Overcoming barriers to self-management: The person-centred diabetes foot behavioural agreement

Objective - Behavioural agreements have been proposed as a clinical strategy for improving concordance with diabetes foot self-management practices, both for individuals ‘At-risk’ of, and with active, diabetes foot disease. This narrative review sought to explore the potential supportive role of person-centred diabetes foot behavioural agreements in promoting protective foot self-management behaviours among ‘At-risk’ individuals. Conclusions - Health care professionals (HCPs) involved in diabetes foot risk stratification and management dedicate considerable time, effort and resources to the prevention of diabetic foot ulcers (DFU) and lower extremity amputation (LEA) and are uniquely placed to deliver person-centred diabetes self-management education and support (DSMES) interventions. Written, verbal and non-verbal agreements are consistent with a wider global move toward DSMES approaches, respectful of people’s preferences, and supporting them to undertake protective self-care behaviours. Practice implications - It is theorised that clear communication of the roles of the person with diabetes, their family or carers and HCPs may improve concordance with self-management behaviours. Rather than a punitive measure or means of facilitating discharge of ‘non-concordant’ individuals, person-centred behavioural agreements should be framed positively, as a means of delineating, prescribing and supporting individual diabetes foot-care responsibilities. This is an area worthy of further research.38pubpu

A journey's end, and new roads beckoning

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Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

Introduction Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives. Research design and methods This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives. Results Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients. Conclusions This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients’ own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.https://doi.org/10.1136/bmjdrc-2022-003034pubpu

Duality of practice in clinical research nursing

Mairghread Ellis - ORCID: 0000-0002-3474-533X https://orcid.org/0000-0002-3474-533XBackground: International evidence suggests that Clinical Research Nurses (CRN) can have a dual role incorporating both clinical care and research responsibilities. This duality of role often assists in meeting the clinical care and research needs of the participants and can contribute to the credibility of the CRN role. Conversely, it can also lead to feelings of confusion and role conflict as CRN’s time is divided. Aim: To identify and explore experiences of clinical and research roles among CRNs. This emerged as a theme in a wider research project exploring CRNs’ experiences of working with clinical nurses. Methods: Following an Interpretative Phenomenological Analysis approach, 10 CRNs participated in face-to-face semi-structured interviews. Transcribed data were analysed and a number of themes emerged. Duality of role was one of these. Findings: Findings indicated that if CRNs fulfil a dual role, this can assist in care provision, research delivery and in building positive relationships with clinical nurses. However, there were also instances when a dual role led to clinical nurses questioning the value of research and to issues with competing demands of clinical care and research. These experiences had an important impact on some of the CRNs and led to reflection on the value of their role. Conclusions: This study identifies new understandings of a dual role of the CRN. The findings will inform the preparation and practice of this group of nurses, whilst also leading to a deeper understanding of the CRN’s role in care and research delivery. It will also contribute to a wider appreciation of organisational factors and social interactions that impact on health care research.https://doi.org/10.1177/1744987121107097627pubpub1-

Honey bees repellent device: preliminary experimental research with the bees hearing sensitivity

Bees are insects that attack, to protect the hive, when they feel threatened. The main objective in this paper was to build an electronic device capable of repelling bees. Thus, a study of the hearing thresholds, of honey bees, has been developed to find out the frequencies range are most sensitive. This knowledge can be important to identify a frequency or a sound capable of repealing them. We also present an electronic circuit developed to build a repelling device able to reproduce a recorded sound or periodic sound. We report also a series of laboratory behaviour experiments, where honey bees (Apis mellifera spp.) had to make the choice between a box where a sound was being played or another box without sound. The experiments were conducted using the following sound frequencies: 100, 150, 200, 300, 400, 500 and 550 Hz; and also, with the sound of three natural predators: the drone, the swallow and the Asian wasp. The honey bees used in the experiments were previously conditioned to go to the box with sound that contained food in order to associate the sound to the presence of food.info:eu-repo/semantics/publishedVersio

It’s time we talked about Charcot foot: Results of a podiatry patient education questionnaire

Ellis, Mairghread - ORCID 0000-0002-3474-533X https://orcid.org/0000-0002-3474-533XIn contrast with diabetic foot ulceration (DFU) and lower-extremity amputation (LEA), current Scottish patient information leaflets reserve Charcot foot education for individuals ‘In Remission’ from, or with active, Charcot foot. A small group of Scottish NHS podiatrists recently agreed Charcot foot education should be delivered to all ‘At-risk’ individuals with diabetic peripheral neuropathy. This study sought to compare discussion about diabetes foot disease and Charcot foot between ‘At-risk’ and ‘In Remission’ groups among this cohort. Fourteen participants completed an ‘At-risk’ component of the Charcot foot patient education questionnaire, while six also completed an ‘In Remission’ component. Topics investigated for both groups included DFU and LEA risk, footwear and insoles, and signs of infection and Charcot foot. Frequency of discussion data was captured with a five-point Likert scale. Median response and interquartile range (IQR) were described and compared between groups. Median values and IQR for discussion of DFU and LEA risk were 5 (IQR 1) and 3 (IQR 1.25) respectively for ‘At-risk’ groups, and 5 (IQR 0.25) and 3 (IQR 2), respectively, among the ‘In Remission’ group. For discussion of footwear and insoles, the median response was 4 (IQR 1) for ‘At-risk’ and 5 (IQR 1) for ‘In Remission’ groups, reversed for discussion of signs of infection. The greatest between-group discrepancy was found for discussion of Charcot foot, with median responses and IQR found to be 3 (IQR 2) and 5 (IQR 0.25) for ‘At-risk’ and ‘In Remission’ groups, respectively. This discrepancy has potential implications for Charcot foot educational strategies, audit and research. It is proposed that ‘always’ should be the benchmark for frequency of Charcot foot education, not just for those ‘In Remission’ but also those ‘At risk’.https://www.diabetesonthenet.com/journals/issue/590/article-details/its-time-we-talked-about-charcot-foot-results-of-a-podiatry-patient-education-questionnairehttps://www.diabetesonthenet.com/journal/the-diabetic-foot-journal22pubpub

Charcot neuroarthropathy patient education among podiatrists in Scotland: a modified Delphi approach.

From PubMed via Jisc Publications Router.Publication status: epublishHistory: received 2018-08-20, accepted 2018-09-12Background This evaluation sought to determine current Charcot neuroarthropathy (CN) diabetes patient education practices among Scottish National Health Service (NHS) and academic podiatrists and evaluate novel visual tools and develop expert consensus for future practice. Methods Questionnaires collected mixed qualitative and quantitative responses, analysed concurrently within a convergence coding matrix. Delphi methodology permitted member-checking and agreement of consensus over two rounds. Results Fourteen participants (16.28%) completed a Round One questionnaire, leading to the generation of four themes; Experience; Person-Centred Care and the Content and Context of CN patient education. Seven consensus statements were subsequently developed and six achieved over 80% agreement among 16 participants (18.60%) with a Round Two questionnaire. Respondents agreed CN patient education should be considered for all ‘At-risk’ individuals with diabetic peripheral neuropathy (DPN). Verbal metaphors, including the ‘rocker-bottom’ foot, soft or brittle bones, collapsing, walking on honeycomb and a shattering lightbulb were frequently employed. Visual tools, including visual metaphors and The Charcot Foot Thermometer, were positively evaluated and made available online. Conclusions Key findings included respondent’s belief that CN education should be considered for all individuals with DPN and the frequent use of simile, analogy and metaphor in CN education. The concept of ‘remission’ proved controversial due to its potential for misinterpretation.115