Knowledge of the Warning Signs of Foot Ulcer Deterioration Among Patients With Diabetes

10.1097/jnr.0000000000000258

Yen-Fan CHIN；Jiun-Ting YEH；Hsing-Yi YU；Li-Chueh WENG

diabetic foot ； foot ulcer ； knowledge ； scale ； validity

The Journal of Nursing Research

26卷6期（2018 / 12 / 01）

420 - 426

英文

Background: Seeking treatment in a timely manner may prevent lower limb amputation subsequent to diabetic foot ulcers. Knowledge regarding the warning signs is one important factor that is related to the timely treatment seeking of patients with diabetic foot ulcers. However, there is no previous research on which aspects of such knowledge that patients with diabetes are lacking. Purpose: The aims of this study were to test the psychometric properties of a questionnaire that was designed to assess the knowledge of the warning signs of diabetic foot ulcer deterioration and to determine the knowledge of these warning signs among patients with a history of diabetic foot ulcers. Methods: A cross-sectional study design was used. Patients with a history of diabetic foot ulcers were recruited using convenience sampling (N = 385). Data were analyzed using Spearman's rank correlation and the Mann-Whitney U test. Results: The questionnaire showed good known-group validity, satisfied internal consistency (Kuder-Richardson Formula 20 = .82), and exhibited acceptable 2-week test-retest reliability (Spearman's rho coefficient = .75). More than 30% of the participants were unaware of the warning signs of peripheral vascular insufficiency and severe infection. Of the participants, 75.8% felt that the time to seek medical treatment of diabetic foot ulcers was when they experienced wound deterioration. Those who held this opinion had significantly less knowledge regarding the warning signs of diabetic foot ulcer deterioration than did those who had not. Other factors that were significantly associated with less knowledge included being older, having less education, not having an existing foot ulcer, having no foot ulcer treatment history, and never having received education regarding foot ulcers. Conclusions/Implications for Practice: The questionnaire showed adequate validity and reliability and thus may be used by healthcare practitioners and researchers to assess the knowledge of at-risk patients regarding the warning signs of diabetic foot ulcer deterioration. Patient education regarding the importance of timely treatment seeking and warning signs should be promoted.

1. Liu, M. H.,Wang, C. H.,Huang, Y. Y.,Cherng, W. J.,Wang, K. W.(2014).A correlational study of illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.The Journal of Nursing Research,22(2),136-145.
   連結：
2. Aliasgharpour, M.,Nayeri, N. D.(2012).The care process of diabetic foot ulcer patients: A qualitative study in Iran.Journal of Diabetes & Metabolic Disorders,11(1),27.
3. Bakheit, H. E.,Mohamed, M. F.,Mahadi, S. E.,Widatalla, A. B.,Shawer, M. A.,Khamis, A. H.,Ahmed, M. E.(2012).Diabetic heel ulcer in the Sudan: Determinants of outcome.The Journal of Foot & Ankle Surgery,51(2),152-155.
4. Bastable, S. B.(Ed.)(2014).Nurse as educator: Principles of teaching and learning for nursing practice.Burlington, MA:Jones & Bartlett Learning.
5. Drugs.com. (2014). Diabetic foot ulcers. Retrieved from http://www.drugs.com/cg/diabetic-foot-ulcers-aftercare-instructions.html
6. Garcia, A. A.,Villagomez, E. T.,Brown, S. A.,Kouzekanani, K.,Hanis, C. L.(2001).The Starr County diabetes education study.Diabetes Care,24(1),16-21.
7. Ghorbani, R.,Soleimani, M.,Zeinali, M. R.,Davaji, M.(2014).Iranian nurses and nursing students' attitudes on barriers and facilitators to patient education: A survey study.Nurse Education in Practice,14(5),551-556.
8. Hingorani, A.,LaMuraglia, G. M.,Henke, P.,Meissner, M. H.,Loretz, L.,Zinszer, K. M.,Murad, M. H.(2016).The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine.Journal of Vascular Surgery,63(2, Suppl.),3S-21S.
9. Jiang, Y.,Ran, X.,Jia, L.,Yang, C.,Wang, P.,Ma, J.,Xu, Z.(2015).Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China.The International Journal of Lower Extremity Wounds,14(1),19-27.
10. Lai, Y. J.,Hu, H. Y.,Lin, C. H.,Lee, S. T.,Kuo, S. C.,Chou, P.(2015).Incidence and risk factors of lower extremity amputations in people with type 2 diabetes in Taiwan, 2001Y2010.Journal of Diabetes,7(2),260-267.
11. Lipsky, B. A.,Aragón-Sánchez, J.,Diggle, M.,Embil, J.,Kono, S.,Lavery, L.,Peters, E. J.(2016).IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes.Diabetes/Metabolism Research and Reviews,32(2, Suppl.),45-74.
12. Martins-Mendes, D.,Monteiro-Soares, M.,Boyko, E. J.,Ribeiro, M.,Barata, P.,Lima, J.,Soares, R.(2014).The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk.Journal of Diabetes and Its Complications,28(5),632-638.
13. National Institute for Health and Care Excellence(2015).NICE guideline: Diabetic foot problems: Prevention and management.
14. Pollock, R. D.,Unwin, N. C.,Connolly, V.(2004).Knowledge and practice of foot care in people with diabetes.Diabetes Research and Clinical Practice,64(2),117-122.
15. Pop-Busui, R.,Boulton, A. J.,Feldman, E. L.,Bril, V.,Freeman, R.,Malik, R. A.,Ziegler, D.(2017).Diabetic neuropathy: A position statement by the American Diabetes Association.Diabetes Care,40(1),136-154.
16. Quah, J. L.,Yap, S.,Cheah, S. O.,Ng, Y. Y.,Goh, E. S.,Doctor, N.,Ong, M. E.(2014).Knowledge of signs and symptoms of heart attack and stroke among Singapore residents.BioMed Research International,2014,572425.
17. Sanders, A. P.,Stoeldraaijers, L. G.,Pero, M. W.,Hermkes, P. J.,Carolina, R. C.,Elders, P. J.(2013).Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers.Diabetes Research and Clinical Practice,102(2),105-111.
18. Schaper、 N.C.,VanNetten, J. J.,Apelqvist, J.,Lipsky, B. A.,Bakker, K.,International Working Group on the Diabetic Foot(2017).Prevention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents.Diabetes Research and Clinical Practice,124,84-92.
19. Schueler, S. J., Beckett, J. H., & Gettings, D. S. (2011). Diabetic foot ulcer. Retrieved from http://www.freemd.com/diabetic-foot-ulcer/home-care.htm
20. Waltz, C. F.(Ed.),Strickland, O. L.(Ed.),Lenz, E. R.(Ed.)(2005).Measurement in nursing and health research.New York, NY:Springer.
21. Wounds International. (2013). International best practice guidelines: Wound management in diabetic foot ulcers. Retrieved from http://www.woundsinternational.com/media/bestpractices/_/673/files/dfubestpracticeforweb.pdf
22. Yan, J.,Liu, Y.,Zhou, B.,Sun, M.(2014).Pre-hospital delay in patients with diabetic foot problems: Influencing factors and subsequent quality of care.Diabetic Medicine,31(5),624-629.
23. Zhou,Z.Y.,Liu, Y. K.,Chen, H. L.,Yang, H. L.,Liu, F.(2015).HbA1c and lower extremity amputation risk in patients with diabetes: A meta-analysis.The International Journal of Lower Extremity Wounds,14(2),168-177.
24. Zubair,M.,Malik, A.,Ahmad, J.(2012).Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital.The Foot,22(1),24-30.