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ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature

[ Vol. 16 , Issue. 1 ]


Sumarno Adi Subrata*, Rutja Phuphaibul, Nirobol Kanogsunthornrat and Apinya Siripitayakunkit   Pages 40 - 51 ( 12 )


Background and Aims: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation.

Methods: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study.

Results: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated.

Conclusion: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.


Nursing care, diabetic foot, foot ulcer, review literature, amputations, diabetes complications, diabetic neuropathies.


Doctor of Philosophy Program in Nursing, International Program, Mahidol University, Bangkok, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok

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