糖尿病患者のフットケア行動に対する看護介入の成果

Evaluation of nursing intervention on foot care behavior in the patients with diabetes mellitus

　本研究は，糖尿病患者のフットケア行動を向上させることを目的に，足潰瘍のない外来糖尿病患者11名に6か月間にわたり，4～6週間ごとのフットケア介入を継続した．介入内容は，（1）糖尿病と足に関する情報提供，（2）爪切りや胼胝削りなどのフットケアを提供し，フットケアモデルを見せることである．また，1回の介入に要する時間は約30～45分間である．介入の評価には，最近，米国でToobertらが開発したセルフケア行動尺度SDSCA（the Summary of Diabetes Self-Care Activities Measure）を翻訳し，日本語版を作成して使用した．この尺度はフットケア，食事，運動，血糖自己測定，服薬，喫煙のセルフケア行動を点数化できるものである．定期的なフットケア介入後のフットケア行動は，介入3か月後に有意に高まっており，6か月後も高い得点が維持できていた．またフットケア行動以外では，食事のセルフケア行動がフットケア介入6か月後に有意に高まっていた．よって，定期的なフットケア介入が糖尿病患者のフットケア行動を高め，さらにその副次的な効果として，食事のセルフケア行動を高めた．

　The purpose of the present study was to evaluate the effect of foot care nursing intervention performed every 4-6 weeks during 6 months on the foot care behavior of 11 out-clinic patients with diabetes mellitus without foot ulcer. The intervention includes; 1) hand on teaching diabetes mellitus and diabetic foot, and 2) demonstration of foot cares such as cutting of toenails and debridement of callus. It takes 30-45 min for each intervention. Recently, Self-care behavior was evaluated by structured interviews and examinations at baseline and at 3 and 6 months using SDSCA (the summary of diabetes self-care activities measure) developed by Toobert, which can score the self-care activities on foot care, diet, exercise, medicine, blood-glucose testing, and smoking. We have translated the original SDSCA and developed the Japanese version SDSCA for the present study. The score on foot care increased significantly at 3 months and kept high score at 6 months. Moreover, the score on diet self care behavior increased significantly at 6 months as the secondary effect of improving foot care behavior. In conclusion, repeated foot care nursing intervention was effective to improve not only the foot care behavior but also the diet self-care behavior in the patients with diabetes mellitus.