wounds and aversion of the complications of this disease.

References

Forbes. J.M.,Cooper.,M. (2016). Mechanisms of Diabetic Complications. Pubmed. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23303908/

Lipincott Nursing Center (2019). Managing Diabetes in the Hospital Setting. Retrieved from: https://www.nursingcenter.com/clinical-resources/nursing-pocket-cards/managing-diabetes-in-the-hospital-setting/

Medscape (2019). Chronic Microvascucar Complications of Diabetes Mellitus. Retrieved from: https://reference.medscape.com/features/slideshow/dmc/

Vissarion., Et al. (2015). Improvement Of Diabetic Patients Nursing Care By The Development Of Educational Programs. Health psychology research, 2(1).