Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics

Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics by Louise Wade MSN, RN MS, West Texas A&M University, 2010 BS, West Texas A&M University, 2010 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Abstract According to the World Health Organization, up to 50% of type 2 diabetic patients develop neuropathy, which may cause major infections, amputation, and Charcot foot due to impaired sensation. Early recognition and care is essential for treatment of Charcot foot and prevention of further injury. Due to the complexity of this potentially lifethreatening complication, assessment is challenging, especially when practitioners whoAccording to the World Health Organization, up to 50% of type 2 diabetic patients develop neuropathy, which may cause major infections, amputation, and Charcot foot due to impaired sensation. Early recognition and care is essential for treatment of Charcot foot and prevention of further injury. Due to the complexity of this potentially lifethreatening complication, assessment is challenging, especially when practitioners who treat adult diabetic patients may not be familiar with Charcot foot. The purpose of this scholarly project was to develop an assessment, screening tool, and algorithm for detecting Charcot foot; an additional goal was to develop practice guidelines for practitioners to assist in the early recognition, treatment, and referral of adult diabetic patients at risk for Charcot foot. Lippitt’s theory of change was used to guide the project. An interdisciplinary team of stakeholders was assembled to guide development of the tool, algorithm, and practice guidelines. Products were developed in accordance with evidence in current peer-reviewed literature and American Diabetes Association recommendations for Charcot foot diagnosis, treatment, and referral. Content was validated using a scale content validation instrument process to obtain input from experts in the care of Charcot foot. An implementation plan was developed to guide introduction of the products into practice, and an evaluation plan created to determine the extent to which intermediate term outcomes are met using these products. The project may contribute to social change by identifying patients at risk for Charcot foot prior to the onset of the complication, therefore preventing further injury, deformity, or amputation in populations that are often unable to afford quality healthcare. Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics by Louise Wade MSN, RN MS, West Texas A&M University, 2010 BS, West Texas A&M University, 2010 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Dedication I dedicate this project to my husband Rex, who suffers from Charcot foot and remains one of the most positive and inspirational people I have ever met. Despite the multitude of complications from diabetes, he has continued to focus on my success rather than his own issues and supported me 100% every step of the way. He is an amazing man and I am truly blessed to have him in my life. Acknowledgments First, I thank God for giving me such a wonderful family and the opportunity to embark on a journey that would have an impact on patients such as my husband. I also thank my husband Rex for the continued love and support he has given me throughout this journey and for always believing in me. He consistently makes me smile every day I am with him. In addition, I thank my children and grandchildren for their love, in spite of my shortcomings. They never seem to notice. Secondly, my sincerest thanks to my mentor Dr. Angela Phillips who has given of her time, support, and patience. She has been not only an invaluable resource for me but a positive role model for many other nurses who have the pleasure of knowing her. Finally, I would like to express my gratitude to the members of my committee; Dr. Stoerm Anderson for his constant support and encouragement throughout the project and for being a positive role model in my life; Dr. Deborah Lewis for her support and suggestions for a successful project completion and finally, Dr. Sandra Cadena as serving as the URR on this project and providing positive comments and encouragement. This entire journey would not have been possible without the encouragement and support of each of these people and I am eternally grateful.