DM is a major health problem because of some features of it as increasing frequency, causing acute and chronic complications that increase mortality and morbidity while its follow-up and treatment is out of control and economic burden placed by it on individuals and society. It is one of the most common complications of diabetes is diabetic foot. Apart from the risk of amputation, increased morbidity, is a major socio-economic problems that cause deterioration of the quality of life of patients and higher treatment costs. Diabetes, diabetic foot care and taking preventive measures is a situation that patient should continue throughout the life.
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The data used to support the findings of this study are available from the corresponding author upon request. Nurses, important members of the diabetes treatment team, have an essential role in the prevention of diabetic foot problems and in the care and education of patients at risk of diabetic foot problems.
The study evaluated the knowledge levels of nurses regarding diabetic foot care management and determined influencing factors. This was a cross-sectional, descriptive study. The research sample comprised nurses who worked in a private hospital. Nurses' knowledge level scores regarding diabetic foot management are adequate, but this knowledge is not used during patient care. In order to facilitate nurses' involvement in diabetic foot management, theoretical and practical training programs should be organized and nurses should be encouraged to participate in these programs.
The diabetic foot is a serious complication of diabetes with high mortality, morbidity, and cost of treatment, which can be prevented by patient education and early diagnosis-treatment [ 1 — 4 ]. Diabetic foot problems are a frequent cause of hospital admissions for patients with diabetes and comprise the main factor determining the quality of life of diabetic patients [ 5 , 6 ]. Risk factors must be known and monitored to prevent diabetic foot complications. The most important risk factors for foot ulceration include peripheral neuropathy, peripheral vascular disease, foot deformity, previous foot ulceration, and amputation of the foot or leg [ 8 — 10 ].
In addition, recurrent chronic abrasions, minor abrasions, bullae, various irritations, verrucas and calluses, improper cutting of toenails, fungal infection, poor foot hygiene, inappropriate footwear use, and bad metabolic control are the most common causes of foot ulcer formation in patients [ 6 , 8 , 11 ].
Because of these changes, feet are easier to traumatize and wounds heal slowly, which increases the risk of infection. In order to control these risk factors, all patients with diabetes should be examined at least once a year for potential foot problems, and those with risk factor s should be examined every months [ 3 , 4 ]. Diagnosis of the foot at risk, regular examination of the foot at risk, education of patients, family, and health workers, management of nonulcerative pathologies, and management of the diabetic ulcer are the main elements of diabetic foot management [ 12 — 14 ].
In addition, other risk factors such as hypertension, alcohol, smoking, hyperlipidemia, obesity, and visual impairment should be addressed in patients [ 11 , 15 , 16 ]. Foot screening and assessment to identify the high-risk foot are aimed at preventing the serious complications of ulceration and amputation. The protective sensory feelings, foot structure and biomechanics, vascular structure, and skin integrity should be assessed during diabetic foot examinations [ 6 , 17 ].
Diabetic individuals should be questioned during neurological evaluations for neuropathy findings. A g Semmes-Weinstein monofilament set, which is an inexpensive, painless, and easy method, is used to evaluate the loss of protective sensation in the foot [ 16 , 18 — 20 ].
A 10 g pressure is applied to certain points in the plantar and dorsal areas of the patient foot. If sensory loss is detected during patient evaluations using this filament, the foot is in danger and the protective sense has disappeared [ 11 , 21 ]. The diagnosis of the foot at risk is confirmed with a vibration test using a Hz tuning fork or a biothesiometer , pinprick sensation, or ankle reflexes [ 17 , 18 , 20 , 22 ].
A patient at risk should be encouraged to wear therapeutic shoes that reduce plantar pressure while walking to prevent recurrent plantar foot ulcers [ 4 , 13 ]. The data obtained during the foot examination determine which risk category patients belong to for diabetic foot problems [ 11 , 19 ].
These categories are designed to facilitate referral to, and subsequent therapy by, a specialty clinician or team and determine follow-up frequency. A high-risk category is associated with an increased risk for ulceration, hospitalization, and amputation [ 11 , 22 , 23 ].
The diabetic foot needs a multidisciplinary team approach because it requires long-term treatment utilizing many areas of expertise [ 12 , 15 , 24 , 25 ].
Multidisciplinary team work can reduce foot ulcer and amputation rates, decrease healthcare costs, and lead to better quality of life for patients with diabetic foot ulcer risk [ 26 , 27 ].
The members of the diabetic foot care team usually consist of a general practitioner, nurse, educator, orthotist, podiatrist, vascular surgeon, infection disease specialist, dermatologist, endocrinologist, dietitian, and orthopedic surgeon [ 17 , 22 , 25 ].
Although all team members should educate the patient, the nurse and podiatrist are often the primary sources of patient information [ 27 ]. Lack of proper education and awareness of regular foot care play a contributory role in the causation of foot problems [ 28 — 30 ]. A specific education course for foot and wound care decreases the rate of foot ulcers and amputations, and existing guidelines state the need for patient education as a prerequisite to prevent ulceration [ 31 , 32 ].
In fact, educating patients on foot self-management is considered the cornerstone to prevent diabetic foot ulcers. The goals of training are to motivate the patient and create adequate skills to maximize the use of preventive methods [ 6 ]. However, nurses are the primary point of contact for patients and are seen as a source of information by patients.
In order for nurses to fulfill this role, they must have knowledge regarding diabetic foot care management and convey this knowledge to the patient [ 33 — 37 ].
Therefore, we assessed the knowledge level of nurses of diabetic foot care and their use of this knowledge in patient care. The aim of this study was to evaluate the knowledge levels of nurses of diabetic foot care management and to determine influencing factors. Is there a difference between the levels of nurses' knowledge about management of diabetic foot care according to their sociodemographic, occupational and diabetic foot management characteristics?
This study was conducted in a private hospital in Istanbul with joint commission international accreditation. It is one of the largest groups of hospitals in the country and ranks among the best hospitals in Turkey in the fields of cardiology, cardiovascular surgery, and organ, tissue, and cell transplants.
In addition, it serves as a training hospital for many specialties by combining its academic activities with health services. This study was carried out in three hospitals including one application and research hospital affiliated with a foundation university and two private hospitals. The research population was nurses working in the hospitals. A random sampling method was used to select the study sample. The study sample consisted of nurses response rate: Nurses who did not agree to participate in the study or who could not be reached for various reasons annual leave, vacation, maternity leave, etc.
The nurses who agreed to participate in the research were asked to answer questionnaire forms by the researcher. The test was self-administered and took minutes. The completed questionnaire forms were collected by the researcher. Nurse Information Form. There were 8 questions about nurses' sociodemographic and professional characteristics and 7 questions related to nurses' diabetic foot management care.
There is no valid and reliable measurement tool in our country to measure the level of knowledge of nurses regarding diabetic foot care management. Therefore, a questionnaire form was prepared. This form can be used as a guiding resource in developing valid and reliable measurement tools in the future to measure knowledge about diabetic foot management in Turkey. The test was developed for this study after the related literature was consulted [ 3 , 4 , 13 , 36 ].
The higher the total score, the higher the knowledge level of diabetic foot management. The experts assessed the scale items for their fitness for the purpose. The experts' mean score for each item was 2 or higher. The questionnaire was also administered to a group of 15 nurses prior to use in the study to assess whether the questions were clear and understandable. Some minor corrections were made on the questionnaire form in line with the suggestions received from the preliminary application of the form, and the questionnaire form was finalized.
The reliability coefficient for the entire form was found to be 0. Before starting the study, written consent was obtained from the hospitals where the research was conducted with the approval of the Clinical Research Ethics Committee Decision No: The sociodemographic and diabetic foot management practices of nurses were determined as independent variables, and their knowledge level scores relating to diabetic foot management were determined as dependent variables.
Descriptive statistics means, standard deviations, frequencies, and percentages were calculated for demographic variables. The suitability of the data for normal distribution was tested using the Single Sample Kolmogorov Smirnov test and parametric tests were used in the advanced analysis because the significance values were greater than 0. Associations between background factors and the foot care knowledge test were analyzed using a t-test for paired group comparisons and one-way ANOVA for more than two-group comparisons.
The relationship between variables was examined by Pearson correlation analysis. Internal consistency of the scale was tested using Cronbach's alpha. The average age of the nurses participating in the survey was More than half of the nurses were female When the distribution of the nurses according to the unit where they were working was examined, The mean duration of occupational time was However, The nurses provided the most patient education regarding blood sugar control In addition, Distribution of nurses according to characteristics related to diabetic foot management care.
The distribution of knowledge level scores regarding diabetic foot management of the nurses in the study is given in Table 3. Distribution of nurses' knowledge level form scores related to diabetic foot management. Significant sociodemographic, professional, and diabetic foot management characteristics of nurses in the study were compared to nurses' knowledge level scores. Comparison of nurses' diabetic foot care knowledge level scores to their training on diabetic foot care. Nurses on the healthcare team have contact with patients for 24 hours and thus play an important role in educating patients [ 20 , 38 ].
Nurses can improve the quality of life of a diabetic individual by assisting in the preparation and implementation of education programs that help patients develop self-care behaviors related to diabetic foot care.
In addition, they can prevent or delay formation of diabetic foot problems by identifying risk groups in the community [ 13 , 27 ]. Therefore, nurses' knowledge levels must be assessed periodically using validity and reliability tools. Theoretical and practical deficiencies can be revised, false information can be corrected, and nurses' knowledge and skills can be improved through obtaining evidence-based data regarding their knowledge, skills, and practices.
The variables to be measured by a good measurement tool must fit for purpose, include cognitive scales related to the subject, and have information to obtain correct data. The survey form that was used in this study was prepared based on the researchers' previous experience and information from previous studies.
In addition, it attempted to address all the factors that affect the development of diabetic foot after an extensive review of the literature scanning. The form not only includes practices about diabetic foot care, but also statements regarding factors that play a key role in diabetic foot development, choice of suitable shoes, and foot examination. Moreover, in the process of designing the items, a great deal of attention was paid for the items not to have more than one statement or opinion and to be clear and understandable.
Experts were consulted to assess the measurement tool and to obtain a more reliable and understandable form. The scale had high reliability too.
This survey is thought to be helpful for future studies to be carried out on this subject. The knowledge levels of nurses of diabetic foot care management and influencing factors were examined in this study. The knowledge level of nurses was high, but they did not provide patients with adequate education on this subject or examine the foot.
Evaluation of Nurses' Knowledge Levels of Diabetic Foot Care Management.