Nursing care for diabetic foot in primary care: scoping review

Associated Editor: Paula Hino (https://orcid.org/0000-0002-1408-196X) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil

Conflicts of interest: nothing to declare.

Databases	Search Strategies
MEDLINE/ PubMedPortal PubMed	((“Nursing” [Mesh] OR “Nursing” OR “Nurses” [Mesh] OR “Nurse” OR “NursingCare” [Mesh] OR “Care, Nursing” OR “Management, NursingCare” OR “NursingCare Management” OR “Home Health Nursing” [Mesh] OR “Nursing, Home Health” OR “Home Health CareNursing” ) AND (“DiabeticFoot” [Mesh] OR “Diabeticfeet” OR “diabeticfootulcer” OR “footulcer” [Mesh]) AND (“Primary Health Care” [Mesh]OR “Primaryattention” OR “National Health Strategies”))
Scopus	((“Nursing” OR “Nursing” OR “Nursing” OR “Nurses” OR “Nurse” OR “Nursing Care” OR “Care,Nursing” OR “Management, Nursing Care” OR “Nursing Care Management” OR “Home Health Nursing” OR “Nursing, Home Health” OR “Home Health Care Nursing” AND “Diabetic Foot” OR “Diabetic Feet” OR “Diabetic Foot ulcer” OR “Foot Ulcer” AND “Primary Health Care” OR “Primary attention” OR “National Health Strategies”))
Web of Science	((“Nursing” OR “Nursing” OR “nursing” OR “Nurses OR “Nurse” OR “Nursing Care” OR “Care, Nursing” OR “Management, Nursing Care” OR “Nursing Care Management” OR “Home Health Nursing OR “Nursing, Home Health” OR “Home Health Care Nursing”) AND (“Diabetic Foot” OR “Diabetic feet” OR “diabetic foot ulcer” OR “foot ulcer”) AND (“Primary Health Care” OR “Primary attention” OR “National Health Strategies”))
CINAHL	((“Nursing” OR “Nursing” OR “nursing” OR “Nurses OR “Nurse” OR “Nursing Care” OR “Care, Nursing” OR “Management, Nursing Care” OR “Nursing Care Management” OR “Home-= Health Nursing OR “Nursing, Home Health” OR “Home Health Care Nursing”) AND (“Diabetic Foot” OR “Diabetic feet” OR “diabetic foot ulcer” OR “foot ulcer”) AND (“Primary Health Care” OR “Primary attention” OR “National Health Strategies”))
LICACS e BDENF	(Nursing) OR (Nursings) OR (Nurses) OR (Nurse) OR (NursingCare) OR (enfermagem) OR (enfermería) OR (CareNursing) OR (Management, NursingCare) OR (NursingCare, Management) OR (Home Health Nursing) OR (Nursing, Home Health ) OR (Home Health CareNursing) OR (Cuidados de Enfermagem) OR (Assistência de Enfermagem) OR (Cuidado de Enfermagem) OR (atencíon de enfermería) OR (cuidado de enfermería) OR (cuidados de enfermería) AND (Diabeticfoot) OR (Diabeticfeet) OR (Diabeticfootulcer) OR (footulcer) OR (pé diabético) OR (pé diabéticos) OR (úlcera do pé diabético) OR (pie diabético) AND (Primary Health Care) OR (Primaryattention) OR (National Health Strategies) OR (Atenção Primária a Saúde) OR (Atenção Primária) OR (Estratégias de Saúde Nacionais) OR (Atención Primaria de Salud) OR (Estrategias de SaludNacionales)
SciELO	(Nursing) OR (Nursings) OR (Nurses) OR (Nurse) OR (NursingCare) OR (enfermagem) OR (enfermería) OR (Care, Nursing) OR (Management, NursingCare) OR (NursingCare Management) OR (Home Health Nursing) OR (Nursing, Home Health) OR (Home Health CareNursing) OR (Cuidados de Enfermagem) OR (Assistência de Enfermagem) OR (Cuidado de Enfermagem) OR (atencíon de enfermería) OR (cuidado de enfermería) OR (cuidados de enfermería) AND (DiabeticFoot) OR (Diabeticfeet) OR (diabeticfootulcer) OR (footulcer) OR (Pédiabético) OR (PésDiabéticos) OR (úlcera do pédiabético) OR (Pie Diabético) AND (Primary Health Care) OR (Primaryattention) OR (National Health Strategies) OR (AtençãoPrimária a Saúde) OR (AtençãoPrimária) OR (Estratégias de SaúdeNacionais) OR (AtenciónPrimaria de Salud) OR (Estrategias de SaludNacionales)

Author, Year of Publication and Citation	Country	Study Types and Number of Participants	Objectives	Nursing care	Main results
Brasil, 2016⁽¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília (DF): Ministério da Saúde; 2016.⁾	Brazil	Guideline Person with chronic illness	Strengthen and qualify care for people with DM through comprehensiveness and longitudinality of care at all points of care.	Foot examination, wound care and health education.
Brasil, 2013⁽¹³13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Estratégias para o cuidado da pessoa com doença crônica: diabetes mellitus. Brasília (DF): Ministério da Saúde; 2013; 160 p.: il. (Cadernos de Atenção Básica, n. 36).⁾	Brazil	Guideline Person with chronic illness	Strengthen and qualify care for people with this disease through comprehensiveness and longitudinal care at all points of care.	Foot examination and wound care
Daly et al., 2020⁽¹⁴14. Daly B, Arroll B, Nirantharakumar K, Scragg RK. Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand. N Z Med J. 2020;133(1527):39-50.⁾	New Zeland	Cross-sectional quantitative study 336 nurses	To assess trends in foot examinations for people with diabetes by primary health care nurses in Auckland, New Zealand (between 2006-2008 and 2016).	Foot examination and health education	Significantly more users were seen by nurses and received foot exams and foot care education in 2016 compared to 2006-2008.
Mullan et al., 2020⁽¹⁵15. Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs. 2020;29(23-24):4653-73.⁾	Australia	Cross-sectional quantitative study 84 accredited diabetes educators	To assess the priority of primary care providers to manage diabetic foot disease (DFD) throughout the course of the disease compared to other aspects of diabetes care.	Glycemic control, foot examination and referral to a specialized service	When diagnosing type 2 diabetes, review of hemoglobin A1c (HbA1c) has been identified as one of the top three priorities. Foot assessment became a priority for participants (n=73; 78%) with priority podiatry referral (n=50; 53%).
Arruda et al., 2019⁽¹⁶16. Arruda LS, Fernandes CR, Freitas RW, Machado AL, Lima LH, Silva AR. Nurse's knowledge about caring for diabetic foot. Rev Enferm UFPE Online. 2019;13:e242175⁾	Brazil	Cross-sectional quantitative study 237 nurses	Understand nurses’ knowledge about foot care for diabetics in Primary Care.	Feet examination (ballpoint pen, cotton wool and glass of water)	When analyzing the items on diabetic foot prevention, better performance was observed for monofilament and neuropathic foot and lower performance for physical examination; regarding the classification of knowledge, professionals presented unsatisfactory (45.6%) and conflicting (54.4%) knowledge.
Pereira et al., 2017⁽¹⁷17. Pereira LF, Paiva FA, Silva SA, Sanches RS, Lima RS, Fava SM. Nurse's actions in diabetic foot prevention: the perspective of the person with diabetes mellitus. Rev Pesquisa, Cuidado é Fundamental Online. 2017;9(4):1008-1014.⁾	Brazil	Qualitative study 20 people with a medical diagnosis of diabetes	Investigate nurses’ actions to prevent diabetic foot from the perspective of people with diabetes mellitus (DM).	Foot examination and health education	Effective actions to prevent diabetic foot appear peripherally in the data set, and action is limited to health education actions.
Vargas et al., 2017⁽¹⁸18. Vargas C, Lima D, da-Silva D, Schoeller S, Vragas M, Lopes S. Conduct of primary care nurses in the care of people with diabetic foot. Rev Enferm UFPE Online. 2017;11(Supl. 11):4535-4545.⁾	Brazil	Qualitative study 22 nurses	To understand the actions of primary care nurses in caring for people with diabetes mellitus (DM) regarding diabetic foot.	Glycemic control, wound care, foot examination and health education	It was evidenced that nurses’ knowledge about the care of people with DM is partial, superficial and fragmented, not allowing adequate actions, especially to detect the risks of developing diabetic foot and evaluate the examination of the feet.
Oliveira et al., 2016⁽¹⁹19. Oliveira PS, Bezerra EP, Andrade LL, Gomes PLF, Soares MJ, Costa MM. Practice nurse family health strategy in the prevention of diabetic foot. Rev Pesquisa, Cuidado é Fundamental Online. 2016 ;8(3):4841-9.⁾	Brazil	Cross-sectional quantitative study 38 nurses	Identify guidance given by nurses to people with DM on foot care, investigate the frequency of foot examination and the aspects evaluated, and verify which health education activities are carried out by nurses for people with DM.	Foot examination and health education	It was observed that nurses provide guidance on the use of comfortable shoes (n=26; 68.4%), evaluate hair and nails monthly (n=19; 50.0%) and carry out health education activities (n=12; 31 .6%).
Daly et al., 2014⁽²⁰20. Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes. 2014;8(2):139-46.⁾	New Zealand	Cross-sectional quantitative study 287 nurses	Identify the factors associated with the examination of patients’ feet by primary health care nurses.	Foot examination and health education	An 86% response rate was achieved across participants. Nurses examined users’ feet in 46% of consultations.
Martins et al., 2008⁽²¹21. Martins CF, Thofehrn MB, Amestoy SC, Lange C. O fazer que faz a diferença: cuidar de um diabético ferido - pé diabético. Ciência, Cuidado e Saúde. 2008;60:448-53.⁾	Brazil	Experience report	To report the evolution of healing (based on therapeutic care) of a 47-year-old diabetic patient suffering from an injury to the right lower limb, with a supposed indication for amputation, being cared for at a UBS in the city of Rio Grande, RS, Brazil.	Wound care, glycemic control, foot examination, referral to a specialized service	I use therapeutic measures to recover the injured limb. After four weeks of follow-up, the client was very satisfied with the progress of the treatment; however, the presence of granulation tissue was observed throughout the entire length of the wound.
Orihuela Casarra et al., 2005⁽²²22. Orihuela Casarra R, Heras Tebar A, Pozo Gil M. Monofilamento 5.07. Uso en las consultas de Enfermería de Atención Primaria. Rev Enferm. 2005;28(12):43-7.⁾	Spain	Observational quantitative study 62 nurses	Check whether the instrument is used in our Primary Care Service, for which we provide a survey to all nurses.	Feet examination (use of 5.07 monofilament)	The majority of participating nurses (79%) are familiar with 5.07 monofilament; they have this monofilament available for use (62%) and more than half said they use it (55%). The main reasons for not using this monofilament are its unavailability and lack of knowledge about it.
Dias et al., 2017⁽²⁸28. Dias JJ, Santos FL, Oliveira FK. Home visit as a tool for promoting the health the diabetic with an amputated foot. Rev Enferm UFPE Online. 2017;11(12): 5464-70.⁾	Brazil	Experience report	To describe the experience of daily home visits to change dressings in the amputation of four toes resulting from diabetic foot complications, indicating successes and limitations.	Health education, wound care and home visit	Daily home visits (Monday-Friday) contributed to reducing the traumatic wound using 5% papain for two months, in addition to establishing a bond and emphasizing health education information.
Couto et al., 2014⁽²⁹29. Couto TA, Santana VSS, Santos AR, Santos RM. Educação em saúde, prevenção e cuidado ao pé diabético: um relato de experiência. Rev Bahiana Saúde Pública. 2014;38(3):760-8.⁾	Brazil	Experience report	Report the experience of carrying out educational activities on diabetic foot care in a UBS in a municipality in Bahia.	Health education	Among the results of the activities are the improvement in the quality of guidance on foot care offered by nursing technicians during dressings and the adherence of users to treatment after being made aware of the importance of monitoring at the health unit.
Cubas et al., 2013⁽³⁰30. Cubas MR, Santos OM, Retzlaff EM, Telma HL, Andrade IP, Moser AD, et al. Pé diabético: orientações e conhecimento sobre cuidados preventivos. Fisioter Mov. 2013;26(3):647-55.⁾	Brazil	Cross-sectional quantitative study 5 nurses	Verify the knowledge of diabetes program users about preventive care for diabetic foot, identify the guidance patients receive on prevention and observe their adherence to preventive self-care procedures.	Health education	The guidance provided by nurses varies; all claim to provide guidance on wearing shoes and cutting nails; however, adherence to these items is not verified; Furthermore, there is a lack of guidelines such as daily foot examination.

Nursing care	Description of nursing activities carried out in PHC for people with diabetic foot
Foot examination	Inspect the feet⁽¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília (DF): Ministério da Saúde; 2016.^,¹³13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Estratégias para o cuidado da pessoa com doença crônica: diabetes mellitus. Brasília (DF): Ministério da Saúde; 2013; 160 p.: il. (Cadernos de Atenção Básica, n. 36). 14. Daly B, Arroll B, Nirantharakumar K, Scragg RK. Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand. N Z Med J. 2020;133(1527):39-50. 15. Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs. 2020;29(23-24):4653-73. 16. Arruda LS, Fernandes CR, Freitas RW, Machado AL, Lima LH, Silva AR. Nurse's knowledge about caring for diabetic foot. Rev Enferm UFPE Online. 2019;13:e242175 17. Pereira LF, Paiva FA, Silva SA, Sanches RS, Lima RS, Fava SM. Nurse's actions in diabetic foot prevention: the perspective of the person with diabetes mellitus. Rev Pesquisa, Cuidado é Fundamental Online. 2017;9(4):1008-1014. 18. Vargas C, Lima D, da-Silva D, Schoeller S, Vragas M, Lopes S. Conduct of primary care nurses in the care of people with diabetic foot. Rev Enferm UFPE Online. 2017;11(Supl. 11):4535-4545. 19. Oliveira PS, Bezerra EP, Andrade LL, Gomes PLF, Soares MJ, Costa MM. Practice nurse family health strategy in the prevention of diabetic foot. Rev Pesquisa, Cuidado é Fundamental Online. 2016 ;8(3):4841-9. 20. Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes. 2014;8(2):139-46. 21. Martins CF, Thofehrn MB, Amestoy SC, Lange C. O fazer que faz a diferença: cuidar de um diabético ferido - pé diabético. Ciência, Cuidado e Saúde. 2008;60:448-53.^-²²22. Orihuela Casarra R, Heras Tebar A, Pozo Gil M. Monofilamento 5.07. Uso en las consultas de Enfermería de Atención Primaria. Rev Enferm. 2005;28(12):43-7.⁾ Assess vital signs⁽²⁹29. Couto TA, Santana VSS, Santos AR, Santos RM. Educação em saúde, prevenção e cuidado ao pé diabético: um relato de experiência. Rev Bahiana Saúde Pública. 2014;38(3):760-8.⁾ Use monofilament in the clinical examination of the feet⁽¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília (DF): Ministério da Saúde; 2016.^,³⁰30. Cubas MR, Santos OM, Retzlaff EM, Telma HL, Andrade IP, Moser AD, et al. Pé diabético: orientações e conhecimento sobre cuidados preventivos. Fisioter Mov. 2013;26(3):647-55.⁾ Use a ballpoint pen, cotton wool and a glass of water in the clinical examination of the feet⁽¹⁶16. Arruda LS, Fernandes CR, Freitas RW, Machado AL, Lima LH, Silva AR. Nurse's knowledge about caring for diabetic foot. Rev Enferm UFPE Online. 2019;13:e242175⁾ Evaluate hair and nails ⁽²⁰20. Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes. 2014;8(2):139-46.⁾
Health Education	Educate about foot care⁽¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília (DF): Ministério da Saúde; 2016.^,¹³13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Estratégias para o cuidado da pessoa com doença crônica: diabetes mellitus. Brasília (DF): Ministério da Saúde; 2013; 160 p.: il. (Cadernos de Atenção Básica, n. 36).^,¹⁴14. Daly B, Arroll B, Nirantharakumar K, Scragg RK. Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand. N Z Med J. 2020;133(1527):39-50.^,¹⁷17. Pereira LF, Paiva FA, Silva SA, Sanches RS, Lima RS, Fava SM. Nurse's actions in diabetic foot prevention: the perspective of the person with diabetes mellitus. Rev Pesquisa, Cuidado é Fundamental Online. 2017;9(4):1008-1014. 18. Vargas C, Lima D, da-Silva D, Schoeller S, Vragas M, Lopes S. Conduct of primary care nurses in the care of people with diabetic foot. Rev Enferm UFPE Online. 2017;11(Supl. 11):4535-4545. 19. Oliveira PS, Bezerra EP, Andrade LL, Gomes PLF, Soares MJ, Costa MM. Practice nurse family health strategy in the prevention of diabetic foot. Rev Pesquisa, Cuidado é Fundamental Online. 2016 ;8(3):4841-9.^-²⁰20. Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes. 2014;8(2):139-46.^,²⁸28. Dias JJ, Santos FL, Oliveira FK. Home visit as a tool for promoting the health the diabetic with an amputated foot. Rev Enferm UFPE Online. 2017;11(12): 5464-70. 29. Couto TA, Santana VSS, Santos AR, Santos RM. Educação em saúde, prevenção e cuidado ao pé diabético: um relato de experiência. Rev Bahiana Saúde Pública. 2014;38(3):760-8.^-³⁰30. Cubas MR, Santos OM, Retzlaff EM, Telma HL, Andrade IP, Moser AD, et al. Pé diabético: orientações e conhecimento sobre cuidados preventivos. Fisioter Mov. 2013;26(3):647-55.⁾ Educate about wearing appropriate footwear and cutting nails ⁽¹⁹19. Oliveira PS, Bezerra EP, Andrade LL, Gomes PLF, Soares MJ, Costa MM. Practice nurse family health strategy in the prevention of diabetic foot. Rev Pesquisa, Cuidado é Fundamental Online. 2016 ;8(3):4841-9.^,²⁰20. Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes. 2014;8(2):139-46.⁾
Wound care	Perform dressings⁽¹¹11. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Brasília (DF): Ministério da Saúde; 2016.^,¹³13. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Estratégias para o cuidado da pessoa com doença crônica: diabetes mellitus. Brasília (DF): Ministério da Saúde; 2013; 160 p.: il. (Cadernos de Atenção Básica, n. 36).^,²¹21. Martins CF, Thofehrn MB, Amestoy SC, Lange C. O fazer que faz a diferença: cuidar de um diabético ferido - pé diabético. Ciência, Cuidado e Saúde. 2008;60:448-53.^,¹⁸18. Vargas C, Lima D, da-Silva D, Schoeller S, Vragas M, Lopes S. Conduct of primary care nurses in the care of people with diabetic foot. Rev Enferm UFPE Online. 2017;11(Supl. 11):4535-4545.^,²⁸28. Dias JJ, Santos FL, Oliveira FK. Home visit as a tool for promoting the health the diabetic with an amputated foot. Rev Enferm UFPE Online. 2017;11(12): 5464-70.⁾
Glycemic control	Assess the level of glycated hemoglobin ⁽¹⁵15. Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs. 2020;29(23-24):4653-73.^,¹⁸18. Vargas C, Lima D, da-Silva D, Schoeller S, Vragas M, Lopes S. Conduct of primary care nurses in the care of people with diabetic foot. Rev Enferm UFPE Online. 2017;11(Supl. 11):4535-4545.^,²⁹29. Couto TA, Santana VSS, Santos AR, Santos RM. Educação em saúde, prevenção e cuidado ao pé diabético: um relato de experiência. Rev Bahiana Saúde Pública. 2014;38(3):760-8.⁾
Home visit	Perform assessment and treatment of diabetic feet ⁽²⁸28. Dias JJ, Santos FL, Oliveira FK. Home visit as a tool for promoting the health the diabetic with an amputated foot. Rev Enferm UFPE Online. 2017;11(12): 5464-70.⁾
Referral to specialized service	Refer to a podiatrist⁽¹⁵15. Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs. 2020;29(23-24):4653-73.⁾ Forward to a nutritionist ⁽²¹21. Martins CF, Thofehrn MB, Amestoy SC, Lange C. O fazer que faz a diferença: cuidar de um diabético ferido - pé diabético. Ciência, Cuidado e Saúde. 2008;60:448-53.⁾

[1] Corresponding Author: Joyce Micaelle Alves Caldeira E-mail: joyce.alves25@yahoo.com.br

Brasil

Brasil

Nursing care for diabetic foot in primary care: scoping review

Abstract

Objective

Methods

Results

Conclusion