title: Evaluation of the effect of nurse education on patient-reported foot checks and foot care behaviour of people with diabetes receiving haemodialysis.
abstract: OBJECTIVE
  To assess whether a programme of nurse education increased the frequency with which nurses conducted foot checks on people with diabetes undergoing haemodialysis and to evaluate whether this influenced self-reported foot care behaviour.
  
  
  METHODS
  A non-randomized stepped-wedge design was used to evaluate a nurse education programme implemented in four UK National Health Service dialysis units. People with diabetes undergoing haemodialysis were invited to complete a questionnaire on the frequency of foot examination by health professionals, on the presence of foot problems and on their own foot care behaviour, using the Nottingham Assessment of Functional Foot-care (NAFF). An education session for nurses, including procedures for foot examination, was conducted sequentially in each of four haemodialysis units. The questionnaire was repeated at 2-monthly intervals.
  
  
  RESULTS
  The education session resulted in a significant increase in the reported number of foot examinations by nurses (P = 0.007). There was also a significant improvement in reported foot care behaviour (P < 0.001), but this occurred between the first and second 2-monthly assessments and was unrelated to the timing of the intervention.
  
  
  CONCLUSIONS
  A single education session can improve the routine checking of the feet of people with diabetes undergoing haemodialysis. The administration of the Nottingham Assessment of Functional Foot-care questionnaire was associated with improved self-reported foot care behaviour, reflecting greater awareness of risk in this population.
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: S L
authors.initials: SL
authors.lastname: Brand
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Musgrove
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: W J
authors.initials: WJ
authors.lastname: Jeffcoate
authors.affiliation: University of Nottingham, Nottingham, UK.
authors.forename: N B
authors.initials: NB
authors.lastname: Lincoln
mesh_terms: D000368:Aged; D002983:Clinical Competence; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000150:complications / Q000451:nursing / Q000628:therapy*; D003955:Diagnostic Tests, Routine; D042241:Early Diagnosis; D004509:Education, Nursing, Continuing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000451:nursing / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011032:Podiatry / Q000193:education; D024382:Professional Role; D006435:Renal Dialysis / Q000451:nursing; D012306:Risk; D012648:Self Care; D057566:Self Report; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology; D000078329:Workforce