Skip to main content
Medical Archives logoLink to Medical Archives
. 2022 Jun;76(3):190–197. doi: 10.5455/medarh.2022.76.190-197

Knowledge of Diabetic Foot Among Nurses at a Tertiary Hospital in Saudi Arabia

Maram Alkhatieb 1, Hassan Abdulwassi 1, Anas Fallatah 2, Khalid Alghamdi 3, Wid Al-Abbadi 3, Rozan Altaifi 3
PMCID: PMC9478813  PMID: 36200121

Abstract

Background:

Diabetic foot is the leading cause of hospitalization among patients with diabetes mellitus (DM). Nurses have a significant role in helping diabetic foot patients by educating them about their condition. Therefore, assessing the knowledge of diabetic foot among nurses will help provide better healthcare services to these patients.

Objective:

This study aimed to assess the knowledge of diabetic foot care among the nursing staff at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.

Methods:

This cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, from March to May 2020. A total of 172 nurses from different departments of the hospital were randomly selected. A validated questionnaire including 68 yes-or-no questions about diabetic foot management was used for the assessment.

Results:

The average total score of the entire questionnaire was 59 (standard deviation, ±7). During our study, the nursing school curriculum was found to be the major source of knowledge for nurses. Statistical significance (p=0.031) was found for the association between educational background and answers to the risk factor questions. According to our results, most nurses indicated that they believed that reporting any changes to the feet and toes and signs of infection to the physician was the best way to prevent the development of DM foot.

Conclusion:

Specialized training programs beyond basic nursing education will reinforce knowledge and skills, resulting in an expected lower risk of amputation for DM patients.

Keywords: Diabetes, Nurses, Education, Diabetic Foot, Saudi Arabia

1. BACKGROUND

Diabetes mellitus (DM) is a common disease that results in patient morbidity and mortality. It occurs with either inadequate insulin secretion or resistance to insulin at the receptor level (1). Obesity, sedentary lifestyle, and family history are considered risk factors for DM development (1). Stroke, ischemic heart disease (coronary artery disease), peripheral arterial disease, and chronic kidney disease are known as chronic complications resulting from DM. Furthermore, retinopathy, neuropathy, and nephropathy are acute complications of DM (2, 3).

In 2019, 500 million individuals globally were diagnosed with DM (4). Moreover, it has been estimated that by 2030, a total of 578 million individuals will have DM (4). Saudi Arabia is considered to have the most prevalent cases of diabetes, with 7 million individuals with diabetes and 3 million individuals with prediabetes, thus ranking first in the Arabian Gulf region and second in the Middle East for diabetes (5).

Uncontrolled and poorly managed DM and a history of peripheral arterial disease result in a higher risk of microvascular complications, including diabetic foot (6, 7). Diabetic foot is considered the leading cause of hospitalization for patients with DM (6). It results from complex pathogenesis related to increased plantar pressure and impaired cellular wound healing, eventually resulting in chronic foot lesions, and is commonly observed in patients with polyneuropathy and angiopathy (6). The risk of diabetic foot is 2.5% per year for DM patients, and the majority of these individuals will require amputation within 4 years of the initial diagnosis (7). A recent study conducted in Saudi Arabia found that 3.3% of patients had diabetic foot (8).

The preoperative role of nurses in the management of diabetic foot involves providing patients with information about proper nutrition to strengthen their immunity. Intraoperatively, their role is to prepare the sterilized equipment needed to perform any procedures. Postoperatively, their role is to prevent the wound from becoming infected (9, 10). Additionally, nurses who manage diabetic foot cases help control the progression of disease and select the appropriate dressing that will help treat the ulcer or wound (11).

Nurses can educate patients before they leave the hospital by providing them with information about controlling their condition, for example, by teaching them how to change the wound dressing and the appropriate way to use their medications (10, 12). Because nurses have a significant role in helping diabetic foot patients by educating them about their condition, assessing their knowledge about this disease will help us provide better healthcare services to these patients (13). Although similar studies have been conducted, none has been performed in Saudi Arabia.

2. OBJECTIVE

Therefore, this study aimed to assess the knowledge of diabetic foot care among the nursing staff at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.

3. METHODS

This was a cross-sectional study involving nurses at KAUH in Jeddah, Saudi Arabia, that was conducted from March to May 2020. Jeddah is one of the largest cities in the western region of Saudi Arabia (near the Red Sea) and has a population of 3.5 million. With a capacity of 800 beds, KAUH is one of the largest tertiary referral and teaching centers in the western region of the country. Our sample consisted of 172 nurses randomly selected from different departments of the hospital.

Google Forms software was used to create the questionnaire, and Google Sheets software was used to distribute and collect data. After acquiring permission from the author of the questionnaire, it was adapted according to the study by Kaya et al. and used for our study (13) to examine the knowledge among nurses regarding diabetic foot. The questionnaire was self-administered, standardized, and confidential. To the best of our knowledge, this is the only questionnaire that tests the knowledge of diabetic foot management among healthcare practitioners. The questionnaire was divided into two sections. The first section collected the sociodemographic information and diabetes management-related knowledge of the nurses. The second section comprised 68 yes-or-no questions about diabetic foot management; these questions were divided into the following four subsections: risk factors, foot examination, foot complications, and footwear selection. The subsections contained 16, 10, 32, and 10 questions. A score of 1 was given for each correct answer, and each incorrect answer was given a score of 0, resulting in an overall score between 0 and 68. The higher the total score, the greater the nurse’s knowledge of diabetic foot management.

The validity and reliability of the questionnaire were tested using Cronbach’s α test, which indicated high reliability (0.89). The reliability coefficients for the subscales were 0.72 for the risk factors subscale, 0.64 for the foot examination subscale, 0.84 for the foot complications subscale, and 0.63 for the footwear selection subscale.

Data were analyzed using IBM SPSS Statistics for Windows (version 21). Demographic data and diabetic foot management practices of nurses were the independent variables, and the dependent variables were their knowledge of diabetic foot management based on their questionnaire scores. Descriptive statistics (means, standard deviations, frequencies, and percentages) were calculated for the demographic variables. Associations between background factors and the foot care knowledge test results were analyzed using a t-test for paired group comparisons; a one-way analysis of variance was performed to analyze more than two factors. The relationship between variables was examined using the Pearson chi-square test. Statistical significance was set at P<0.05. The internal consistency of the scale was tested using Cronbach’s α test.

This study was approved by the Research Committee of the KAUH Department of Biomedical Ethics. Participation in this study was voluntary. Participants were informed of the aim, purpose, and course of the study. Nurses were not offered any incentive to participate. Oral consent was obtained from each participant before data collection.

4. Results

Sociodemographic and Professional Characteristics of Nurses

Most of the nurses working at KAUH were female (86%), and the majority were married (74.4%). The mean age of the nurses participating in the study was 38 years (standard deviation [SD], ±9 years), 59.3% of the participants received their bachelor’s degree, 27.3% worked in the intensive care unit, and 87.8% were registered nurses. The mean duration of working as a nurse in their department was 74 months (SD, ±89 months) (Table 1).

Table 1. Nurse Characteristics SD, standard deviation.

Characteristic N %
Average age, years 38 (SD, ±9; range, 22-61)
Average time working as a nurse, years 12.8 (SD, ±7.6; range, 0.3-30)
Average time working in the department, months 74 (SD, ±89; range, 1-400)
Sex Male 24 14.0%
Female 148 86.0%
Marital status Single 40 23.3%
Married 128 74.4%
Divorced 2 1.2%
Widowed 2 1.2%
Nationality Saudi 28 16.4%
Indian 80 46.8%
Philippine 62 36.3%
Jordan 1 0.6%
Education Bachelor’s degree 102 59.3%
Diploma 63 36.6%
Master’s degree 7 4.1%
Department Surgery 27 15.7%
Mixed services 13 7.6%
Operating room 7 4.1%
Obstetrics and gynecology 2 1.2%
Daycare unit 10 5.8%
Dialysis 7 4.1%
Medicine 35 20.3%
Pediatrics 6 3.5%
Intensive care 47 27.3%
Wound care 13 7.6%
Endoscopy 5 2.9%
Position Student/intern 10 5.8%
Registered nurse 151 87.8%
Supervisor 11 6.4%

Characteristics of Nurses and Training to Perform Diabetic Foot Management

When evaluating the nurses’ training, we found that the majority received training as part of their nursing school curriculum (59.9%), whereas 15.7% relied on their in-service training program as their source of knowledge. Blood sugar was the most common topic discussed with the patients (77.3%), and applying initiatives to prevent diabetic foot was the main duty of KAUH nurses (70.3%) (Table 2).

Table 2. Nurses’ Education and Training.

Characteristic Answer N %
Have You Received Any Training to Perform Diabetic Footcare?
Within the curriculum of nursing education No 69 40.1%
Yes 103 59.9%
Within an in-service training program No 145 84.3%
Yes 27 15.7%
I attended courses, seminars, and symposium programs related to performing diabetic footcare No 127 73.8%
Yes 45 26.2%
I received no training No 154 89.5%
Yes 18 10.5%
Do You Discuss the Following Topics With Diabetic Patients?
Blood sugar control No 39 22.7%
Yes 133 77.3%
Foot examination No 88 51.2%
Yes 84 48.8%
Footcare No 63 36.6%
Yes 109 63.4%
Footwear selection No 104 60.5%
Yes 68 39.5%
Amputation No 148 86.0%
Yes 24 14.0%
None No 146 84.9%
Yes 26 15.1%
Do You Perform the Following For Diabetic Patients in Your Department?
Provide information about diabetic foot risk factors and etiology No 62 36.0%
Yes 110 64.0%
Perform foot examinations No 99 57.6%
Yes 73 42.4%
Apply initiatives to prevent diabetic foot No 51 29.7%
Yes 121 70.3%
Help with footwear selection No 101 58.7%
Yes 71 41.3%

Nurses’ Knowledge Based on the Diabetic Foot Management Scores

The average total score for the entire questionnaire was 59 (SD, ±7). Table 3 shows the scores for the four subsections of the questionnaire (risk factors, foot examination, foot complications, and footwear selection).

Table 3. Scores for the four subsections of the questionnaire, SD, standard deviation.

Mean SD Lowest Score Highest Score
Risk factors 14 2 8 16
Foot examination 9 1 5 10
Foot complications 27 4 14 31
Footwear selection 8 2 4 10
Total score 59 7 37 67

When examining each factor individually, we found that almost all the nurses (98.8%) considered glycemic control to be the most important risk factor affecting their patients. Regarding the foot examination, most nurses (99.4%) indicated that the factor they most commonly focused on was foot color (pale, red, cyanosed). All nurses indicated that reporting any changes to the feet and toes (color, temperature, or shape) and signs of infection to the physician was the best way to prevent DM foot development. Most nurses (98.3%) reported that recommending soft and comfortable shoes was the most beneficial advice provided to patients (Table 4).

Table 4. Answers to the Four Subsections of the Questionnaire.

N %
Do You Considering the Following as Risk Factors?
Poor glycemic control No 2 1.2%
Yes 170 98.8%
Presence of the sense of chill, pain, burning, tingling, and tenderness in the foot No 28 16.3%
Yes 144 83.7%
Neuropathic foot (loss of sensory motor function) No 5 2.9%
Yes 167 97.1%
Peripheral vascular disease No 12 7.0%
Yes 160 93.0%
Inadequate foot care and lack of hygiene No 10 5.8%
Yes 162 94.2%
Presence of foot edema No 24 14.0%
Yes 148 86.0%
Presence of foot callus No 41 23.8%
Yes 131 76.2%
Dry and cracked foot skin No 31 18.0%
Yes 141 82.0%
Diabetic foot history or diabetic ulcer on the opposite extremity No 24 14.0%
Yes 148 86.0%
Infection (redness, tenderness, and temperature increase of the foot) No 10 5.8%
Yes 162 94.2%
Trauma (barefoot walking, poor-quality shoes, accident, foreign body in the shoes) No 12 7.0%
Yes 160 93.0%
Foot deformity (mallet toes, claw toes, hallux valgus, amputation, Charcot deformity, low foot, etc.) No 36 20.9%
Yes 136 79.1%
Smoking No 28 16.3%
Yes 144 83.7%
Obesity No 19 11.0%
Yes 153 89.0%
Age 65 years or older No 24 14.0%
Yes 148 86.0%
Patients not trained to recognize or care for diabetic foot No 13 7.6%
Yes 159 92.4%
Do You Perform the Following During Foot Examinations?
Foot skin (color change, edema, atrophy, dryness, crack, callus, ulcer, etc.) is evaluated No 1 0.6%
Yes 171 99.4%
Color (pale, cyanosis, red) is evaluated No 5 2.9%
Yes 167 97.1%
Temperature (temperature, coldness) is evaluated No 13 7.6%
Yes 159 92.4%
Presence of foot neuropathy (pain, tingling, burning, tenderness, sensory loss) is evaluated No 4 2.3%
Yes 168 97.7%
Muscle functions (atrophy caused by motor damage in the muscles) are assessed No 16 9.3%
Yes 156 90.7%
Circulation (foot is pale and cyanosis) is evaluated No 6 3.5%
Yes 166 96.5%
Presence of foot ulcers (temperature increase, redness, edema, and tenderness of the foot) is evaluated No 3 1.7%
Yes 169 98.3%
Presence of deformity (hammer finger, claw, hallux valgus, amputation, Charcot deformity, low foot, etc.) is evaluated No 22 12.8%
Yes 150 87.2%
Toenails (thickening, ingrowth, and length of the nails) are evaluated No 22 12.8%
Yes 150 87.2%
Shoe suitability is assessed No 9 5.2%
Yes 163 94.8%
Do You Provide the Following Advice for Preventing Foot Complications?
Feet should be checked every day by the patient or a relative using the eyes, hands, and a mirror (callus, crack, redness, bulla, open wound, etc.) No 1 0.6%
Yes 171 99.4%
Feet should be washed with warm water every day No 23 13.4%
Yes 149 86.6%
The water temperature used for washing feet should be checked No 9 5.2%
Yes 163 94.8%
Feet, especially the spaces between the toes, should be dried very well after each wash No 1 0.6%
Yes 171 99.4%
Moisturizing cream should be applied to feet No 12 7.0%
Yes 160 93.0%
Moisturizing cream should be applied to the spaces between the toes No 27 15.7%
Yes 145 84.3%
Toes should be kept dry to prevent fungal growth No 5 2.9%
Yes 167 97.1%
Cutting tools and chemicals should not be used to remove calluses or hardened skin areas No 11 6.4%
Yes 161 93.6%
Callus and skin stiffness should be thinned with a pumice stone No 40 23.3%
Yes 132 76.7%
Exercise in the form of twisting and stretching the toes several times per day should be performed to prevent the formation of foot corns and calluses No 27 15.7%
Yes 145 84.3%
It is beneficial to use a callus band and plaster No 45 26.2%
Yes 127 73.8%
Only socks should be worn to warm feet No 42 24.4%
Yes 130 75.6%
Direct heat sources (radiators, hot water bottle, electrical appliances, etc.) should be used to warm feet No 92 53.5%
Yes 80 46.5%
Socks should not be torn, wrinkled, or oversized No 16 9.3%
Yes 156 90.7%
Socks should be checked for wetness and darkness No 16 9.3%
Yes 156 90.7%
Socks should be changed every day No 7 4.1%
Yes 165 95.9%
Rubber socks that restrict the circulation should not be worn No 24 14.0%
Yes 148 86.0%
Wool socks should be worn during winter and mercerized socks should be worn during summer No 10 5.8%
Yes 162 94.2%
You should not walk with bare feet No 9 5.2%
Yes 163 94.8%
Relieve foot pressure by not standing for long periods No 9 5.2%
Yes 163 94.8%
Legs should not be crossed when sitting No 26 15.1%
Yes 146 84.9%
If there is clawing of the toes, then massage should not be performed to prevent joint stiffness No 50 29.1%
Yes 122 70.9%
Toenails should be controlled in terms of thickening, ingrowth, and length No 13 7.6%
Yes 159 92.4%
Toenails should be cut flat No 21 12.2%
Yes 151 87.8%
Skin around the toenails should not be cut No 20 11.6%
Yes 152 88.4%
Thickened nails should be cut with a special scissors after they are softened in warm water No 13 7.6%
Yes 159 92.4%
Blind patients must never cut their own toenails No 6 3.5%
Yes 166 96.5%
Toenails should be rounded No 49 28.5%
Yes 123 71.5%
Any changes to the feet and toes (color, temperature, or shape) and signs of infection should be reported to the physician immediately Yes 172 100.0%
Foot exercises should be performed every day to help circulation No 4 2.3%
Yes 168 97.7%
In case of any foot lesion, only shoes should be replaced to reduce the load on feet No 53 30.8%
Yes 119 69.2%
Smoking is strictly forbidden because it will reduce the amount of blood to the feet No 7 4.1%
Yes 165 95.9%
Do You Provide the Following Information About Footwear Selection?
Shoes should fit properly No 8 4.7%
Yes 164 95.3%
Soft and comfortable shoes are recommended No 3 1.7%
Yes 169 98.3%
Shoes should be checked for foreign bodies (such as nails, gravel, etc.) before each wear No 7 4.1%
Yes 165 95.9%
Shoes should be worn without socks No 99 57.6%
Yes 73 42.4%
If shoe insoles are worn away, then they should be replaced No 5 2.9%
Yes 167 97.1%
Shoes should not lose their exterior protection feature No 4 2.3%
Yes 168 97.7%
Shoes should be cleaned frequently No 91 52.9%
Yes 81 47.1%
Allow feet to get used to new shoes by wearing them No 24 14.0%
Yes 148 86.0%
High-heel shoes tapering forward are recommended No 103 59.9%
Yes 69 40.1%
If there is a foot deformity, then a physician should be consulted so that proper treatment and/or orthopedic shoes can be prescribed No 9 5.2%
Yes 163 94.8%

Nurses’ Sociodemographic, Professional, and Diabetic Foot Management Care Characteristics and Diabetic Foot Management Scores

Significant sociodemographic, professional, and diabetic foot management characteristics of the nurses involved in this study were compared to the total questionnaire scores. No statistically significant correlations were observed between the sex, marital status, duration of work in the department, training to educate patients about diabetic foot risk or problems, and training to perform foot examinations (p>0.05).

Additionally, there were no statistically significant differences between the subscale scores and training to perform DM foot care (all P<0.05). A further examination of the data revealed statistical significance only for marital status and footwear selection scores (8.13±1.59; p=0.009) and for educational background and risk factor scores (p=0.031) (Table 5).

Table 5. Training and Subsection Scores, SD, standard deviation; SEM, standard error of the mean.

Have You Received Diabetic Footcare Training N Mean SD SEM p
Risk factors Yes 102 14.18 2.245 0.222 0.823666
No 70 14.10 2.181 0.261
Foot examination Yes 102 9.47 1.031 0.102 0.421117
No 70 9.33 1.271 0.152
Foot complications Yes 102 27.12 3.936 0.390 0.764220
No 70 26.93 4.223 0.505
Footwear selection Yes 102 7.96 1.515 0.150 0.895414
No 70 7.93 1.662 0.199
Total score Yes 102 58.73 7.188 0.712 0.691543
No 70 58.29 7.043 0.842

5. Discussion

Diabetic foot is a macrovascular complication of DM, and the majority of these patients will require amputation (14). Diabetic foot is considered the leading cause of hospitalization among individuals with DM (6). In addition to regular preventive care and treatment, a crucial aspect of diabetic foot prevention is the frequent education of all individuals with DM at every healthcare visit (15, 16). Diabetic foot management requires a multidisciplinary approach with an emphasis on the role of nurses because they are in direct communication with patients for long periods (13).

According to one study, education provided by nurses to patients at high risk for diabetic foot about proper foot care resulted in the prevention of foot ulcers and reduced amputations (17). Therefore, nurses must have sufficient knowledge and practical training to have an important role in the prevention of diabetic foot (18).

This study assessed the knowledge of several aspects of diabetic foot management among nurses at KAUH. Our results showed that most of the nurses received training regarding diabetic footcare through their school curriculum when they were nursing students. However, some nurses did not receive any training. Reinforcing that training to perform diabetic foot management as part of an in-service training program would compensate for any previous missed opportunities to receive training. One study mentioned that the low levels of knowledge of diabetic foot care were attributed to the lack of proper training and several other important factors, such as imprecise communication between different parties involved in the management plan and insufficient time allotted for each visit (19).

According to the International Diabetes Federation Report, the optimal management plan for the prevention and treatment of diabetic foot consists of regular foot evaluations, determination of the at-risk foot, education provided to the patients and healthcare staff, appropriate footwear, and early treatment of foot problems (20). Most of our participants reported that they educate their patients about blood sugar control and general footcare, perform diabetic foot risk factor assessments, and apply preventive initiatives. Other topics, such as the importance of regular foot examinations, footwear selection, and the risk of amputation, were not discussed with patients by the majority of nurses. Additionally, regular foot examinations were not performed by the nurses. Therefore, an optimum diabetic foot management plan was not implemented, as suggested previously.

Nurses were greatly concerned about poor glycemic control because it is a significant risk factor for diabetic foot; in one study, this concern led to a 1% decrease in glycated hemoglobin and can lead to a 35% reduction in diabetic complications (21). However, they were not as concerned with peripheral vascular disease, peripheral neuropathy, and infection, which are the three major factors for diabetic foot ulcers (22). The majority of nurses agreed that patients who are not educated about diabetic foot are at risk for its development. A systemic review concluded that patient education has an overall short-term positive impact on the foot care knowledge and behaviors of patients (23). However, it is uncertain whether patient education can prevent foot ulceration and amputation.

There was a significant relationship between the educational background of the nurses and their knowledge of the risk factors for diabetic foot. Most of the nurses had a high average questionnaire score compared to those reported by other studies (2430). The majority of those studies attributed the poor knowledge and scores to the lack of formal educational and training programs because of limited access. The higher average score in our study could be attributed to the relatively better schools attended by the nurses and the fact that more than half of them had received a bachelor’s degree in nursing.

Appropriate education can prevent up to 85% of diabetic foot amputations (31). Additionally, it can reduce the burden of the disease and the respective costs of care (24). Consistent, intensive nursing education and interactive forms of training, such as workshops, regarding diabetic foot care are needed to further enhance the knowledge and assessment skills of nurses. Implementing a dedicated training program administered by a diabetic foot specialist with advanced training in this field is a feasible and inexpensive way to prevent foot ulcers and amputations in the long term, improve patient awareness and attitudes, and increase nurses’ confidence in managing diabetic foot ulcers (17, 32).

6. Conclusion

Nurses’ knowledge of diabetic foot is a crucial factor in the prevention of diabetic foot. The educational backgrounds of nurses reflect their knowledge of diabetic foot. Because nurses are in direct and frequent contact with patients, specialized training programs beyond basic nursing education will reinforce their knowledge and skills, resulting in an expected lower risk of amputation in the long term.

Acknowledgments:

The authors would like to acknowledge patients who participated in this study.

Declaration of participation consent:

The authors certify that they have obtained all appropriate consent forms.

Author’s contribution:

M.K. H.A A.F. gave a substantial contribution to the conception and design of the work. M.K. H.A A.F. K.A W.A. R.T. gave a substantial contribution of data. M.K. H.A. K.A. gave a substantial contribution to the acquisition, analysis, or interpretation of data for the work. M.K. H.A A.F. K.A W.A. R.T. had a part in article preparing for drafting or revising it critically for important intellectual content. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflicts of interest:

There are no conflicts of interest.

Financial support and sponsorship:

Nil.

REFERENCES

  • 1.American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Supplement 1):S13–S28. doi: 10.2337/dc19-S002. [DOI] [PubMed] [Google Scholar]
  • 2.Faselis C, Katsimardou A, Imprialos K, Deligkaris P, Kallistratos M, Dimitriadis K. Microvascular complications of type 2 diabetes mellitus. [1];Current Vascular Pharmacology. 2020 Mar;18(2):117–124. doi: 10.2174/1570161117666190502103733. [DOI] [PubMed] [Google Scholar]
  • 3.Viigimaa M, Sachinidis A, Toumpourleka M, Koutsampasopoulos K, Alliksoo S, Titma T. Macrovascular complications of type 2 diabetes mellitus. [1];Current Vascular Pharmacology. 2020 Mar;18(2):110–116. doi: 10.2174/1570161117666190405165151. [DOI] [PubMed] [Google Scholar]
  • 4.Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, Shaw JE. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. [1];Diabetes research and clinical practice. 2019 Nov;157:107843. doi: 10.1016/j.diabres.2019.107843. [DOI] [PubMed] [Google Scholar]
  • 5.Abdulaziz Al Dawish M, Alwin Robert A, Braham R, Abdallah Al Hayek A, Al Saeed A, Ahmed Ahmed R, Sulaiman Al Sabaan F. Diabetes mellitus in Saudi Arabia: a review of the recent literature. [1];Current diabetes reviews. 2016 Dec;12(4):359–368. doi: 10.2174/1573399811666150724095130. [DOI] [PubMed] [Google Scholar]
  • 6.Volmer-Thole M, Lobmann R. Neuropathy and diabetic foot syndrome. International journal of molecular sciences. 2016 Jun;17(6):917. doi: 10.3390/ijms17060917. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care: 78 April 1999, Boston, Massachusetts American Diabetes Association. [1];Diabetes care. 1999 Aug;22(8):1354–1360. doi: 10.2337/diacare.22.8.1354. [DOI] [PubMed] [Google Scholar]
  • 8.Al-Rubeaan K, Al Derwish M, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM, Alamri BN. Diabetic foot complications and their risk factors from a large retrospective cohort study. [6];PloS one. 2015 May;10(5):e0124446. doi: 10.1371/journal.pone.0124446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Yuanyuan CH, Xiaodao HA, Yongjie XU, Weihua LI. Nursing project management to reduce the operating room infection. Iranian Journal of Public Health. 2017 Feb;46(2):192. [PMC free article] [PubMed] [Google Scholar]
  • 10.Gröndahl W, Muurinen H, Katajisto J, Suhonen R, Leino-Kilpi H. Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland. [1];BMJ open. 2019 Apr;9(4):e023108. doi: 10.1136/bmjopen-2018-023108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani MR. Nurses’ role in diabetic foot prevention and care; a review. [1];Journal of Diabetes and Metabolic Disorders. 2012 Dec;11(1):24. doi: 10.1186/2251-6581-11-24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Maidwell A. The role of the surgical nurse as a health promoter. [8];British Journal of Nursing. 1996 Aug;5(15):898–904. doi: 10.12968/bjon.1996.5.15.898. [DOI] [PubMed] [Google Scholar]
  • 13.Kaya Z, Karaca A. Evaluation of nurses’ knowledge levels of diabetic foot care management. [2];Nursing research and practice. 2018 Jul;:2018. doi: 10.1155/2018/8549567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.American Dietetic Association. Diabetic Foot Wound Care. Am Diabetes Assoc [Internet] 1999;22(7-8 April):1354–1360. doi: 10.2337/diacare.22.8.1354. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10480782. [DOI] [PubMed] [Google Scholar]
  • 15.Global Report on Diabetes World Health Organization [Internet] March 15. 2018. Available from: https://www.who.int/publications/i/item/9789241565257.
  • 16.Kir Bicer E. Diyabetli Hastalarda Ayak Bakım Uygulamalarıve ÖzEtkililiğ in Değerlendirilmesi [Evaluation of Foot Care Practices and Self Efficacy for Patients with Diabetes] Istanbul University Institute of Health Sciences. 2011.
  • 17.Ren M, Yang C, Lin DZ, Xiao HS, Mai LF, Guo YC, et al. Effect of intensive nursing education on the prevention of diabetic foot ulceration among patients with high-risk diabetic foot: A follow-up analysis. Diabetes Technol Ther. 2014;16(9):576–581. doi: 10.1089/dia.2014.0004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Stolt M, Suhonen R, Puukka P, Viitanen M, Voutilainen P, Leino-Kilpi H. Nurses’ knowledge of foot care in the context of home care: A cross-sectional correlational survey study. J Clin Nurs. 2015;24(19–20):2916–2925. doi: 10.1111/jocn.12922. [DOI] [PubMed] [Google Scholar]
  • 19.Ramirez-Perdomo C, Perdomo-Romero A, Rodríguez-Vélez M. Knowledge and practices for the prevention of the diabetic foot. Rev Gauch Enferm. 2019;40:e20180161. doi: 10.1590/1983-1447.2019.20180161. [DOI] [PubMed] [Google Scholar]
  • 20.Federation ID. International Working Group on the diabetic foot: International Diabetes Federation. 2000.
  • 21.Sapkota S, Brien JA, Greenfield J, Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes – Impact on adherence. PLoS One. 2015;10(2):1–17. doi: 10.1371/journal.pone.0118296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Browne A, Sibbald R. The diabetic neuropathic ulcer: an overview. Ostomy Wound Manage. 1999;45(1A Suppl) [PubMed] [Google Scholar]
  • 23.Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev. 2014;2014(12):633–658. doi: 10.1002/14651858.CD001488.pub5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Kumarasinghe SA, Hettiarachchi P, Wasalathanthri S. Nurses’knowledge on diabetic foot ulcer disease and theirattitudes towards patients affected: A cross-sectionalinstitution-based study. J Clin Nurs. 2017;27(1-2):203–212. doi: 10.1111/jocn.13917. [DOI] [PubMed] [Google Scholar]
  • 25.Sharmisthas S, Wongchan P, Hathairat S. A Survey of Nurses Knowledge Regarding Prevention and Management of Diabetic Foot Ulcer in Bangladesh. BIRDEM Med J. 2014;4(1):22–26. [Google Scholar]
  • 26.Bilal M, Haseeb A, Rehman A, Hussham Arshad M, Aslam A, Godil S, et al. Knowledge, Attitudes, and Practices Among Nurses in Pakistan Towards Diabetic Foot. Cureus. 2018;10(7) doi: 10.7759/cureus.3001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Nash M. Mental health nurses’ diabetes care skills–a training needs analysis. BrJ Nurs. 2009;18(10) doi: 10.12968/bjon.2009.18.10.42472. [DOI] [PubMed] [Google Scholar]
  • 28.Shiu ATY, Wong RYM. Diabetes foot care knowledge: A survey of registered nurses. J Clin Nurs. 2011;20(15-16):2367–2370. doi: 10.1111/j.1365-2702.2011.03748.x. [DOI] [PubMed] [Google Scholar]
  • 29.Oyetunde MO, Famakinwa TT. Nurses’ knowledge of contents of diabetes patient education in Ondo – state, Nigeria. J Nurs Educ Pract. 2014;4(4) [Google Scholar]
  • 30.Wui NB, Azhar AA bin, Azman MH bin, Sukri MS bin, Singh ASAH, Abdul Wahid AM bin. Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia. MedJ Malaysia. 2020;75(4):391–395. [PubMed] [Google Scholar]
  • 31.Tabatabaei-Malazy O, Khatib O. Prevention and public approach to diabetic foot. IranJ Diabetes Lipid Disord. 2007;7(2):123–133. [Google Scholar]
  • 32.Aalaa M, Sanjari M, Shahbazi S, Shayeganmehr Z, Abooeirad M, Amini MR, et al. Diabetic foot workshop: Improving technical and educational skills for nurses. Med J Islam Repub Iran. 2017;31(1):40–42. doi: 10.18869/mjiri.31.8. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Medical Archives are provided here courtesy of The Academy of Medical Sciences of Bosnia and Herzegovina

RESOURCES