Person-Centred caring towards improvement of diabetic foot care compliance in rural primary health care, KwaZulu-Natal
BACKGROUND The five-year mortality rate after a diabetic diabetic is higher than 40% globally. In KwaZulu-Natal, 2500 diabetic foot amputations are carried out per year. Only 7.8% of patients with diabetes undergo foot examinations within KwaZulu-Natal public health, while 90% are not educated about foot care. Person-centredness and caring can potentially improve foot care outcomes for patients with Type 2 Diabetes Mellitus. AIM & OBJECTIVES This study aims to identify how registered nurses could achieve person-centred caring to improve diabetic foot care compliance in the rural primary healthcare context in KwaZulu-Natal. The objectives of the study were to: determine the experiences of patients with Type 2 Diabetes Mellitus regarding person-centred caring in the management of foot care. To describe the experiences of registered nurses regarding person-centred caring in the management of diabetic foot care. To explore current practices of registered nurses regarding diabetic foot care. To compare data from in-town clinics to out-of-town clinics and develop a person-centred caring, guideline-based in-service training programme for registered nurses in the management of diabetic foot care. METHODOLOGY A mixed-method-convergent design was used for the study. The rural King Cetshwayo district was stratified according to subdistrict and in-town versus out-of-town. One in-town clinic and two out-of-town clinics were selected from each sub-district for data collection. Interviewed surveys were conducted with 376 patients with Type 2 Diabetes Mellitus to determine their experiences of person-centred caring, in foot care management at the primary healthcare clinics. During the qualitative strand of the study, 18 semi-structured interviews were conducted with registered nurses working at primary healthcare clinics. Qualitative content analysis was used to analyse the semi-structured interviews. FINDINGS The central theme of the study is that the registered nurses feel they are nursing the queues. They feel patients with Type 2 Diabetes Mellitus and their foot care gets neglected. As a result, these patients don’t attend clinics and relatives are sent to collect medication. Registered nurses are rushing to “push” the long queues of integrated chronic patients. Nursing care gets neglected due to staff shortages, non-conduciveness of facilities and a lack of training. In the quantitative data, the patients with Type 2 Diabetes Mellitus significantly disagreed that nurses were competent in managing diabetic foot care. The competence was a significant predictor of diabetic foot problems, which suggests that when diabetic foot problems arose, registered nurses became more competent. Even though patients significantly disagreed that nurses were competent in managing diabetic foot care, they significantly agreed that they are cared for with compassion. RECOMMENDATIONS AND CONCLUSION The data supports that diabetic foot care was only done when problems arose and that currently there is no preventative diabetic foot care. There is a need for an in-service training programme that considers the district’s rurality. This training will have to equip registered nurses with the knowledge to implement person-centred caring while managing the foot care of patients with Type 2 Diabetes Mellitus.
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