Determination of health care awareness at the patients toward diabetic foot in Al-Hila teaching hospital.

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Introduction:-
Diabetic foot based on (WHO) criteria is an infection, ulceration and\or destruction of deep tissues associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb.Also it is consider as a complication of chronic disorder of altered carbohydrate, fat, and protein metabolism due to either a relative or absolute lack of insulin or one of endocrine dysfunction (1) .
Diabetes can cause damage to nerves and vascular supply of the feet and legs.Patients with neuropathy have no sensation and therefore, might be an aware of any trauma to their feet (2) .
For all that it seems as a simple condition, diabetes is a daunting illness in that has so many potential complications such as eye disease, kidney disease, circulatory disease, the arterial disease and diseases of the nerves (3) .
Among patient with diabetes mellitus, chronic foot ulcers remain one of the primary indicators for hospitalization and can result to adverse clinical outcomes with close to (15%) of all diabetics who developing a lower extremity ulceration, at some points in their life times (4) .
Diabetic foot disease is a major health problem, and the association with morbidity and mortality is unacceptably high, however, amputations are not inevitable, and the strategies that available to help patients with diabetes who have feet disease can be effective in reducing morbidity (5) .
Consequently, it is imperative that nurse recognize the symptoms of early on set neuropathy and incorporate with patient teaching for proper foot care in order to minimize the like hood of progression of diabetic foot ulceration (6) .
Foot is an integral part of nursing care and the nurse must be accountable and responsible for such care.The major focus of nursing care of any diabetic patient should include extensive information on foot care and the opportunity to practice it (7) .

Methodology:-
A descriptive design study using the assessment approach for determination of the health care awareness toward diabetic foot.The study was carried out during the period of 2\7\2010 to 2\7\2011.
The setting of the study includes inpatient (surgical wards, consultation unit ) from the following:--Al-Hila teaching hospital.The teaching hospitals are composed of medical and surgical wards, and medical outpatient and surgical outpatient.
A purposive "non probability" sample of (200) patient with diabetic foot were selected from Al-Hila Teaching Hospitals.
The study instrument was a questionnaire which was developed by the investigator for the purpose of data collection.It was consisted of two parts: The part 1-General information:-It was consisted of (8) items which included ( age, gender, marital status, educational level, occupation, residence, monthly income ,and smoking).2-The Part 2-Health care awareness: It consisted (20) item concerned health care awareness for diabetic foot problems (8) , and some modified from researcher.The items were rated in scale as yes and no, and then each selection has a special scale for a statistical application ( 2 and 1).
The content validity of the instrument was established through a panel of (10) experts to investigate the content of the questionnaire for clarity and adequacy in order to achieve the present study's objectives.The mean of experience was (21.4) year and (Sd=4.1), the experts agreed that (20) item of health care awareness were clear and adequate for the measurement of the study.
I n order to determine the test re-test reliability for health care awareness score, a pilot study was carried out on (10) patient with diabetic foot for two different periods, Pearson Correlation Coefficient was (r= 0.87).
The data were collected through the utilization of a constructed questionnaire, using the interview technique.Interview took a timetable of (25) minute for each patient.The assessment was conducted during the period of 1\10\2010 to 1\5\2011.

Data were analyzed through the application of:
A-Descriptive statistical data analysis approach: 1-Frequency.

Discussion:
The presents an interpretation of the study findings and discussion of the evidence, this was supported through the available literature.The findings of the study sample shows that the majority of the sample were (47-56)year old who were accounted for (26%).thisresult was similar to another research who noted that the mean age of the sample was (58) years (9) .The patients in this age group, which considered a productive period as far as being established in their occupation and financially independent.Because of this, the patient will be under stress because of his/ her disease and its complications The results shows that majority of the sample were males (149) patient who were accounted for (74.5%) and married 111) patient who were accounted for 55.5%).This result was in agreement with another research who had found that (63%) from the study sample were males and (78%) of them were married (10).
The results shows that majority of the sample were secondary graduate (46) patient who were accounted for (23%).),This result is supported by another study who had found that the level of education of the study sample among Bahraini adults with diabetes mellitus was illiterate (11) .WHO reported that to save feet limbs from gangrene, ulceration and infection by providing preventive medicine and patient education and also preventive of diabetic foot depends very largely upon patient education.That mean the low educated of the patients was the risk factors for diabetic foot.
The researcher results shows that the majority of the samples were employed (145) patient who were accounted (72.5%) .
The researcher results shows that majority of the study samples were barely sufficient of monthly income (97) patient who they were accounted for (48.5%).
This table shows that majority of the study samples were live in urban (139) patient who were accounted for (69.5%) about the result of researcher .
The results shows that majority of the study sample were smokers (132) patient who were accounted for (66%).this result was in agreement with another study result who mentioned that (62%) from the patients were smokers (12) .There was association and effect between hyperglycemia and number of cigarettes smoked/day and a positive association with total smoking exposure as measured by pack-years (12) .
WHO reported that diabetes leads to impaired circulation making the extremities (especially the feet) very vulnerable to injury and infection and also diabetes is a leading cause of narrowing and Harding of the blood vessel in the feet and the smoking is main cause for atherosclerosis that mean the smoking was one from the risk factors for diabetic foot of the study sample patients.
The results shows that majority of the sample were score32 (38) patient who were accounted for (19%).The table indicated that if the score less than 30 mean there is unawareness (15%) in cumulative percent and the remaining (85%) were awareness.
The results show that there is no relationship between demographic characteristics with health care awareness that mean health care awareness for all.
The findings of the study sample indicated that the mean of score is low severity for items (2), and high severity for items (3, 4, 5, 8, 9, 11, 13, 17, and 18), and moderate on the remaining items.
This result agreed with another researcher who said that personal hygiene items were the key to prevent diabetic foot ulcer or reduce it (5) .National Diabetes Education Program reported that for the diabetic patient to check their feet for ( cuts, sores, red spots, swelling, and infected toenails), wash their feet in warm not hot water, dry their feet well, be sure to dry between toes, do not put lotion or cream between their toes, if they have corns and calluses ,check with your doctor foot care specialist, about the best way to care for them, do not cut corns and calluses, trim their toenails with clippers after they wash and dry their feet (trim toenails straight across and smooth them with an emery board or nail file, don't cut in to the corners of the toenails), wear shoes and socks at all time (do not walk barefoot, always wear socks, choose clean, highly padded socks, check the inside of their shoes before they put them on, wear shoes that fit well and protect their feet), put their feet up when they are sitting, don't smoke (13) .Care plans should identify special care that is required for each person with diabetes e.g.nails, skin treatment, heal pads appropriate foot wear, extreme of heat should be avoided as this can cause skin damage (14) .Foot care was more common among insulin users than non users and those who self-monitored their blood glucose level daily than those who did not (15) .Increasing the chance of injury of the diabetic foot lesion resulted from a break in the skin leading to infection then must be treated at once (16) .The key to maintaining healthy feet is to prevent injury and foot problem by following: -Daily foot care quits.-wash the feet everyday with mild soup and dry it well.-Keepthe toenails neatly trimmed.-Check the feet for any cracks, skin dry, cut, redness.-Report signs of ingrown toenails and swelling.-Avoid exposure to the sun with the protection of sunscreen.-Donot apply heating pad, do not cross leg, do not use hard equipment to smooth corns and never walk barefoot (17) .People with diabetes have to pay special attention to the health and care of their feet, with regular visits to their physicians for neurological, vascular and skin assessment (16) .Moderate of mean of score for personal hygiene it mean that the patients with diabetic foot were an aware for the complication of diabetic foot.

67 and above 32 16.0 100.0 total 200 100.0 This table shows that the majority of the sample were (47-56)year old who were accounted for (26%).Table 2 . Distribution of the study sample according to their gender.
This table shows that majority of the sample were males (149) patient who were accounted for (74.5%).