Examining the Suitability, and Feasibility of a Nurse-led Foot Care Educational Intervention in Adult Patients with EndStage Kidney Disease Receiving Haemodialysis

Abstract

People with end-stage kidney disease undergoing haemodialysis are at risk for peripheral arterial disease, lower limb amputation, and foot ulceration. Neuropathy and previous ulceration are the major risk factors for foot ulceration in patients undergoing dialysis. Similar risks apply to people with diabetes mellitus. Providing haemodialysis patients with education about foot care is crucial because it can help improve patients’ foot care knowledge, foot self-care behaviour, and prevent or minimize the incidence of foot ulcer development and amputation of the lower limb. Haemodialysis nurses are well-placed to provide information, education, and support for patients with end-stage kidney disease receiving haemodialysis in the dialysis unit. However, there are no studies of nurse-led foot care educational intervention programs for end-stage kidney disease patients receiving haemodialysis, despite the fact that patients with end-stage kidney disease have prevalence rates of risk factors similar to those in patients with diabetes mellitus. Therefore, there is a need for a nurse-led foot care educational intervention that can feasibly be delivered by haemodialysis nurses to patients with end-stage kidney disease receiving dialysis. Aim and objectives: The present study aimed to develop a nurse-led foot care educational intervention programme and explore its feasibility for use with patients who have end-stage kidney disease treated with haemodialysis. There were three phases to the study, with each phase having its own objectives. Phase 1: Developing a nurse-led foot care educational intervention programme: The nurse-led foot care educational intervention programme was informed by: a) a systematic review, which was undertaken to examine the factors that help or hinder the successful implementation of foot care educational programmes for patients with end-stage kidney disease receiving haemodialysis; b) an umbrella review, which was undertaken to derive further evidence from existing systematic reviews and meta-analysis of the effectiveness of interventions directly aimed at diabetes patients; c) an interdisciplinary advisory group made up of key stakeholders; and d) foot care education guidelines (National Institute for Clinical Excellence (NICE, 2019), the Registered Nurses Association of Ontario (RNAO, 2013), and the International Working Group on the Diabetic Foot (IWGDF, 2019)). Phase 2: Implementation of the foot care educational intervention programme: Early testing of programme theory and evaluation of the feasibility of measurement tools through a one-group pretest-posttest design with haemodialysis nurses, haemodialysis patients and their informal caregivers was carried out. The evaluation also involved measuring the foot care knowledge of haemodialysis nurses, foot care knowledge, and foot self-care behaviours of haemodialysis patients as well as the foot care knowledge of informal caregivers. Phase 3: Process evaluation: A qualitative exploration of factors affecting the acceptability of the intervention with key stakeholders (haemodialysis nurses, haemodialysis patients and their informal caregivers) following the implementation of the intervention programme. Conclusion: A nurse-led foot care educational intervention programme for patients with end-stage kidney disease receiving haemodialysis is highly acceptable for haemodialysis nurses, haemodialysis patients, and their informal caregivers, and a definitive trial is feasible with small modifications such as adding a foot assessment form during the future implementation and evaluation of randomised controlled trials. The researcher and the advisory group will search for a valid and reliable form for a foot assessment form. If one is not available, the researcher and advisory group will develop it. Foot-care assessment is important, as previous research indicates that regular foot assessments, education, suitable footwear, and timely referral for care escalation can effectively prevent foot problems.