Nursing Roles in Diabetic Foot Care: An Interpretive Description Study

Abstract

Aim: Despite low rates of diabetic foot screening, increasing acute care costs for diabetic foot ulcers (DFU), and higher rates of diabetes-related amputation in equity-denied communities in Canada, there is a limited understanding of nursing involvement in diabetic foot care in the current literature. The purpose of this qualitative interpretive descriptive study is to explore the roles that nurses experience while providing care to prevent DFU or support adults with DFU in Ontario. Procedure/Method: A purposeful sample of 15 experienced nurses, specializing in diabetes care, wound care, and foot care from across Ontario, participated in semi-structured interviews. Using Thorne’s interpretive description methodology, a conceptual description and narrative of nursing DFU care in Ontario was created from the interview transcripts and field notes. Results: Five themes were identified: 1) requiring specialized skills and education, 2) noticing inequities in nursing care, 3) navigating a scattered and siloed system, 4) responding to the moment, and 5) evaluating through stories. Nurses described care as variable between regions and practice settings due to differences in nursing education, training, and practice support. Participants noted multiple challenges to providing DFU care in Ontario, including complex referral processes, lack of affordable preventive care, limited monitoring of patient outcomes, and variable access to offloading devices, footwear, and vascular surgery. Implications/Applications: This study offers insight into current nursing roles and underscores the need for standardized and integrated care for people living with DFU across various sectors (i.e., home and primary care). Timely assessment and treatment of DFUs would be facilitated by standardization of access to nurses specialized in DFU care, in addition to intersectoral monitoring and measurement of patient outcomes.