A Study the Performance of Diabetic Patients towards Foot Care at Endocrine and Diabetes Center in Al- Nasiriyah City
QassimJawellOdah Abed*1 ,AmerMuhssenNasir*2 , AshwaqYasKhudhair*3
1*Msc. Adult Nursing, AL-Kut technical institute - Middle Technical University, Baghdad, IRAQ
2*Msc. Adult Nursing, Al-Nasiriyah Technical Institute, Southern Technical University, Basrah , IRAQ, *3Msc.Biochemistry, Al-Karama Teaching Hospital, Lab. Biochemical-
Ministry of Heath IRAQ Co-author Email:[email protected]
Objectives: The purpose of the study is toward evaluating the performance of chronic diabetic patients concerning foot care at Endocrine and Diabetic Center in Al- Nasiriyah city.
Methodology:A cross-sectional study of patients attending the Endocrine and Diabetes Center in Al- Nasiriyahcity.The study was conducted during the study period from September 13, 2019 to August 25, 2020 .sample of study was (80) patient with chronic diabetes mellitus consult the Diabetes and Endocrine center in.2 Al- Nasiriyah city. Data were composed finished the usage of the built form and the procedure of the self-administrative bang. The questionnaire remained contained of three fragments: close relative socio-demographic physiognomies (age, gender, educational level, occupation, monthly income and residence).the second part consists of consist of questions related performance diabetic patient toward foot care, this part consists of (13) items. Gratified validity of the apparatus was strong-minded through the use of panel specialists and the internal constancy of the tool was determined through the experimental study and the calculation of Alpha Correlation Coefficient (r = 0.870). Data were examined through the request of descriptive and inferential statistical methods by using Statistical Package for Social Science (IBM SPSS) version 20.0.
Recommendation: The study recommended the possibility of conducting future studies regarding care for diabetic foot and improving patients' performance in this direction (at the national level)
Keywords: Chronic Diabetes, Foot, Care Performance.
Introduction
Diabetic foot is a disease that touches diabetic patients through the emergence of some compulsive indications in the foot such as bulge, wounds and injuries as a consequence of neuropathy, poor circulation or microbial contagions. [1]. Diabetic foot is a therapeutic disorder in which the feet of a diabetic or a diabetic suffer damage to its structure, purpose, or both As a consequence of the person consuming diabetes, and this occurs after a extended retro of diabetes, and this take place as a result of outlying neuropathy and short blood circulation to the feet as a result of diabetes. The best method to protect the feet is to switch gore sugar levels near or near normal [2]. The deterrence of diabetic foot problems should be a major goal for a diabetic patient, by laundry and ventilation the feet, particularly between
the toes daily and not to use hot water bladders. The patient payments the feet every day, The risk of developing foot ulcers increases when a diabetic wears a new shoe, and walks with it a long distance in a stage of diabetes in which the sensation decreases and the blood circulation in the feet is disturbed. Also, the new, narrow shoe does not help heal wounds or sores if they appear in the foot, due to the lack of blood flow in the skin and the increased pressure on the sole of the foot due to body weight, lack of ventilation inside the shoe, and an increase in sugar in the casing [3].. Do not treat any deviations in the casing of the feet without referring a doctor first. Cut the nails conventional to avoid the nails joining the skin, not to put the feet on the heater or fire in winter times to warm them while not walking barefoot. Not to or flip- flops or other open-toed shoes. Avoid high-heeled shoes or shoes with pointed or pointed toes. And the patient must quickly go to the surgery consultant to check and find out the reasons [4]. The patient’s negligence in seeing a doctor may lead to gangrene and then to amputation of the affected organ and may lead to blood poisoning and death.
Methodology
Design of study: Descriptive Cross-sectional design was conducted though out the present study for period from September 13, 2019 to August 25, 2020.
The setting of the study: The study was conducted at Diabetes and Endocrine center in Al- Nasiriyah city
Sample of the study: sample of study was (80) patient with chronic diabetes mellitus consult the Diabetes and Endocrine center in Al- Nasiriyah city
Criteria:
A- Patients with chronic diabetes who return to center B- Patients accepted to cooperate in in study.
C- Male and female patient.
Tools of study: In order to determine performance of patients with chronic diabetic toward foot care in at Diabetes and Endocrine center in Al- Nasiriyah city. The researchers constructed questionnaire consists of:
Part 1: Socio demographic physiognomies include (age, sex, educational level, once-a-month income and placement).
Part 2: Questionnaire consists of questions related performance of patients with chronic diabetic toward foot care.
This part consist of (13) items
Ethical clearance: Written permission were obtained from the DhiQaru Health Department and the Diabetes and Endocrine Center in the city of Nasiriyah, as well as taking requests from patients to explain to them the nature of the research and what its objectives
Data collection: The data when collected with constructed questionnaire though an application direct interviewing and indirect answers as mean of data collection.
Scoring and Rating: The items was valued and scored rendering to the next designs:
1. The evaluation of respondents for each query was counted with (2) yes, (1) No.
2. The advanced grade of recording of the questionnaire (MS) the greater assessment of performance of diabetic patients toward foot caring. Statistics of the education were ordered rendering to two heights of scale (pass and fail) early specified which were scored as (2 and 1) for each level correspondingly.
Validity of the Opinion poll: The at ease cogency of survey were dogged by board of (5) specialists. Those establishments were request to assessment the items; survey for content, clarity, relevancy, and proficiency; some items were left out and others remained auxiliary after a face-to-face argument with each skillful and afterwards the appliance was represent valid after getting all the elucidations and endorsements in consideration.
Reliability Indicators inspector: In order to determine stability standing amid the assistant and professional to be sure that both of them had been bordering on extinction, the same reply for the truthful items that essential to be overseen.
Statistical analysis: Data was investigated by IBM.SPSS (Statistical Package for Social Sciences) variety to figures was presented as quantity and in each hundred figures analyzed completes an application of frequency.
Result
Table (1): Dispersal of the (80) Patients Conferring to the Demographical Appearances
Basic Information Groups Frequenc
y Percent
Age groups
20 – 29 5 6.3
30 – 39 23 28.7
40 – 49 16 20.0
50 – more 36 45.0
Total 80 100
Mean ± SD 43.2± 0.999
Gender
Male 28 35.0
Female 52 65.0
Total 80 100
Education Level
Not read and
write 30 37.5
Read and write 17 21.3
Primary 15 18.8
Intermediate 6 7.5
Secondary 8 10.0
Institute and colleague
graduation or higher
4 5.0
Total 80 100
Marital status
Married 74 92.5
Single 6 7.5
Divorced 0 0
Widow 0 0
Total 80 100
Occupation
Employee 6 7.5
Government employee
14 17.5
Free Work 1 1.3
Unemployed 31 38.8
Retired 14 17.5
Housewife 13 16.3
Student 1 1.3
Total 80 100
Income
Sufficient 14 17.5
Barely sufficient 23 28.7
Insufficient 43 53.8
Total 80 100
Residency
City 37 46.3
Rural 43 53.8
Total 80 100
0 10 20 30 40 50 60 70 80
Not read and
write Read and
write Primary Intermediate Secondary Institute and colleague graduation or
higher
Frequancy
Figure (1) show disruption level of education for patient with chronic diabetic toward foot care
Table (2) Summary Statistical criteria of performance diabetic Patients toward foot care with chronic diabetic by Frequency, Main of Score, and Assessment Regarding (cut off point = 1.5).
No Items Yes No M.S Asses
F % F % s
1 Wash the foot with warm water and special soap. 19 23.8 61 77.2 1.23 F 2 Use of creams and lotion that permitted by medical
facilities to relief crackles.
52 65.0 28 35.0 1.65 P 3 Rinse the fooف with soft tissues to prevent fungi
growth
60 80.0 20 20.0 1.5 P 4 Change stocks and clean foot and don not wear
compression stocks.
20 25.0 60 75.0 1.25 F 5 Cutting the foot nails contiousely and carefully. 36 45.0 44 55.0 1.55 P 6 Elevated the foot during sitting to ensure the good
peripheral circulation.
41 51.2 39 48.8 1.5 P 7 Don't walking without wearing shes 31 38.8 49 61.2 1.38 F 8 Don't cross the foot to each other 20 25.0 60 75.0 1.25 F 9 Stop smoking that causes poor bold circulation 51 63.8 29 36.2 1.36 P 10 Libricate the foot to prevent dryness. 20 25.0 60 75.0 1.25 F 11 Don't use hot bag for warming the foot 19 23.8 61 77.2 1.23 F 12 Don't leave the foot in water for long time. 27 33.8 53 66.2 1.33 F 13 Are you feeling of numbness, coldness or hotness in
your foot.
10 12.5 70 87.5 1.12 F
Figure (2): show distribution performance of patients with diabetic toward foot care
Discussion
Table (1): Dispersal of the (80) Patients Bestowing to the Demographical Appearances The consequences of the study showed that additional than partial of the study sample in this table, the mainstream of the study example in middle age ranged between (40-59) years. They represent (52) patients (65%), with an average age of (43.2) years. This result is consistent with, which shows that the widely held of the study sample individuals are middle-aged (42.4). This may be due to the prolonged prevalence of type / 2 diabetes and uncontrolled high blood pressure among this age group (the researcher), and this finding is supported by (7), who confirmed that diabetes and high blood pressure are the most common causes of myocardial infarction[5].. Heart disease in patients. Regarding sex, it is seen that (65%) of the study sample are females and the rest are males. This result is like to the study he led [6].
With regard to educational levels, the more they number, the more they have a low educational level, such as not reading, writing, reading and writing, primary school graduate, and this result is a normal result for our civilization because the main number of relations under the line of poverty with deficient once-a-month revenue. Version to the subject of nuptial status, the majority of the example members are committed (74) and they establish (95%) of the entire sample [7]. We also know that persons are pretentious by wedded rank, but in optimistic of the Iraqi ethos, the marital grade after illness may still last due to the strong suit of the socio-cultural separation in southern Iraq [8].
Table (2) Summary Statistical criteria of performance diabetic Patients toward foot care with chronic diabetic by Frequency, Main of Score, and Assessment Regarding The results of the study show that patients have poor knowledge about what is presented (passing) in (2, 3, 5, 6 and 9) elements and display (failure) in all elements. These results are consistent with the study conducted by which supports the results from during the study, patients with chronic diabetic foot ulcer had poor knowledge of foot care and this proved that
, 1.36
, 1.55
, 1.5 performance of
patient towardfoot
care; 1.65 , 1.5 , 0, 0, 0, 0, 0, 0
, 1.25
, 1.38
, 1.25
, 1.23 , 1.33
, 1.12
, 1.23 , 0, 0, 0
they do not possess a high level of education) [9]. Most of the patients who participated in the study sample that they have primary education level and this is consistent with the lower performance towards diabetic foot care because the study showed that all patients with a higher educational level are more conversant with the disease and how to care for the foot [10]. This study agrees with Where a study was that patients with elementary education did not have complete knowledge on how to care for diabetic foot was conducted at a hospital at the hospitals of Lahore [11].
Recommendation
The study recommended the possibility of conducting future studies regarding care for diabetic foot and improving patients' performance in this direction (at the national level).
Conclusion
Based on the results of the study, it was found that most of the patients reviewing the Diabetes Center had low performance and practices regarding diabetic foot care. Therefore, the center must organize adequate training and develop instructions and protocols on how to care for the feet
Guidance on how to care for diabetic foot for patients with diabetes time
� Foot care tips for diabetics
� Based on the results of the study and previous discussion, the current study
� recommends the following guidelines:
� Wash the feet with warm water and special soap.
� Using creams and lotions allowed by medical facilities to relieve cracks.
� Rinse the feet with soft tissues to prevent the growth of fungi
� Change stocks and clean feet and do not wear pressurized stocks.
� Cut toenails contagious and cautiously.
� Lift the foot while sitting to ensure good peripheral blood circulation.
� Do not walk without wearing a blindfold
� Do not cross feet to each other
� Stop smoking that causes poor circulation
� Librex foot to prevent dehydration.
� Do not use the hot bag to warm the feet
� Do not leave the foot in the water for a long time.
� Do you feel numb, cold or hot in your feet?
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