Self-Care Theory in Diabetic Foot Ulcerations

Self-Care Theory

Description and Selection Rationale

Self-care theory is a nursing supposition formulated by Dorothea Orem between 1959 and 2001. It is employed in several settings, such as rehabilitation and primary care. The theory advocates for patient independence when managing illnesses (Taylor & Renpenning, 2011). The theory was chosen due to its major philosophy. The philosophy is in line with the guidelines of proper diabetic management and treatment. Self-care theory stresses that patients should take care of themselves. According to Taylor and Renpenning (2011), when the ailing persons perform appropriate self-care, they can recover faster and holistically.

Application of Self-Care Theory

The theory works by incorporating different nursing concepts to develop perspectives used to look into a particular phenomenon. Consequently, the supposition can be used on a wide range of patients. Taylor and Renpenning (2011) observe that the theory specifies when nursing is needed and how patients’ needs should be met.

In the project, various treatments for DFUs were discovered. However, Vacuum-Assisted Closure (VAC) was the proposed solution. Self-care nursing theory was used to implement the recommendation by defining the roles of nurses and patients in the treatment procedure. When administering VAC, caregivers, and patients should play their roles to ensure efficacy (Taylor & Renpenning, 2011).

Incorporation of Self-Care Theory into the Project

Diabetic Foot Ulcerations (DFUs) are a major problem for elderly people living with type 2 diabetes. Self-care theory can be used in several ways to manage the problem. The supposition will be used to secure the appropriate medical assistance. Also, the theory will help patients learn different kinds of self-care strategies after the administration of VAC.

Appraisal of Identified Articles

Article 1

Article 1 is by Dumville et al. (2013). The authors consider foot wounds to be a serious and common global health condition for elderly diabetic patients. The article notes the fact that Negative Pressure Wound Therapy (NPWT) can be used to treat the condition. However, to evaluate the effectiveness of the treatment, Dumville et al. (2013) compare it to standard care and other adjuvant therapies used to heal foot sores in people living with diabetes mellitus.

Dumville et al. (2013) provide extensive information on DFUs. However, the article does not state statistics that are vital in the explanation of the prevalence of the condition. Also, the authors conclude that negative pressure wound therapy is not an effective treatment for DFUs. As a result, the findings do not support the proposed solution.

Article 2

Article 2 is written by Fernando, Crowther, Pappas, Lazzarini, and Cunningham (2014). In this paper, Fernando et al. (2014) consider foot ulcerations to be the main symptoms of diabetes mellitus. In the article, the authors aim to provide a comparison between the plantar pressures of diabetic patients who had peripheral neuropathy and those suffering from foot ulcers. The article provides detailed statistical data to show the prevalence of DFUs. According to Fernando et al. (2014), the incidence of DFU in America ranges between 4% and 12%. The article also states the prevalence rate of the condition in the U.S. An analysis of the paper indicates that the authors provide conclusive findings. Their findings stress the fact that neuropathy is associated with increased foot wounds.

Article 3

In the third article, Fraccalvieri, Ruka, Bocchiotti, Zingarelli, and Bruschi (2012) provide critical analysis of the role of NPWT in the treatment of foot wounds among people living with diabetes. It is noted that the authors provide extensive information on DFUs. However, no statistical data is available to show the prevalence of the problem. Despite this, Fraccalvieri et al. (2012) are of the view that gauze-based NPWT results in minimal pain compared to moist dressing. The findings support the use of VAC to treat lesions among diabetic patients.

Article 4

In Article 4, Fraccalvieri et al. (2011) state that chronic wounds are common among diabetes mellitus patients. The article aims to determine the effectiveness of negative pressure therapy as a treatment of foot ulcers. In their study, the researchers analyze different sets of information. Fraccalvieri et al. (2011) note that NPWT leads to improved outcomes among patients living with chronic lesions. The conclusions are consistent with the recommendations of using VAC to treat DFUs as stated in the project. However, the article does not provide statistical data on morbidity and mortality rates of DFU.

Article 5

In article 5, Jan, Shah, Khan, Fayaz, and Ullah (2012) note that diabetic foot ulcers are serious health problems. The conditions are associated with high mortality rates annually. The article provides statistical data on the risk and prevalence rates of DFUs. People living with diabetes have 40% higher chances of undergoing lower limb amputations compared to non-diabetics suffering from DFU. Despite stating the risk and incidence rates, the article does not provide conclusive information on the use of VAC. However, it offers several alternatives to help patients.

Article 6

Article 6 provides extensive and detailed information on the prevalence and treatment of DFUs among diabetics. Lev-Tov, Li, Dahle, and Isseroff (2013) note that up to a fifth of the adult population in the United States suffer from diabetes mellitus. Also, the rate of developing DFU ranges between 10% and 25%. The article also states that only about 30% of the cases are cured under standard care (Lev-Tov et al., 2013). The findings from the journal article reveal that cellular mechanisms are effective in the treatment of foot ulcers. As such, the article supports the need for the use of evidence-based approaches to control DFU.

Article 7

In article 7, Lone et al. (2014) aim at establishing the effectiveness of NPWT in treating foot wounds among diabetics. The article provides in-depth statistical data on the risk rates of contracting DFU. However, no information is provided on prevalence, mortality, and morbidity rates associated with the condition. According to Lone et al. (2014), diabetic patients have a 25% risk of suffering from foot wounds. Also, they have an 85% chance of being amputated. In terms of treatment, the authors stress that NPWTs are effective in the treatment of DFU. The article’s findings support the recommended solution.

Article 8

In article 8, Margolis et al. (2013) report the findings of a longitudinal cohort study. The primary purpose of the research was to determine the effectiveness of a hyperbolic oxygen approach in the management of DFUs. The article provides extensive information on DFU and its treatment. However, no statistical data on prevalence, risk, and mortality rates are availed by the authors. According to Margolis et al. (2013), Hyperbolic Oxygen Technique has minimal impacts on the healing of foot ulcers. Due to this, the article advocates for the improvement of NWTPs, such as VAC.

Article 9

In article 9, Nain, Uppal, Garg, Bajaj, and Garg (2011) note that foot disorders, such as lesions and infections, are prevalent among diabetes mellitus patients. Also, the article notes that the treatment of the wounds is a major challenge. The reason is due to impaired healing and increased complications. The primary aim of the study was comparative. It contrasts the efficacy of negative pressure dressing methods against conventional approaches. The findings made by Nain et al. (2011) show the effectiveness of NPWT in the treatment of DFU. As such, the journal article supports the proposed solution of using VAC. Even though the editorial supports the recommendation, it does not provide statistical data on the prevalence and mortality rates associated with DFUs.

Article 10

In article 10, Ravari et al. (2013) are of the view that DFU is a serious problem associated with amputation among diabetic patients. The reason for this is due to the non-healing of wounds and numerous treatment complications in these patients. The article notes that there are various methods used in the management of DFU. One of the approaches is VAC. In their study, Ravari et al. (2013) aim to determine the efficacy of VAC. To this end, the findings made by the authors show that VAC is safe and more effective in the treatment of diabetic foot ulcers compared to moist dressing. Due to this, the article supports the proposal. However, the editorial does not provide statistical data on the severity of DFU.

Article 11

In article 11, Seo et al. (2013) think that non-healing chronic lesions are difficult to treat among patients suffering from diabetes. Due to this, the wounds can result in severe medical complications. In the analysis of DFU and its effects, the authors claim that the condition tends to have high prevalence and mortality rates. However, the article does not provide statistical data to support the frequency and risks associated with the condition. In terms of treatment, Seo et al. (2013) stress the fact that NPWT is one of the most effective techniques that can be used by caregivers and patients to control and manage the problem. The reason is that it enhances granulation, which facilitates healing. The findings support the proposed solution for treating DFU.

Article 12

Article 12 is authored by Sumpio (2012). In their study, Sumpio (2012) notes that foot ulcers are major public health issues among patients living with diabetes. Also, controlling ulcers is a complex clinical issue. Managing the condition requires a multidisciplinary collaboration between different healthcare professionals. The article provides statistics on the prevalence rates of the condition in the United States. However, it does not provide statistical data on morbidity and mortality rates. Sumpio (2012) notes that 26 million people in the U.S are reported to have diabetes. The information provided in the journal article considers NPWT to be an effective treatment method for DFU. As such, it is noted that the article supports the proposed solution of using VAC.

Article 13

Article 13 reports the findings of a study conducted by Yang et al. (2014). In this publication, Yang et al. (2014) consider DFUs to be diabetic-related infections. The infections result in extended stays in hospitals. The article provides extensive information on the problem. Yang et al. (2014) are of the view that persistent non-healing wounds cause high morbidity rates. However, the authors do not provide statistical data on the morbidity, prevalence, and mortality rates to support their claims. Despite this, the article considers NPWT to be an effective intervention for DFU. As a result, the information supports the proposed solution for applying VAC.

Article 14

In article 14, Yarwood-Ross and Dignon (2012) note that foot lesions are common among elderly and diabetic patients across the globe. The authors’ primary aim is to establish some of the most effective therapies that can be used in the treatment of the condition. The article notes that the prevalence, morbidity, and mortality rates of DFU are often high in the country. However, Yarwood-Ross and Dignon (2012) fail to provide statistical information to support the claims. Despite this, the editorial supports the proposed solution of using VAC.

Article 15

Article 15 is written by Yotsu, Pham, Oe, Nagase, and Sanada (2014). In this publication, Yotsu et al. (2014) consider DFU to be an infection linked to diabetes mellitus. The article provides readers with statistical data on the prevalence and risk rates associated with the problem. For example, Yotsu et al. (2014) think that the incidence of DFU range between 4% and 10%. Also, the article stresses the importance of using several therapies like VAC. As a result, the article supports the proposed solution.


Dumville, J., Hinchliffe, R., Cullum, N., Game, F., Stubbs, N., Sweeting, M., & Peinemann, F. (2013). Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Systematic Reviews, 17(10), 103-112.

Fernando, M., Crowther, R., Pappas, E., Lazzarini, P., & Cunningham, M. (2014). Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration, and no history of ulceration: A meta-analysis of observational studies. PLoS ONE, 9(6), 99-105.

Fraccalvieri, M., Ruka, E., Bocchiotti, M., Zingarelli, E., & Bruschi, S. (2012). Patients’ pain feedback using negative pressure wound therapy with foam and gauze. International Wound Journal, 8(5), 492-499.

Fraccalvieri, M., Zingarelli, E., Ruka, E., Antoniotti, C., Coda, R., Sarno, A., & Bruchi, S. (2011). Negative pressure wound therapy using gauze and form: histological, immunohistochemical, and ultrasonography morphological analysis of the granulation tissue and scar tissue: Preliminary report of a clinical study. International Wound Journal, 8(4), 355-364.

Jan, W., Shah, H., Khan, M., Fayaz, M., & Ullah, N. (2012). Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetic foot ulcers. Journal of Postgraduate Medicine Institute, 26(4), 402-407.

Lev-Tov, H., Li, C., Dahle, S., & Isseroff, R. (2013). Cellular versus a-cellular matrix devices in treatment of diabetic foot ulcers: Study protocol for a comparative efficacy randomized controlled trial. Trials, 14(8), 141-149.

Lone, A., Zaroo, M., Laway, B., Pala, N., Bashir, S., & Rasool, A. (2014). Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: A prospective case-control study. Diabetic Foot Ankle, 5(10), 34-41.

Margolis, D., Gupta, J., Hoffstad, O., Papdopoulos, M., Glick, H., Thom, S., & Mitra, N. (2013). Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and the prevention of amputation: A cohort study. Diabetes Care, 36(7), 1961-1966.

Nain, P., Uppal, S., Garg, R., Bajaj, K., & Garg, S. (2011). Role of negative pressure wound therapy in healing of diabetic foot ulcers. Journal of Surgical Technique and Case Report, 3(1), 17-22.

Ravari, H., Modaghegh, M., Kazemzadeh, G., Johari, H., Vatanchi, A., Sangaki, A., & Shahrodi, M. (2013). Comparision of vacuum-asisted closure and moist wound dressing in the treatment of diabetic foot ulcers. Journal of Cutaneous and Aesthetic Surgery, 6(1), 17-20.

Seo, S., Yeo, J., Kim, I., Kim, J., Cho, T., & Lee, D. (2013). Negative-pressure wound therapy induces endothelial progenitor cell mobilization in diabetic patients with foot infection or skin defects. Experimental and Molecular Medicine, 45(11), 62-71.

Sumpio, B. (2012). Contemporary evaluation and management of the diabetic foot. Scientifica, 9(1), 1-17.

Taylor, S., & Renpenning, K. (2011). Self-care science, nursing theory, and evidence-based practice. New York: Springer Pub.

Yang, S., Han, R., Liu, Y., Hu, L., Li, X., & Zhu, L. (2014). Negative pressure wound therapy is associated with up-regulation of BFGF and ERK1/2 in human diabetic foot wounds. Wound Repair and Regeneration, 22(4), 584-544.

Yarwood-Ross, L., & Dignon, A. (2012). NPWT and moist wound dressings in the treatment of the diabetic foot. British Journal of Nursing, 12(21), 26-32.

Yotsu, R., Pham, M., Oe, M., Nagase, T., & Sanada, H. (2014). Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: Neuropathic, ischemic, and neuro-ischemic type. Journal of Diabetes and its Complications, 28(4), 528-535.