Establishment Of Foot Care Service Center For Diabetes Patients In Chennai, An Essay.

Diabetes and its complications create a need for foot care services in Chennai

Questions:

1. Executive summary This outlines your business proposal. This is the first section in your plan but it is the last to be written. It should highlight the most important elements of the plan, which could include why you are proposing the change, what could be the potential benefits for the service user and the organisation and how the outcomes or clinical effectiveness to demonstrate achievement is being planned.

2. Background and rationale for the service development. This includes highlighting the potential need for the service. It could also include current practice and resources.

3. Who is the service development aimed at? Prevalence and demographic information could be included. Illustrate any important trends and reasons behind them.

4. The service change. Here you detail comprehensively what the service will be about, how it will be organised, resources required. How will outcomes be identified/measured to identify achieved objectives? Identify what could be financial or human resources benefits to the change of service. Relationship of the service in relation to either local, national or international strategic priorities. How does the change (if appropriate), address changing needs in the client population?

5. Clinical effectives or Outcome: potential impact of the service: service aim,service change should include.patient feedback or survey

a) for the service user/client (e.g. better concordance, empowerment, self-efficacy, improved knowledge)

b) for the organisation (e.g. reduce consultation time with GP, reduced hospital admissions, improved patient survey results, improved job satisfaction)

6. Distribution of your plan. Who would you disseminate your business plan to and why. What benefits would there to sharing the plan with the respective individuals ?(benefit patients,nurses,community decrease mortality,morbidity,

7. Action plan.  It is not included in word count.it should be written in table template formThis could be a listed box of what are the priority actions to be taken, when  to action and by whom.

8. Appendices. It is also included  in word count.The SWOT analysis should be one of the appendices

9. References. Must be Harvard style

The report presents a business plan for the establishment of a foot care service center for the diabetes patient. The service will be provided by the nurses. The center will be Chennai. Chennai is known as the Health Capital of India. From various reports it is evident that the maximum numbers of patients suffering from diabetes are from Chennai. Diabetes results in various types of health complications. Among the various health complications, diabetes damages the blood vessels which prevent the smooth flow of blood throughout the body. This creates several foot problems among the diabetes patients. Thus it is very essential to take care of the feet. A foot care center will be able to provide right guidance to the patients as they will provide the service scientifically. This will help the patients to overcome their feet related problems. The problem has been discussed in the report. It also provides a guideline of the various services that are provided by the health care center. Type 2 diabetes has influenced the individuals with the 40 or more age gathering. In any case it is perceived that there is increment in the quantity of diabetic patients in the age gathering of 20-29 years. Around 15% of the patients experiencing Diabetes have foot issues. The foot issues are consequences of lower appendage removal. More than half of this sickness happens as an aftereffect of diabetes. Diabetes is common among offspring of the age gather over 20 years. The administration will be given to individuals of the age gathering of 20 years or more. Diabetes has been common among the adolescent in India fitting in with the age gathering of 20 to 29 years. From the information of 2012 gave by the International Diabetes Federation, the predominance of diabetes among the grown-ups is in the age gathering of 20 to 79 years. Thus it is important to develop a foot care center for the diabetes patients to reduce the complication related to diabetes.

Foot complications resulting from diabetes and their impact on patients

Diabetes is a non- communicable disease that constitutes a larger portion of the cost, time and human resources of the health systems of the world. The changes in lifestyle and industrial process there has been increase in the rate of incidence of diabetes and the complications to this disease has also increased. Diabetic foot is considered as the most common complications of this disease. According to a report presented by World Health Organization (WHO) the number of patients suffering from diabetes will increase to 171 million. The increase the number of patients suffering from diabetes will be by 380 million by 2025(Jha, 2015). Diabetes has become an epidemic disorder. Diabetes has significant consequences on the health care providers as well as the community. This problem has to be solved in a serious manner by development of national as well as international strategies by interaction with the health team members. It is necessary to provide health care services to patients and the families must have knowledge of the ways in which a diabetes patient should be handled. Improving the quality of service by the nurses, the clinical performance can be superior which can lead to effective changes in the client and patient societies. Diabetes has become an epidemic disease in South India (Who.int, 2015). Diabetes is a common disease in Chennai and Bangalore. The major reasons for diabetes in the urban areas are sedentary mode of lifestyle and eating habits (Jha, 2015). Among the various other complications that results from diabetes, different types of foot problems also arises from diabetes. The treatment of diabetic foot is expensive all over the world. Nurses are the health care providers that are actively involved in the prevention of diabetes and its early detection. The diabetes nurses play an educating role in this field for the prevention of diabetic foot, care of foot and prevention from foot injury (Aalaa et al., 2012). In addition to this nurses play an important role for the detection of any kind of change in the sensation of foot or skin by application of appropriate technology. The nurses have to attend special training so that they can apply the latest instructions of diabetic foot on the patients so that they can provide effective service to the patients and promote the health care service to the patients (Aalaa et al., 2012).

Nearly 80% of the people suffering from diabetes come from low and middle income countries. The major regions in the world affected by diabetes are Asia and eastern Pacific regions. The largest number of adults suffering from diabetes is from China (around 9% of the population) followed by India (8% of the population). However the Government is unaware of the current prevalence of diabetes. There will be future rise of the disease which will lead to further complications. There must be implementation of new strategies and policies for the prevention and management of the disease (Who.int, 2015). According to the data provided by the International Diabetes Federation (2013), approximately 50 % of the populations suffering from diabetes live in the three countries – China, India and USA. The major reasons behind diabetes are unhealthy eating habits; physical inactivity along with inherent genetic attributes has resulted in the increase in diabetes. The complications related to diabetes have resulted in the increase in complications which has contributed to the overall morbidity and mortality rate. The highest prevalence of diabetes is in Ernakulum in Kerala (19.5%) and the lowest prevalence of diabetes is in the Kashmir Valley (6.1%) (Better Health Channel, 2015). Diabetes is prevalent in the rural as well as the urban areas. But diabetes has been growing at a faster rate in the urban areas than in the rural population. The increase in prevalence of diabetes is evident from the studies that have been performed in Chennai city in South India. It shows that the increase in Diabetes from 1989 to 2006 is 8.3 % to 18.6% (India, Tandon and Raizada, 2015); (Better Health Channel, 2015).

Nurses' role in diabetes prevention and management and education

Type 2 diabetes has affected the people belonging to the 40 plus age group. However it is noticed that there is increase in the number of diabetic patients in the age group of 20-29 years. About 15% of the patients suffering from Diabetes have foot problems. The foot problems are results of lower limb amputation. More than 50% of this disease occurs as a result of diabetes (Nytimes.com, 2015). Diabetes is prevalent among children of the age group above 20 years. The service will be provided to people of the age group of 20 years and above. Diabetes has been prevalent among the youth in India belonging to the age group of 20 to 29 years. From the data of 2012 provided by the International Diabetes Federation, the prevalence of diabetes among the adults is in the age group of 20 to 79 years (International Diabetes Federation, 2015).

The nurse led foot care service centre will be established for the age group of people more than 20 years of age. It has been seen that in urban as well as in the rural areas, diabetes is seen to be a common disease among the people of the age group of 20 to 29 years (International Diabetes Federation, 2015).  The major reasons for diabetes at such an early age are the sedentary lifestyle and bad eating habits. The target audience of the organization will be people of this age group.

The diabetes foot care service centre will be developed in Chennai named “Diabetes Foot care Centre” (Hamid, 2012). There is high prevalence of diabetes in the urban population in South India. An oral glucose tolerance test was performed which showed that out of the 678 people suffering from diabetes (346 men and 332 women), 21% of diabetes was prevalent among people who were above the age of 40 years.  The peak prevalence of diabetes was seen among the age group of 55 to 64 years (Ramachandran et al., 1988). Thus the service center will be developed in Chennai (The Times of India, 2015).

The objectives of the service care center will be as follows –

1. To create medical practice that will exceed the expectations of the patients.
2. To form a health care practice that will be able to provide complete foot care to the diabetes patients.
3. To increase the number of patients in the foot care centre by 20% each year by providing superior performance and generating positive word of mouth.
4. To develop a comprehensive website that will include online booking capability. It will also contain information about the various ranges of services provided by the service care centre.

Time bound - The organization will start its operation within one year. It will start its establishment once the business plan is sanctioned.

Diabetes Foot care center will have an efficient team of experienced nurses. There will be 25 nurses in the Foot care center. There will be three doctors attending the patients. The nurse will work under the guidelines of the doctors.  Since the people suffering from diabetes are vulnerable to nerve and vascular damage. It results in poor circulation and poor healing of the ulcers of the foot.  This results in high rate of amputation among the patients. The procedures to be followed in the service center are as outlined below. The center will have a website that will contain information about their various services. It is designed to provide primary care to the patients counseled by the health care providers (Kerr, 2012).

1. Identification of the high risky diabetic foot by conducting various tests.
2. Diagnosis of the foot problems.
3. Starting the intervention as early as possible to prevent further deterioration which can lead to damage of the nerves.
4. The nurses will provide proper foot care advice to the patients after the service has been provided.

Global and national diabetes statistics and prevalence

The entire procedure of foot care to the patients will comprise of the following steps-

• A pocket card will be provided to the patients for quick reference for preventing the foot problems.
• The pocket card will consist of a disposable monofilament which is used for sensory testing.
• A visual foot inspection will be conducted.
• The patients have to fill a reproducible form for the annual foot examination.
• The patients will be provided with prescription forms and therapeutic foot ware will be advised to the patients.
• There will be additional tools in the foot care center that will facilitate visual and comprehensive foot exams.
• After the entire procedure has been completed in the care center, the patients will be provided with education materials for taking care at home (Ndep.nih.gov, 2015).

The cost of providing the foot care service to the patients will depend on the severity of the disease suffered by the patients.

Chiropody is a service provided to the patients to prevent amputation (Nhscareers.nhs.uk, 2015). The nurses will be trained to provide the treatment to calluses, corns and ulcers of the diabetic foot (Ontariochiropodist.com, 2015). The treatment will also comprise of pedicure services like trimming of the nails. The clinic will provide chiropody at a reasonable rate of Rs 2500 per session. The duration for each session is three hours. At the end of the session the patients will be advised to use proper foot wear so that the reoccurrence of the disease can be prevented (Nhs.uk, 2015).

The nurses will be trained by the Doctors specialized in the field of providing treatment to the diabetic patients (Aalaa et al., 2012); (Nawccb.org, 2015). The nurses will be provided a three months training prior to the inauguration of the foot care center (cafcn.ca/education, 2015). The center will be able to avoid any kind of negligence of treatment to the patients (Nursingtimes.net, 2015). The nurses will be treated in the following aspects –

1. Examination of the foot – Symptoms of neuropathy (conditions in which the nerves will be affected) will be checked by the nurses (Medical News Today, 2014) ; (Mayoclinic.org, 2015). The nurses will also check for infection development. Necrosis is done at the clinic for this purpose (Mayoclinic.org, 2015) ; (Healthline, 2015).

2. Use of equipments –

3. The nurses will be trained to use the various equipments like the Biothesiometry for the detection of the sensory loss in the patients (DAVIS et al., 2015) ; (Whyde, 2015) ; (Range et al., 2015).

4. The nurses will be trained to use Doppler for the detection of the decrease in circulation of blood (Webmd.com, 2015); (Imd.gov.in, 2015) ; (Mayoclinic.org, 2015).

Measurement of Foot pressure distribution will identify the areas in which the callus and corn in the foot are prone to develop. The nurses will be trained for proper measurement of these areas (Thibodeaux, 2015).

1. Apart from the technical aspect, the nurses will be trained with special skills to provide good hospitality to the patients (Dr. Mohan's Diabetes Specialities Centre | Diabetes Care in Chennai, 2015).

The fund required for starting the foot care center for the diabetes patients will be Rs 5, 00,000. The distribution of the funding system will be as follows –

Fund Arrangement	Amount ( Rs)
Donation by Charitable organization	Rs 1,00,000
Loan from Bank	Rs 4,00,00

The foot care service center will be set up in Chennai since Chennai is one of the most diabetes prone areas in the country. The service will bring positive change in the patients. The service care center can determine the changes provided by the service by the increase in the number of patients each month.  This will achieved by generation of positive word of mouth by the patients. The number of booking for the service will increase. The patients will can do the booking online. Good service will increase the number of bookings and the profitability of the company will increase.

Diabetes prevalence and risk factors in India

The service provided by Diabetes foot care center aims at reducing the foot problems of the diabetic patients. This can be achieved by providing service to the patients at an early age of onset of the disease. Prolonged suffering from diabetes can make the foot related problems more complex. Thus the service care center aims at raising the awareness among the general public of the importance of taking proper foot care. The inception of various critical diseases can be prevented. The objectives of the organization will be fulfilled if it can bring positive change in the patients. The organization will improve its service by taking regular feedback from the customers visiting the health care center. This will help to identify the fallacies in the treatment which can be improved in future.

The outcome of the treatment can be known by direct response from the patients. This can be done by the foot care center by providing them a feedback form at the end of each treatment. The feedback form will identify the strengths and weakness of the treatment. The direct response from the patients is crucial for the organization. Positive feedback will generate goodwill and increase the number of customers of the organization (Aldrich and McGraw, 2011). Negative feedback will help to identify the fallacies which can be improved further (Small Business - Chron.com, 2015). The service will make the clients knowledgeable of the various ways in which they can take adequate care of their foot. There will be increase in awareness among the patients about the adverse effects of diabetes. They will attend the foot care center on a regular basis. This will be beneficial for their health in the long run (How To Be Your Own Management Guru, 2015). 

The organization can grow in the future by providing good service to the patients. This can be achieved by having a good team of nurses and doctors who will be responsible for providing good service to the patients. This will improve the good will of the organization. It will generate positive word of mouth which will be increase the number of bookings from the patients. The clients have to fill a feedback form at the end of the treatment. This will help the organization to ascertain the positive and negative feedback about the organization.  The results from the survey will help to identify whether the procedure of the treatment is not helpful for the patients or the nurses are not trained well. This will help the organization to improve its performance. The job satisfaction of the employees will improve by gaining positive feedback from the clients.  Their interest in the job will increase. In order to improve their service further, the doctor and the nurse will increase the consultation time. This will help them to identify the problems of the patients minutely and they will be able to provide services that will be effective. The admissions at the service care centre will increase. This will increase the profitability of the organization. It will be able to hire more employees to provide service to more patients.

Increasing prevalence of diabetes among young people and foot complications

The organization can perform its distribution activities by making contacts with various hospitals in Chennai. Chennai is known for providing best health care service to the patients in India. They can visit the health care centers so that the doctors from the health care centers can recommend about their patients to take treatment from the foot care service center. In this way the popularity about the foot care center will increase at an early stage. Chennai is known as the health capital of India (Indiahealthvisit.com, 2015). Thus the foot care center will get enough patients from the various hospitals in Chennai (The Times of India, 2015). The doctors of the foot care center can contact with their colleagues from various clinics to send the diabetic patients to their foot care center. At the initial stage the organization will be able to gain popularity by contacts. But the foot care center has to provide good service to the patients in order to run their business in the long run. This can be achieved by collaborative effort from the doctor and the nurses. Positive word of mouth is an effective strategy to grow business.

Conclusion

It is important for the diabetes patients to take proper care of their feet. Amputation is a major problem faced by the diabetes patients.  Chennai has one of the most diabetes affected people in India. Diabetes Foot care center will be able to treat the patients effectively.

8. References

Aalaa, M., Malazy, O., Sanjari, M., Peimani, M. and Mohajeri-Tehrani, M. (2012). Nurses’ role in diabetic foot prevention and care; a review. Journal of Diabetes & Metabolic Disorders, 11(1), p.24.

Aalaa, M., Malazy, O., Sanjari, M., Peimani, M. and Mohajeri-Tehrani, M. (2012). Nurses’ role in diabetic foot prevention and care; a review. Journal of Diabetes & Metabolic Disorders, 11(1), p.24.

Aldrich, J. and McGraw, K. (2011). Improving public opinion surveys. Princeton, N.J.: Princeton University Press.

Better Health Channel, (2015). Diabetes - foot care - Better Health Channel. [online] Available at: https://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_and_feet [Accessed 16 Jan. 2015].

cafcn.ca/education, (2015). Canadian Association of Foot care Nurses. [online] Available at: https://www.cafcn.ca/education.html [Accessed 17 Jan. 2015].

DAVIS, E., JONES, T., WALSH, P. and BYRNE, G. (2015). The Use of Biothesiometry to Detect Neuropathy in Children and Adolescents With IDDM. [online] care.diabetesjournals.org. Available at: https://care.diabetesjournals.org/content/20/9/1448.full.pdf [Accessed 17 Jan. 2015].

Dr. Mohan's Diabetes Specialities Centre | Diabetes Care in Chennai, (2015). Diabetic Foot Care | Diabetic Foot | Reflexology. [online] Available at: https://drmohansdiabetes.com/patient-care/foot-clinic [Accessed 17 Jan. 2015].

Hamid, Z. (2012). The medical capital’s place in history. [online] The Hindu. Available at: https://www.thehindu.com/news/cities/chennai/article3796305.ece [Accessed 17 Jan. 2015].

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How To Be Your Own Management Guru. (2015). pp.100-200.

Imd.gov.in, (2015). Doppler Radar Products. [online] Available at: https://www.imd.gov.in/section/dwr/dynamic/dwr.htm [Accessed 17 Jan. 2015].

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Proposal for a foot care service center in Chennai for diabetes patients

Indiahealthvisit.com, (2015). :: India Health Visit ::. [online] Available at: https://www.indiahealthvisit.com/chennai-health-capital.htm [Accessed 17 Jan. 2015].

International Diabetes Federation, (2015). India. [online] Available at: https://www.idf.org/membership/sea/india [Accessed 16 Jan. 2015].

Jha, D. (2015). South India worst hit by diabetes - The Times of India. [online] The Times of India. Available at: https://timesofindia.indiatimes.com/india/South-India-worst-hit-by-diabetes/articleshow/18175487.cms [Accessed 16 Jan. 2015].

Kerr, M. (2012). Foot Care for People with Diabetes:  The Economic Case for Change. [online] diabetes.org.uk. Available at: https://www.diabetes.org.uk/Documents/nhs-diabetes/footcare/footcare-for-people-with-diabetes.pdf [Accessed 17 Jan. 2015].

Mayoclinic.org, (2015). Diabetic neuropathy Symptoms - Diseases and Conditions - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/symptoms/con-20033336 [Accessed 17 Jan. 2015].

Mayoclinic.org, (2015). Doppler ultrasound: What is it used for? - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/doppler-ultrasound/expert-answers/faq-20058452 [Accessed 17 Jan. 2015].

Mayoclinic.org, (2015). Peripheral neuropathy Symptoms - Diseases and Conditions - Mayo Clinic. [online] Available at: https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/basics/symptoms/con-20019948 [Accessed 17 Jan. 2015].

Medical News Today, (2014). What are the signs and symptoms of neuropathy?. [online] Available at: https://www.medicalnewstoday.com/articles/239561.php [Accessed 17 Jan. 2015].

Nawccb.org, (2015). Diabetic Wound Certification Program. [online] Available at: https://www.nawccb.org/dwc-certification [Accessed 17 Jan. 2015].

Ndep.nih.gov, (2015). Feet Can Last a Lifetime: A Health Care Provider's Guide to Preventing Diabetes Foot Problems. [online] Available at: https://ndep.nih.gov/publications/publicationdetail.aspx?pubid=116 [Accessed 17 Jan. 2015].

Nhs.uk, (2015). Podiatrists, chiropodists and foot problems - Live Well - NHS Choices. [online] Available at: https://www.nhs.uk/Livewell/foothealth/Pages/Foot-problems-podiatrist.aspx [Accessed 17 Jan. 2015].

Nhscareers.nhs.uk, (2015). Chiropodist/podiatrist - NHS Careers. [online] Available at: https://www.nhscareers.nhs.uk/explore-by-career/allied-health-professions/careers-in-the-allied-health-professions/chiropodistpodiatrist/ [Accessed 17 Jan. 2015].

Nursingtimes.net, (2015). Diabetic Foot Problems - Online Nurse Training Course from Nursing Times Learning. [online] Available at: https://www.nursingtimes.net/online-nurse-training-courses/diabetic-foot-problems/ [Accessed 17 Jan. 2015].

Nytimes.com, (2015). Type 2 Diabetes Complications - Type 2 Diabetes Health Information - NY Times Health. [online] Available at: https://www.nytimes.com/health/guides/disease/type-2-diabetes/complications.html [Accessed 16 Jan. 2015].

Ontariochiropodist.com, (2015). What is Chiropody?. [online] Available at: https://www.ontariochiropodist.com/pg_1.asp?CategoryID=0&ArticleID=1 [Accessed 17 Jan. 2015].

Ramachandran, A., Jali, M., Mohan, V., Snehalatha, C. and Viswanathan, M. (1988). High prevalence of diabetes in an urban population in south India. BMJ, 297(6648), pp.587-590.

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Strengths

• The foot care center will be located in one of the most populated urban place in
• The organization will get adequate patients from the various hospitals of Chennai.

Weakness

• At the initial stage gaining confidence of the clients will be a problem.
• There are many diabetes care centers in Chennai which will be a problem.

Opportunities

• Chennai is known as the Health Capital of India. Chennai is one of the highest diabetic prone areas in India. Thus it is a good location for the foot care center.

Threats

• There are many foot care centers in Chennai for diabetes patients. Immense competition is a major threat.
• There are less health care professionals in the organization. This creates stress among the nurses.