Exploring nursing practice excellence in diabetic foot care: a qualitative study of Japanese advanced practice nurses

Abstract

Background

Diabetes mellitus is a common metabolic disease with various complications. Among them, diabetic foot ulcer (DFU) has intractable and serious effects. However, with appropriate care and education, lower-limb amputation can be avoided. Therefore, preventive intervention by nurses is particularly important to avoid lower-limb amputation due to diabetic foot lesions.

Purpose

The purpose of this study was to identify the nursing practice competencies required for diabetic foot care as perceived by advanced practice nurses.

Methods

This study included eight certified nurse specialists and certified nurses who had completed an advanced practice nurse education program in Japan. The subjects underwent individual semi-structured interviews regarding the nursing practice competencies required in foot care for patients with diabetes. Data were analyzed qualitatively inductively.

Results

A total of 136 codes were obtained from which 19 subcategories and six major categories were extracted. These were as follows: ability to assess patients from multiple perspectives, such as assessment using kinematic factors and predicting the patient's future; passion for foot care; direct foot care techniques; building relationships with patients to facilitate foot care, such as techniques to promote patient self-care; ability to enhance teamwork by involving multiple professions, such as human resource development and building a smooth collaborative system; and ability to manage the foot care environment in the organization. Particularly, assessment techniques using kinematic components were considered to encompass areas that are fundamental to physical therapy and are not adequately included in current foot care training programs.

Conclusions

In addition to the ability to care for patients while analyzing and evaluating varied information, including kinematic factors, practical skills of nurses involved in foot care for patients with diabetes were characterized by management skills, including leadership and negotiation skills.