الفهرس 
AcknowledgmentsOnly 14 pages are availabe for public view
 |  | from | 156 |  |  |
| | | from | 156 | | |
Abstract
Summary
Diabetic foot is one of the most significant and devastating complications of diabetes, and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes, occurs changes in skin color, swelling in the foot or ankle, pain in the legs, open sores on the feet that are slow to heal or are draining, in grown toes nails or toenails infected with fungus, corns or calluses and dry cracks in the skin, especially around the heel, foot odor that is unusual or won’t go away (Krishnasamy et al ., 2018).
The aim of this study was to evaluate the effect of self- management training on knowledge and glycaemia control for patient with diabetic foot.
The following hypotheses were formulated to fulfill the aim of the study:
Patient’s level of knowledge and glycemic control will be improved after receiving self -management training.
Quasi- experimental study (Pre/posttest) was utilized to conduct this study .A convenience sample of (60) adult patients from both sexes and their age ranged from (18-65) years, were included patients received self-management training.
The data of the study collected from the internal medicine departments and diabetic outpatient clinic at Assiut University Hospital.
The following tools were utilized for data collection:
Tool (l): Patient Assessment Questionnaire: This tool developed by the researcher based on the current national and international literatures and included four parts.
Part 1: Patient’s Demographic data :Which included age, gender, and marital status, level of education, occupation and residence.
Part 2: Patient’s Medical data: This part included past and presence patient’s medical history, date of admission and discharge, previous admission, presence of other chronic diseases, regularity of medications, family history, duration of illness and risk factor identification.
Part 3: Assessment of patient’s diabetic foot: This part used to assess the signs and symptoms of foot ulcer regarding to loss of feeling, numbness, blisters without pain, skin discoloration, temperature change, red streaks, wound with and without drainage, painful tingling and foot complications such as diabetic foot neuropathy ,foot ulcer, diabetic foot infection, gangrene, foot deformity and amputation.
Part 4: Assessment of patient’s level of knowledge: This part used to assess patient’s level of knowledge about diabetic foot (pre/post). Which included 19 questions.
Scoring system:
Scores assigned to each item were between 0 and 2 points as follows; (correct, incomplete correct and incorrect). According to total scores, it was between (0-38). Considering satisfactory knowledge at >75% of the total score, fair level of knowledge at 50 to <75% level, while poor level of knowledge total score was < 50%.
Tool (ll): Diabetic self-management scale questionnaire (Norbert, 2015) :- ( pre /post) this tool used to assess self – management of patients and glycaemia control .It consisted of four subscales:
5. Glucose management.
6. Dietary control.
7. Physical Activity.
8. Health Care Use.
Self – management training for diabetic foot patients:
It developed by researcher based on patient’s needs and literature review (Parker et al., 2017, Kurnia & Amatayakul, 2018).It aimed to improve self – care management for patient with diabetic foot to prevent complications. It was including instructions about; diet, medications, exercise and foot care as following:
1-Informations about definition of diabetes mellitus and diabetic foot, and causes , signs and symptoms , complications, diagnosis and prevention of diabetic foot ulcer.
2-Informations about diet for patients with diabetes. Which included (Purpose of diet regulation, stick allowed diet and how to prepare a meal for patients with diabetes.
3- Exercise training program for patients with diabetic foot. It included benefits, precautions before exercise application, types and technique for each type of exercise.
A-Foot and toes stretches.
B-Ankle inversion/eversion/dorsiflexion.
C- Resistance ankle exercises.
D - Strength plantar fasciitis exercises.
4- Responsibilities of the Patient toward him/herself.
5-The patient should do some periodic checks to help control the level of sugar
6- Diabetes treatment.
7-Medications for diabetic foot.
8-Diabetic foot care.
The main results of the present study were as the follows:
1- The mean age of patients was 51.4±12.6 years old, two fifths (40%) of the studied patients were less than 56-65yrs old. As regard gender more than half of the studied patients were male, as regard the occupation one third of the patients employee and other one third (30%) did not work. More than three quarters (78.3%) of the studied patient from rural area. and more than one fifth of the patients, (24%) were illiterate.
2- As regard chronic disease three fifths of patients (60.0%) had chronic disease . Half of the patients (50%) had regular intake of medications and two fifth , of patients (40%) complained from DM for > 10 years .The majority of patients (85%) had experience of peripheral vascular disease, and (80%) had neuropathy.
3- One fifths of the patients (20%) had the infection, whereas (6.7%) of patients had experience of gangrene, deformity and amputation while, (15%) of patients had neuropathy.
4- Before training program, three quarters 75% of patients had poor level of knowledge, while after implementing of the self- management training, 70% of patients had satisfactory level of knowledge .There were highly statistical significance differences between total of knowledge scores about self – care for diabetic foot in pre and posttest.
5- There were statistically significance differences in all domains of self-management scales of the studied patients before and, after self –management training.
6- There was statistical significance difference between total level knowledge and total self- management scales after self- management training for patients.