Willingness, Knowledge, and Skills of Nurses in the Prevention and Management of Diabetic Foot Ulcers: A Cross-sectional Study in Indonesia
DOI:
https://doi.org/10.55018/janh.v8i2.282Keywords:
Diabetes Mellitus, Diabetic Foot, Foot Ulcer, Nursing CareAbstract
Background: Nurses play a crucial role in the prevention and management of diabetic foot ulcers (DFUs); therefore, they should possess adequate knowledge, skills, and a willingness to do so. However, limited evidence exists on Indonesian nurses’ willingness, knowledge, and skills in the prevention and management of DFU. The study aimed to evaluate willingness, knowledge, and skills in the prevention and management of DFU among Indonesian nurses and to identify factors associated with these.
Methods: A cross-sectional survey study was conducted. A total of 549 nurses working in medical-surgical inpatient units at four hospitals in Central Java, Indonesia, were selected using convenience sampling, given ease of online access and willingness to participate. Data on willingness, knowledge, and skill in the prevention and management of DFU were collected using an online survey. The Chi-square and logistic regression tests were used for data analysis. This study was reported in accordance with the STROBE guidelines.
Results: The majority of nurses had no DFU training (65,2%), but had a bachelor's education level (51.9%) and were involved in DFU patient care (92.7%). Approximately 45.9% of nurses have adequate willingness, while 33.2% and 32.2% have adequate knowledge and skill, respectively. Higher education was associated with an adequate willingness (aOR 1.91, 95%CI:1.26-2.90, p=0.002), knowledge (aOR 1.55, 95%CI:1.07-2.26, p=0.020), and skills (aOR 1.72, 95%CI:1.18-2.51, p=0.005), among nurses. The DFU training was associated with adequate knowledge (aOR 2.71, 95%CI:1.86-3.95, p<0.001), and skills (aOR 2.63, 95%CI:1.81-3.85, p<0.001) of nurses. The DFU caring experience was also associated with nurses' knowledge (aOR 3.61, 95%CI:1.06-12.62, p=0.039) and skills (aOR 3.41, 95%CI:1.01-11.57, p=0.049). Furthermore, adequate knowledge (aOR 1.35, 95%CI:1.47-7.65, p=0.004) and adequate skills (aOR 5.60, 95%CI:2.41-13.01, p<0.001) were associated with willingness.
Conclusion: Under half of nurses in hospital settings had adequate willingness, knowledge, and skill in the prevention and management of DFU. Higher education level, practical training, and caring experience were associated with the nurses’ willingness, knowledge, and skills. Adequate willingness was also associated with adequate knowledge and skill.
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Aalaa, M., Amini, M. R., Delavari, S., Tehrani, M. R. M., Adibi, H., Shahbazi, S., Shayeganmehr, Z., Larijani, B., Mehrdad, N., & Sanjari, M. (2022). Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16(7), 102543. https://doi.org/10.1016/j.dsx.2022.102543
Abate, T. W., Enyew, A., Gebrie, F., & Bayuh, H. (2020). Nurses’ knowledge and attitude towards diabetes foot care in Bahir Dar, North West Ethiopia. Heliyon, 6(11), e05552. https://doi.org/10.1016/j.heliyon.2020.e05552
Abdullah, W. H., Al-Senany, S., & Al-Otheimin, H. K. (2017). Capacity building for nurses’ knowledge and practice regarding prevention of diabetic foot complications. Int J Nurs Sci, 7(1), 1–15. https://doi.org/10.5923/j.nursing.20170701.01
Ajzen, I. (2020). The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies, 2(4), 314–324. https://doi.org/10.1002/hbe2.195
Alotaibi, A., Gholizadeh, L., Al-Ganmi, A. H. A., & Perry, L. (2018). Factors influencing nurses’ knowledge acquisition of diabetes care and its management: A qualitative study. Journal of Clinical Nursing, 27(23–24), 4340–4352. https://doi.org/10.1111/jocn.14544
Alsaigh, S. H., Alzaghran, R. H., Alahmari, D. A., Hameed, L. N., Alfurayh, K. M., & Alaql, K. B. (2022). Knowledge, awareness, and practice related to diabetic foot ulcer among healthcare workers and diabetic patients and their relatives in Saudi Arabia: a cross-sectional study. Cureus, 14(12). https://doi.org/10.7759/cureus.32221
Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023). Diabetic foot ulcers: a review. Jama, 330(1), 62–75. https://doi.org/10.1001/jama.2023.10578
Bilal, M., Haseeb, A., Rehman, A., Arshad, M. H., Aslam, A., Godil, S., Qamar, M. A., Husain, S. N., Polani, M. H., Ayaz, A., & others. (2018). Knowledge, attitudes, and practices among nurses in Pakistan towards diabetic foot. Cureus, 10(7). https://doi.org/10.7759/cureus.3001
Bonham, P. A., Brunette, G., Crestodina, L., Droste, L. R., González, A., Kelechi, T. J., Ratliff, C. R., & Varnado, M. F. (2022). 2021 Guideline for Management of Patients With Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease: An Executive Summary. Journal of Wound, Ostomy and Continence Nursing, 49(3), 267–285. https://doi.org/10.1097/WON.0000000000000860
Bosnjak, M., Ajzen, I., & Schmidt, P. (2020). The theory of planned behavior: Selected recent advances and applications. Europe’s Journal of Psychology, 16(3), 352. https://doi.org/10.5964/ejop.v16i3.3107
Buloala, L.-W. R., & John, M. E. (2018). Knowledge of diabetic foot care among nursing practitioners in rivers state, Nigeria. Texila International Journal of Nursing, 4(2). https://doi.org/10.21522/TIJNR.2015.04.02.Art003
Bus, S. A., Lavery, L. A., Monteiro-Soares, M., Rasmussen, A., Raspovic, A., Sacco, I. C. N., van Netten, J. J., & on the Diabetic Foot, I. W. G. (2020). Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36, e3269. https://doi.org/10.1002/dmrr.3269.
Bus, S. A., Sacco, I. C. N., Monteiro-Soares, M., Raspovic, A., Paton, J., Rasmussen, A., Lavery, L. A., & van Netten, J. J. (2024). Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews, 40(3), e3651. https://doi.org/10.1002/dmrr.3651
Edmonds, M., Manu, C., & Vas, P. (2021). The current burden of diabetic foot disease. Journal of Clinical Orthopaedics and Trauma, 17, 88–93. https://doi.org/10.1016/j.jcot.2021.01.017
Gitarja, W. S., Jamaluddin, A., Wibisono, A. H., Megawati, V. N., & Fajar, K. (2018). Wound care management in Indonesia: issues and challenges in diabetic foot ulceration. Wounds Asia, 1(2), 13–17.
Kaya, Z., & Karaca, A. (2018). Evaluation of nurses’ knowledge levels of diabetic foot care management. Nursing Research and Practice, 2018. https://doi.org/10.1155/2018/8549567
Kumarasinghe, S. A., Hettiarachchi, P., & Wasalathanthri, S. (2018). Nurses’ knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: A cross-sectional institution-based study. Journal of Clinical Nursing, 27(1–2), e203--e212. https://doi.org/10.1111/jocn.13917
Ligita, T., Wicking, K., Francis, K., Harvey, N., & Nurjannah, I. (2019). How people living with diabetes in Indonesia learn about their disease: A grounded theory study. PLoS One, 14(2), e0212019. https://doi.org/10.1371/journal.pone.0212019.g001
Nayeri, N. D., Samadi, N., Mehrnoush, N., Allahyari, I., Bezaatpour, F., & NaseriAsl, M. (2020). Experiences of nurses within a nurse-led multidisciplinary approach in providing care for patients with diabetic foot ulcer. Journal of Family Medicine and Primary Care, 9(6), 3136. https://doi.org/10.4103/jfmpc.jfmpc_1008_19.
Rodrigues, B. T., Vangaveti, V. N., Urkude, R., Biros, E., & Malabu, U. H. (2022). Prevalence and risk factors of lower limb amputations in patients with diabetic foot ulcers: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16(2), 102397. https://doi.org/10.1016/j.dsx.2022.102397
Schaper, N. C., Van Netten, J. J., Apelqvist, J., Bus, S. A., Fitridge, R., Game, F., Monteiro-Soares, M., Senneville, E., & Board, I. E. (2024). Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews, 40(3), e3657. https://doi.org/10.1002/dmrr.3657
Subrata, S. A., Phuphaibul, R., Grey, M., Siripitayakunkit, A., & Piaseu, N. (2020). Improving clinical outcomes of diabetic foot ulcers by the 3-month self-and family management support programs in Indonesia: A randomized controlled trial study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 857–863. https://doi.org/10.1016/j.dsx.2020.05.028
Sukri, M., Singh, A., Singh, L. H., bin Abdul Wahid, A. M., & Ortho, M. S. (2020). Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia. Med J Malaysia, 75(4), 391.
Suryani, M., Samekto, W., Susanto, H., Dwiantoro, L., & others. (2021). Effect of foot-ankle flexibility and resistance exercise in the secondary prevention of plantar foot diabetic ulcer. Journal of Diabetes and Its Complications, 35(9), 107968. https://doi.org/10.1016/j.jdiacomp.2021.107968
Van Netten, J. J., Bus, S. A., Apelqvist, J., Lipsky, B. A., Hinchliffe, R. J., Game, F., Rayman, G., Lazzarini, P. A., Forsythe, R. O., Peters, E. J. G., & others. (2020). Definitions and criteria for diabetic foot disease. Diabetes/Metabolism Research and Reviews, 36, e3268. https://doi.org/10.1002/dmrr.3268
Van Netten, J. J., Woodburn, J., & Bus, S. A. (2020). The future for diabetic foot ulcer prevention: a paradigm shift from stratified healthcare towards personalized medicine. Diabetes/Metabolism Research and Reviews, 36, e3234. https://doi.org/10.1002/dmrr.3234
Walker, C. A., Rahman, A., Gipson-Jones, T. L., & Harris, C. M. (2019). Hospitalists’ needs assessment and perceived barriers in wound care management: a quality improvement project. Journal of Wound, Ostomy, and Continence Nursing: Official Publication of The Wound, Ostomy and Continence Nurses Society, 46(2), 98. https://doi.org/10.1097/WON.0000000000000512
Yusuf, S., Okuwa, M., Irwan, M., Rassa, S., Laitung, B., Thalib, A., Kasim, S., Sanada, H., Nakatani, T., & Sugama, J. (2016). Prevalence and risk factor of diabetic foot ulcers in a regional hospital, eastern Indonesia. Open Journal of Nursing, 6(1), 1–10. https://doi.org/10.4236/ojn.2016.61001
Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of Medicine, 49(2), 106–116. https://doi.org/10.1080/07853890.2016.1231932
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