Personer med typ 2-diabetes ökar världen över. Enligt en ny studie vill patienterna att vården utgår från deras unika behov och resurser. Utöver kunskap om kost, motion och medicinering önskar de även få stöd kring känslomässiga och psykosociala aspekter av sjukdomen.

Background: Despite a variety of literature reviews, there is limited understanding of the learning strategies healthcare professionals use to help patients adopt and maintain effective foot care practices.

Aim: To explore learning processes and educational strategies for persons with diabetes focusing on foot care and examine how different learning processes influence these strategies.

Method: The scoping review followed the methodological framework established by Arksey and O'Malley and refined by Levac et al. Additionally, the PRISMA-ScR checklist was followed. A literature search was conducted in the PubMed, CINAHL, MEDLINE and Academic Search Premier databases, using specific search terms related to diabetic foot care and learning strategies. The selection process involved screening 906 articles based on inclusion criteria such as relevance to diabetic foot care, learning processes, and educational strategies, and excluded studies that were not written in English. The data were charted and quantitative and qualitative data were synthesised and thematically analysed to identify key learning strategies.

Results:The analysis identified two main themes: learning insights for comprehensive understanding and self-efficacy, and increased practical knowledge leads to improved footcare. Subthemes included integrative and reflective learning, motivational and collaborative learning, task-oriented and procedural learning, and feedback and reinforcement-based learning.

Conclusion: Effective diabetic foot care education should be multifaceted, incorporating deep learning, practical skills, and motivational elements. Early learning plays a central role in this process. Tailoring educational interventions to personal learning styles and providing continuous support can significantly improve patients' foot care outcomes. A framework for understanding the progressive stages of patient learning and self-management is presented as a starting point. Future research should focus on developing and evaluating educational models that address diverse learning needs, ultimately contributing to better management and prevention of diabetic foot complications.

Background

Despite a variety of literature reviews, there is limited understanding of the learning strategies healthcare professionals use to help patients adopt and maintain effective foot care practices.

Aim

To explore learning processes and educational strategies for persons with diabetes focusing on foot care and examine how different learning processes influence these strategies.

Method

The scoping review followed the methodological framework established by Arksey and O'Malley and refined by Levac et al. Additionally, the PRISMA-ScR checklist was followed. A literature search was conducted in the PubMed, CINAHL, MEDLINE and Academic Search Premier databases, using specific search terms related to diabetic foot care and learning strategies. The selection process involved screening 906 articles based on inclusion criteria such as relevance to diabetic foot care, learning processes, and educational strategies, and excluded studies that were not written in English. The data were charted and quantitative and qualitative data were synthesised and thematically analysed to identify key learning strategies.

Results

The analysis identified two main themes: learning insights for comprehensive understanding and self-efficacy, and increased practical knowledge leads to improved footcare. Subthemes included integrative and reflective learning, motivational and collaborative learning, task-oriented and procedural learning, and feedback and reinforcement-based learning.

Conclusion

Effective diabetic foot care education should be multifaceted, incorporating deep learning, practical skills, and motivational elements. Early learning plays a central role in this process. Tailoring educational interventions to personal learning styles and providing continuous support can significantly improve patients' foot care outcomes. A framework for understanding the progressive stages of patient learning and self-management is presented as a starting point. Future research should focus on developing and evaluating educational models that address diverse learning needs, ultimately contributing to better management and prevention of diabetic foot complications.

AIM: To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group-based self-management education with a digital website.

DESIGN: A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self-experience of COPD as a special competence, were involved as research partners at the design of this study.

METHODS: Eleven individual and two group interviews with five participants in each group were conducted.

RESULTS: Group-based self-management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self-reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in-depth reflection that support learning over time.

Purpose:

Guidelines recommend starting glucose-lowering drug upon type 2 diabetes mellitus diagnosis together with lifestyle changes. Lifestyle changes are as essential as the drug, earlier recommendations allowed some months of lifestyle changes while being drug-free. Prescription on diagnosis may interfere with patients’ understanding and motivation for lifestyle changes if they cannot evaluate the effect on blood glucose.

Methods:

A phenomenographic approach and interviews were conducted with patients who started a glucose-lowering drug at diagnosis.

Results:

Three qualitatively different conceptions of being prescribed glucose-lowering drugs in connection to type 2 diabetes mellitus diagnosis were found: “Drugs as something unwelcome,” “Drugs as a support,” and “Drugs as a means to reach the goal”. These conceptions range broadly from drugs as unwelcome to drugs as a support for lifestyle changes and an opportunity to influence the course of the lifelong disease to reach a goal.

Conclusions:

This study has identified various perspectives of patients’ understanding of the role of lifestyle changes in managing their disease. The patients undergo a process, and the perspectives vary, providing a more extensive and nuanced understanding. It is, therefore, impossible to apply a routine protocol and a person-centred approach is required when prescribing a glucose-lowering drug.

OBJECTIVE: The objective of this study was to explore patients' learning and support needs within contemporary diabetes care to help them deal with daily life challenges.

DESIGN: A qualitative descriptive design was used following the Consolidated Criteria for Reporting Qualitative Studies. The 15 individual face-to-face interviews were analysed using qualitative content analysis.

SETTING: Participants were drawn from three healthcare centres in rural and urban regions of West Sweden.

PARTICIPANTS: The study involved 15 patients (8 men, 7 women) with T2DM who experienced contemporary diabetes care.

RESULTS: Patients expressed a strong desire for access to person-centred, multidimensional learning, with a focus on genuine partnership, tailored education, and emotional engagement. Digital tools were seen as valuable aids in their self-care efforts. Sub-themes were 'Desiring genuine partnership and tailored patient education' and 'Needing support related to altered perspectives on life and awareness of care standards but with finite care resources'.

CONCLUSION: The findings suggest that integrating person-centred, multidimensional learning strategies into diabetes care could be beneficial, particularly when addressing both practical and emotional needs. Encouraging active patient engagement through flexible digital solutions and providing support for emotional well-being may improve the overall patient experience. However, further research and practical application are needed to fully understand how these strategies could be effectively implemented to support patients with T2DM in managing their daily health challenges.

This qualitative study describes how reflection can be supported by using reflective tools in group education in type 2 diabetes. The changed conditions for living with a long-term illness may lead to increased anxiety and new demands that affect one’s current life situation. The didactic model, ‘The challenge – to take charge of one’s life with long-term illness’, has been developed into ‘Taking responsibility in life with type 2 diabetes – a model for group education in primary care’. Specialized diabetes nurses and dieticians received training, a manual and continuous guidance in applying the model. Reflection diaries, notes and interviews both from the patients and the caregivers were analyzed using a phenomenological hermeneutic method. The results show that using images as reflective tools engages thoughts and feelings in a way that appears to be important for one’s learning in life with a chronic illness. The images contribute to allowing a distance from one’s situation, actions, thoughts and feelings, which seems fruitful for investigating and discovering new ‘things’ about oneself. With the support of reflective tools and guiding questions, reflection is led to a deeper existential level where both caregivers and patients contribute by asking questions that support the reflection process.

With the advent of digital transformation in healthcare, the use of digitally-enabled devices and services is rising, heralding a promising new era in diabetes treatment. This shift in healthcare consumption necessitates the development of new working patterns and recognises the need for lifelong learning (Carlsson et al., 2022) and digital literacy. Our study, therefore, delves into the realm of Continuing Professional Development (CPD) for Diabetes Specialist Nurses (DSNs), who play a pivotal role in integrating technology into clinical practice. While DSNs acknowledge the potential of digitalisation for learning, they also express reservations about its impact on the currency of their knowledge and the delivery of person-centred care (PCC) (Öberg et al., 2018). The quality of workplace learning is crucial for CPD, yet there is a gap in how much workplaces promote learning and CPD (Deutscher & Braunstein, 2023) to maintain PCC. 

Our study comprehensively explores the associations between workplace learning potential and the extent of PCC among DSNs. To gather data, we conducted a cross-sectional online survey with 157 DSNs to assess their perceptions of learning opportunities and PCC within their workplace that promotes CPD. 

The findings of our study bear significant implications. We found a positive association between workplace learning potential and PCC practice. Nurses who perceive workplace learning support are more likely to uphold PCC principles. The finding underscores the need to create supportive learning environments within healthcare organisations to facilitate learning and PCC. It is crucial to highlight the importance of nurses being prepared to adapt to changes in healthcare service delivery and deliver PCC in line with the patient's abilities and needs in the face of digital transformation. Striking a balance between the rapid digital transformation in healthcare and PCC is crucial for nurses to remain competent and compassionate practitioners, and this balance can be promoted by providing ample learning opportunities that promote CPD. 

References:

Carlsson, M., Alm, A. K., & Rising, M. H. (2022). An evaluation of registered nurses’ experiences of person-centered care and competence after participating in a course in digital competence in care. BMC Nursing, 21(1), 368. https://doi.org/10.1186/s12912-022-01151-2 

Deutscher, V., & Braunstein, A. (2023). Measuring the quality of workplace learning environments–a qualitative meta synthesis of employee questionnaires. Journal of Workplace Learning, 35(9), 134-161. 

Öberg, U., Orre, C. J., Isaksson, U., Schimmer, R., Larsson, H., & Hörnsten, Å. (2018). Swedish primary healthcare nurses’ perceptions of using digital ehealth services in support of patient self‐management. Scandinavian Journal of Caring Sciences, 32(2), 961-970. https://doi.org/10.1111/scs.12534 

Background: Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual’s quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. Objective: The study aimed to validate a structured foot examination form by assessing health care professionals’ experiences of working with it “foot side” when examining patients with diabetes. Methods: Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users’ data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled “Optimised care of persons with diabetes and foot complications,” with Västra Götaland Region as the responsible health care authority, where the results will be further developed. Results: Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. Conclusions: The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines.

Background: Symptom burden, impaired functional performance and decreased quality of life are not only consequences of the underlying physiological disorder chronic obstructive pulmonary disease (COPD) but also dependent on a patient's ability to learn to live with and manage their illness. A digital website may be important for empowering patients with COPD to learn about and self-manage their illness. The aim of this study was to describe a developing process of a digital COPD-web as a part of a self-management education program for persons living with COPD.

Methods: A qualitative approach with a phenomenological perspective was used. The study was based on group and individual interviews with a multidisciplinary COPD-team and patients who developed the COPD-web.

Results: The developing process appears as a person-centred and holistic self-care approach both in content and development. Developing a digital COPD-web requires ongoing multidisciplinary collaboration and spawns a sense of pride that reinforces shared responsibility. The phenomenon consists of four constituents: learning by participating in development, the patient perspective as guiding approach, responsibility and motivation as driving forces and digital technology as a knowledge arena.

Conclusion: The results indicate that constructive collaboration between a multidisciplinary COPD-team and patients as co-creators in an ongoing creative and reflective process is a key concept to develop a digital COPD-web with a holistic approach. Digital resources in the future might create time and space for reflective conversations in a COPD-web with virtual chatrooms.