Ošetřovatelské perspektivy 2023, 6(1):51-66 | DOI: 10.25142/osp.2023.002

A PATIENT’S NON-ADHERENCE TO THE TREATMENT OF DIABETIC FOOT ULCERS: LONGITUDINAL CASE STUDY

Pavla Kudlová¹, Jan Chrastina², Pavel Xinopulos³

¹ Institute of Health Sciences, Faculty of Humanities of Tomas Bata University in Zlín, and 2nd Surgical Clinic of Faculty Hospital in Olomouc

² Institute of Social-pedagogical Studies of Teacher Education, Faculty of Palacky University in Olomouc

³ Department of Plastic and Aesthetic Surgery and 2nd Surgical Clinic in Faculty Hospital in Olomouc, and a private surgical outpatient ward

Introduction: On average, diabetic foot ulcerations heal within 3 to 6 months. By adhering to treatment measures this period can be shortened and re-ulcerations prevented.

Aims: To analyze the causes and risk factors of re-ulcerations/recurrences/relapses of diabetic foot ulcers (DFU) on 1 case, to assess the effects of the applied treatment measures, and to suggest more effective methods to maintain motivation to treatment and successful healing of diabetic ulcerations.

Methods: A case study of a client diagnosed with DFU who was monitored, treated and educated in a vascular-surgical outpatient ward for 11 years (2010–2021). For data collection we used monitoring, tests and scales, an interview, a medical documentation analysis including laboratory, physical, clinical and anthropometric indicators, and a DFU photo documentation.

Result: A long-term DFU treatment (local surgical and wound therapy, pharmacological, short education about regimen measures) caused the client’s loss of motivation and non- adherent behavior manifested by his nonadherence to the prescribed regimen measures (diet, relieving the ulcers), worsening of laboratory indicators (HbA1c), physical indicators (hypertension), clinical indicators (nonhealing scum of the wound, re-ulceration, infection), anthropometric indicators (BMI), insufficient treatment efficacy, and worsening of the prognosis of DFU (amputation). The fact that there were no physical inspections during the covid pandemic made this condition even  worse.

Conclusion: Despite a long DFU treatment the client’s DFU did not heal. Such a long- term patient must not only be educated but also led and supported, positively motivated to undergo treatment and to adhere to the regimen measures through life values, individual lifestyle, and open partnership with healthcare professionals.

Keywords: diabetic foot ulcer (DFU), non/adherence, re-ulceration, risk factors, regimen measures, to support and to  lead

Received: November 6, 2022; Revised: December 20, 2022; Accepted: January 3, 2023; Published: June 29, 2023  Show citation