In house Continuing Nursing Education (CNE) on “Diabetic Foot Care” at Kauvery Hospital, Cantonment

Subadhra Devi1, Mahalakshmi2

1Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Background

The Continuing Nursing Education (CNE) Program, “Diabetic Foot Care” was conducted on 19th Apr 2025. A team of dedicated healthcare professionals collaborated to deliver comprehensive care, focusing on wound healing, patient education, and personalized counseling to empower individuals with diabetes to manage their condition effectively. Their mission was clear to provide exceptional care and improve the patient lives of those affected by diabetes. This important program was initiated by Dr.Gowri along with Nursing Superintendent  Mrs.Mahalakshmi, in collaboration with Ms.Subadhra Devi, Nurse Educator Cantonment. A total of 50 members attended the events.

  • Organizing Chairperson: 1
  • Organizing Secretary: 1
  • Speakers (Doctors): 3
  • Speakers (Nurses): 6
  • Delegates-50

Objective

The primary objective of the in-house continuing nursing education program on diabetic foot care is to improve patient outcomes. By enhancing nurses’ knowledge and skills, we aim to provide high-quality care that prevents complications and promotes healing and to enhance nursing expertise in diabetic foot care. Through ongoing education and training, nurses will develop the skills and confidence to provide specialized care. The program also seeks to promote interdisciplinary collaboration among healthcare professionals. By working together, we can ensure comprehensive care and better outcomes for patients. Ultimately, the program aims to empower patients to manage their diabetic foot care effectively. By educating patients and providing them with the necessary tools and support, we can help them take control of their condition.

Program Overview

CNE program covered 9 pivotal topics delivered by esteemed speakers

Pre Test: Ms. Reenimary, nursing in charge initiated the program with pretest utilizing QR codes

1) Diabetic Foot Disease, Burden of the Problem by Dr. Gowri P Senior Consultant Diabetologist

Diabetic foot disease is a serious and growing complication of diabetes, affecting millions worldwide. Dr. Gowri highlights that it is not just a medical concern but a public health crisis leading to prolonged hospital stays, high treatment costs, and unfortunately, even amputations. The burden is especially heavy in developing countries, where limited awareness and delayed treatment often worsen outcomes. Dr. Gowri emphasizes the importance of early screening, proper foot care, and multidisciplinary management in reducing this burden. Her message is clear: Prevention, education, and timely intervention can save limbs, and lives.

2) Approach to a Foot Ulcer” by Dr. Muralidhasan Consultant Plastic Surgeon

Dr. Muralidhasan emphasizes that foot ulcers in diabetic patients are not just wounds, they are warning signs of serious complications. His approach begins with thorough assessment, identifying infection, ischemia, and neuropathy as critical factors influencing healing. He stresses the importance of a team-based approach involving diabeologists, surgeons, podiatrists, and nurses. Proper wound care, offloading techniques, and strict glycemic control are central to successful outcomes. Ultimately, Dr. Muralidhasan’s message is that with early intervention, education, and structured care, we can prevent amputations and improve quality of life for diabetic patients.

3)Workshop – I Basic Ulcer Management, Dr. Muralidhasan Consultant Plastic Surgeon and S/N Ms. Subadhradevi

The session began with hand hygiene, where Ms. Subadhra demonstrated the correct technique for handwashing and sanitizing before and after wound care. This step is vital to prevent infection and cross-contamination, especially in high-risk diabetic patients. Next, she covered wound handling and cleaning. She explained the importance of using sterile gloves, gentle debridement when necessary, and cleaning the ulcer with appropriate solutions such as normal saline or antiseptics without damaging healthy tissue. The session then moved on to dressing techniques and materials. Dr. Muralidhasan introduced various dressing types including gauze, hydrocolloids, foam dressings, and antimicrobial layers. He explained how to choose the right material based on the wound’s condition whether it’s dry, exudative, or infected. She also emphasized maintaining a moist wound environment, avoiding tight bandaging, and ensuring regular dressing changes. Throughout the session, Dr. Muralidhasan highlighted the importance of patient education teaching them about foot hygiene, the need for daily inspection, and when to seek medical help. His practical, clear approach provided us with valuable knowledge and confidence in handling diabetic foot ulcers with care and precision.

4) Ischemic Diabetic Foot Dr. Arunagiri Viruthagiri Sr. Consultant & Head – Vascular and Endovascular Surgeon

Dr. Arunagiri focused on the critical challenge of ischemia in diabetic foot patients, a condition where poor blood flow severely impairs wound healing and increases the risk of amputation. He explained the importance of early identification through clinical signs, Doppler studies, and ankle-brachial index measurements. The session stressed that timely vascular assessment and referral for revascularization, when needed, are essential. Dr. Arunagiri also underlined the importance of multidisciplinary care involving vascular surgeons, diabetologists, and wound care specialists. His key message is that restoring blood flow is the cornerstone of saving both limbs and lives in ischemic diabetic foot cases.

5) Workshop – II Evaluation of Vascular Diabetic Foot by Dr. Arunagiri Viruthagiri Sr. Consultant & Head – Vascular and Endovascular Surgeon

This session was organized into three focused stations, each designed to enhance our understanding of vascular assessment in diabetic foot care.

The first station covered pulse examination, where we learned to palpate key arteries such as the dorsalis pedis and posterior tibial. Identifying weak or absent pulses is a crucial early step in detecting ischemia in diabetic patients.

The second station focused on the Ankle-Brachial Index (ABI) — a simple, non-invasive test that compares blood pressure in the ankle and arm to detect peripheral arterial disease. Dr. Arunagiri Viruthagiri explained how values below 0.9 indicate compromised blood flow, which demands immediate attention.

The third station addressed risk factor modification. Dr.Gowri stressed that managing vascular health goes beyond examination. She highlighted key interventions like smoking cessation, adopting a heart-healthy diabetic diet, maintaining optimal blood pressure, and using appropriate medications such as antiplatelet agents and statins.

His message was clear, early detection and proactive management of vascular issues can greatly reduce the risk of foot ulcers, infections, and amputations in diabetic patients. This workstation provided not only technical skills but also a deeper appreciation for holistic and preventive diabetic foot care.

6) Patient Education on Foot Care – Nurses Role by Ms. B. Mahalakshmi Nursing Superintendent

In this session, Ms. Mahalakshmi emphasized the crucial role nurses play in educating diabetic patients about proper foot care. She highlighted that many complications, including ulcers and amputations, can be prevented through consistent patient education. Key topics covered included teaching patients to inspect their feet daily, maintain foot hygiene, wear proper footwear, avoid walking barefoot, and report any changes such as cuts, blisters, or color changes immediately. Ms. Mahalakshmi also stressed the importance of individualized patient counseling, use of simple language, and demonstration techniques to ensure patient understanding and adherence. Her message was clear, empowered nurses lead to empower patients, and with the right education, we can significantly reduce the burden of diabetic foot complications.

7) The High Risk Foot by Dr. Gowri P, Senior Consultant, Diabetologist

In this session, Dr. Gowri emphasized the importance of identifying high-risk diabetic feet, which are more prone to developing serious complications. She categorized wounds based on their severity, highlighting that Grade V wounds, which involve extensive gangrene or severe infection, are often non-reversible and may require surgical intervention or amputation. She explained that early detection of foot issues such as neuropathy, ischemia, or minor ulcers can prevent progression to higher grades. Proper classification of wounds helps guide treatment, improve outcomes, and avoid limb loss. Dr. Gowri’s message was clear, once a wound reaches Grade V, reversal is rarely possible so prevention, early care, and risk identification are absolutely vital.

8) Workshop – III Peripheral Neuropathy Testing, Basics of Footwear Dr. Gowri P, Senior Consultant Diabetologist

This session focused on the practical aspects of managing high-risk diabetic feet, providing hands-on learning through visual aids, demonstrations, and essential clinical tools.

Ms. Vangikodi began with visual identification using foot images, helping us recognize common high-risk features like calluses, deformities, dry skin, fissures, ulcers, and signs of infection. She emphasized that visual inspection is the first critical step in daily and clinical assessments.

Next, Dr. Gowri demonstrated how to assess neuropathy using tools such as:

Vibrothermia – to evaluate vibration perception

Thermal testing – to check the patient’s ability to sense heat and cold, which is often diminished in diabetic neuropathy

Monofilament testing – to assess protective sensation

These tests help classify the level of sensory loss, which is a key indicator of risk for developing ulcers or injuries.

Another important part of the session was on appropriate footwear. She explained the importance of well-fitting, pressure-relieving shoes for patients with high-risk feet. She discussed the use of:

Soft, padded insoles, seamless socks, custom orthopedic footwear for patients with deformities or previous ulcer

Dr. Gowri session was a practical and informative guide on how we, as healthcare professionals, can identify, assess, and protect high-risk feet to prevent complications and improve patient quality of life.

Panel Discussion Nursing Strategies in Diabetic Foot Disease, Prevention, Management and Patient Education by Ms. B. Mahalakshmi Nursing Superintendent,Ms. Shakila Associate Professor, Ms.Subadhra Devi Nursing supervisor

I am pleased to present a detailed overview of the panel discussion on Nursing Strategies in Diabetic Foot Disease: Prevention, Management, and Patient Education, skillfully led by the team. This session brought forward a well-rounded and practical discussion on the nursing approach to diabetic foot care, highlighting how prevention, timely intervention, and education can dramatically improve patient outcomes.

Ms. Subadhra began by focusing on prevention strategies, stressing the importance of early identification of at-risk patients. She discussed regular foot assessments, including skin inspection, pulse palpation, and monofilament testing, as simple yet powerful tools in detecting early warning signs.

Ms. Shakila continued the discussion by addressing wound management and nursing care. She elaborated on evidence-based dressing techniques, infection control practices, and the importance of maintaining a moist wound environment for optimal healing. She also emphasized the nurse’s role in coordinating with physicians, podiatrists, and physiotherapists as part of a multidisciplinary team.

Ms. Mahalakshmi highlighted the third pillar of patient education. She stressed the need to empower patients with knowledge about daily foot care, the importance of proper footwear, blood sugar control, and when to seek medical help. Her emphasis on using simple language, visuals, and demonstrations made the message accessible to all patient populations.

Together, the panelists conveyed a unified message, nurses are the backbone of diabetic foot care. Their vigilance, skill, and communication can prevent severe complications and support healing through every stage of care.

It was truly an enriching and well-rounded discussion that reflected the passion and dedication of nurses in protecting patients from diabetic foot disease.

As a concluding session Ms. Subadhra Devi, the nursing supervisor conducted a Post-test with QR codes

As we concluded these informative programs, we assessed participants’ understanding of key concepts through a quick post-test. To make this process simple and convenient, the test was conducted digitally using a QR code. To motivate and encourage active participation, we introduced a reward system where nurses with the highest test scores were recognized and awarded prizes. This approach not only fostered a spirit of friendly competition but also emphasized the importance of continuous learning and professional excellence in nursing.

Conclusion

The Continuing Nursing Education (CNE) program has provided us with valuable knowledge and practical skills essential for effective diabetic foot care. We have learned the importance of early detection, proper wound management, vascular assessment, and patient education in preventing complications. I would like to thank all the participants for their active involvement and dedication. Their commitment to continuous learning is vital in improving patient outcomes and enhancing the quality of care speakers provide. Let’s take forward the knowledge gained today and apply it in all health care workers in daily practice to make a meaningful difference in the lives of our patients.

Kauvery Hospital