Primary care nurses’ knowledge and attitudes towards the management and prevention of diabetic foot ulcers

Abstract

Background: Diabetic foot ulcers (DFU) are serious complications of diabetes that are increasing the risk of lower limb amputations, thus affecting morbidity and mortality. Literature shows that these complications can be prevented or delayed with adequate management. Nurses working in primary care are well positioned to be a key health care professional to prevent and manage DFU. They play a crucial role in identifying and managing predisposing factors of DFU. Thus, having sound knowledge about DFU care and a positive attitude towards these patients is very important in promoting patient centred care. Aim: To evaluate primary care nurses’ knowledge and attitudes towards the management and prevention of diabetic foot ulcers in the primary health care centres in Malta. Design: A quantitative, cross-sectional design was selected. Method: An online questionnaire was distributed by an intermediary to all nurses who work in wound care clinics within the primary health care centres in Malta (n=105). A total of 50 questionnaires were returned generating a response rate of 48%. Results: The findings showed that primary care nurses had suboptimal overall knowledge about management and prevention of DFU with a mean percentage score of 57.38%. No statistical significance was found between socio-demographical variables and other characteristics of interest with knowledge scores. An overall positive attitude was recorded with a mean percentage score of 79.5%, however, some negative attitudes were uncovered, namely acknowledging that DFU care is too time consuming and not having time to educate every patient about DFU prevention. There was also no statistical significance between knowledge scores and socio-demographical variables and characteristics of interest. There was, however, statistical significance between the positive attitudes scores and the interest towards DFU with a p- value of 0.005. Moreover, statistical significance was also found between knowledge and positive attitude scores with a p-value of 0.006. Conclusion and Implications: Primary care nurse have suboptimal knowledge about management and prevention of DFU, and an overall positive attitude towards care for patients with DFU. There is the need for specialized training courses that are offered to nurses on a continuous basis. Nurses should be given an incentive to attend these courses to develop their skills, keep abreast with evidence-based practices, and optimize the provision of care. The introduction of additional tissue viability clinics with specialist nurses in primary care centers should be encouraged.