Abstract:
IMPROVED FOOT MANAGEMENT OF PEOPLE WITH DIABETES BY PRIMARY HEALTH CARE NURSES IN AUCKLAND, NEW ZEALAND
Dr Barbara Daly, School of Nursing, University of Auckland; Prof Bruce Arroll, General Practice and Primary Health Care, University of Auckland; Dr Krishnarajah Nirantharakumar, Institute of Applied Health Research, University of Birmingham, UK; Prof Robert Scragg, School of Population Health, University of Auckland.
AIMS: Evaluate trends in foot examinations and education for people with diabetes by primary health care nurses between 2006-8 and 2016 in Auckland.
OBJECTIVES: To describe and compare the proportion of people with diabetes receiving foot examinations and education by nurses.
METHODS: All primary care nurses in 2006-8 and 2016 were identified and 26% (n=287) and 24% (n=336) randomly sampled and surveyed, respectively. Nurse participants completed a self-administered questionnaire and telephone interview about care provided for people with diabetes in Auckland. Nurses were able to provide information for 265 (86% of the total) patients consulted on a randomly selected day in 2006-8 and 166 (37%) randomly selected patients in 2016.
RESULTS: Significantly more patients consulted by practice nurses received foot examinations in 2016 (58%) compared with 36% in 2006-8. Further, more patients (65%) in 2016 received foot protection advice compared with 26% in 2006-8, mostly relating to self-examination, wearing suitable footwear and moisturising feet and heels. Of the 43% of patients who had no foot examination in 2016, 23% had no previous examination documented. In addition, significantly more nurses in 2016 than in 2006-8 self-reported routinely examining diabetes patient’s feet (45% versus 31%) and giving foot protection advice (28% versus 13%). These practices were associated with nurses undertaking >5 hours of diabetes education within the past five years. However, older and more experienced nurses were less likely to engage in foot protection advice than more recent nurse graduates.
CONCLUSIONS: Practice nurses have significantly expanded their role in managing people with diabetes over the last decade by increasing foot examinations and providing recommended foot care education. Improved management was associated with nurses attending diabetes education in the past five years. Gaps were identified in conducting the recommended number of foot examinations, categorising patient’s risk of foot disease and recording previous examinations.