AN EXAMINATION OF NURSING STUDENTS’ KNOWLEDGE AND ATTITUDE TOWARDS DIABETIC ULCER CARE AND THEIR CONTRIBUTING FACTORS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Diabetes mellitus, commonly referred to as diabetes, is a global public health issue, with millions of individuals affected worldwide. Among the complications of diabetes, diabetic ulcers are particularly severe and can lead to morbidity, disability, and even mortality if not properly managed. Diabetic ulcers, particularly foot ulcers, affect approximately 15% of diabetic patients during their lifetime and are a leading cause of non-traumatic lower-limb amputations (Armstrong et al., 2017). Globally, an estimated 537 million people between the ages of 20 and 79 are currently living with DM. This number is predicted to rise to 643 million by 2030 and will reach a staggering 783 million by 2045 (International Diabetes Federation, 2022). In Nigeria, diabetes has become increasingly prevalent due to changes in lifestyle, urbanization, and dietary habits (Ekpebegh & Longo-Mbenza, 2021). Consequently, the incidence of diabetic complications, including ulcers, has risen significantly, posing a challenge to the healthcare system.

Diabetes is a pancreas (insulin producing gland) disorder brought about by high levels of glucose in blood. The pancreas, located between and the spine and stomach plays a crucial role in digestion process. The role of pancreas in the process of digestion is evident in its releasing of insulin (a hormone) into the blood (Wale et al., 2019; Diaby et al., 2021). The hormone produced by the pancreas assists the blood to carry glucose to all body cells. In some situations, the insulin does not function as intended, thereby leading to abnormal glucose transfer to the body cells. As a result, glucose accumulates in the blood. With this increased stay of glucose in the blood, the blood sugar level might get too high and this results into diabetes (Diaby et al., 2017). With the increasing prevalence of diabetes in Nigeria, where it is estimated that over 4.7 million people are affected, effective management of diabetic ulcers has become a pressing public health concern (International Diabetes Federation, 2019). The role of nurses in the management of diabetic ulcers has become more critical. Nursing students, who are trained to deliver holistic care, must be well-prepared to manage such complications. Their ability to effectively care for patients with diabetic ulcers depends not only on their academic training but also on their attitude towards this aspect of care.

Several factors contribute to nursing students' knowledge and attitude towards diabetic ulcer care. One of the key factors is the quality of education and training they receive during their academic programs. Studies have shown that nursing curricula in many institutions may lack sufficient emphasis on wound care, particularly the management of chronic wounds such as diabetic ulcers (Sibbald et al., 2018). This deficiency in the curriculum can lead to inadequate preparation of nursing students for real-world clinical scenarios. Furthermore, clinical exposure plays a crucial role in shaping students' attitudes and competence in managing diabetic ulcers. Inadequate practical experience, limited access to wound care facilities, and insufficient supervision by experienced healthcare professionals during clinical rotations can impede the development of essential skills (Apelqvist et al., 2018).

Another critical factor influencing nursing students’ knowledge and attitude towards diabetic ulcer care is their personal perception of the importance of this aspect of nursing. In a study conducted by Thomas et al. (2019), it was found that nursing students with a personal interest in wound care or those who had previously cared for diabetic patients displayed better knowledge and a more positive attitude towards diabetic ulcer care. This suggests that personal motivation and prior exposure play a significant role in shaping students' attitudes and competence.

Cultural and socio-economic factors also contribute to nursing students' knowledge and attitude towards diabetic ulcer care in Nigeria. In many Nigerian communities, there is still a strong reliance on traditional medicine for the management of wounds and ulcers (Oguejiofor et al., 2021). Nursing students, particularly those from rural backgrounds, may be influenced by these traditional beliefs, which can impact their approach to diabetic ulcer care. Additionally, the availability of resources for proper wound care is often limited in Nigerian healthcare facilities, especially in rural areas. This resource scarcity can affect nursing students' ability to practice proper ulcer management, leading to a lack of confidence in their skills and a negative attitude towards caring for patients with diabetic ulcers (Oguntibeju, 2019).

Diabetic ulcers pose a significant health challenge, and nursing students must be adequately equipped to manage these wounds effectively. Although several studies have investigated the knowledge and attitudes of nurses toward diabetic ulcer care (Abate et al., 2020); no prior study has investigated these elements in nursing students or the factors affecting these variables in Nigeria. Studies of nursing students’ knowledge have so far focused on knowledge related to DM, DM prevention, and DM self-management (Anastasiou et al., 2019). Studies on knowledge and attitudes also focused on nursing students’ knowledge and attitude regarding pressure ulcer prevention (Kısacık & Sonmez, 2020); therefore, this study seeks to assess nursing students’ knowledge and attitudes toward diabetic ulcer care and factors related to these variables.

1.2 Statement of the Problem

Diabetic ulcers represent a significant complication of diabetes mellitus, leading to increased morbidity, prolonged hospital stays, and, in severe cases, amputations. In Nigeria, where diabetes prevalence is on the rise, effective management of diabetic ulcers has become an urgent healthcare concern (International Diabetes Federation, 2019). Despite the critical role of nursing professionals in wound care management, there is a troubling lack of comprehensive training and knowledge among nursing students regarding diabetic ulcer care (Olumide et al., 2020). This gap not only jeopardizes patient outcomes but also raises concerns about the preparedness of future healthcare providers in a nation struggling with the dual burden of diabetes and limited healthcare resources.

Research has indicated that nursing students often enter the workforce with insufficient knowledge about chronic disease management, particularly in specialized areas like diabetic ulcer care (Bennett et al., 2015). This inadequacy can stem from various factors, including outdated curricula, limited clinical exposure, and insufficient emphasis on practical skills during training (Musa et al., 2018). Additionally, cultural beliefs and practices surrounding diabetes and wound care may further complicate nursing students' attitudes and approaches to management, highlighting the need to explore the sociocultural context in which these students are educated (Mohammed et al., 2021).

Furthermore, the prevailing socioeconomic conditions in Nigeria, characterized by inadequate healthcare infrastructure and disparities in access to educational resources, may contribute to the poor preparedness of nursing students (World Health Organization, 2018). These systemic issues not only impact the quality of nursing education but also influence students' confidence and attitudes towards managing diabetic ulcers effectively. Consequently, a significant knowledge-attitude gap exists, posing challenges to patient care and overall public health outcomes related to diabetes management.

The lack of empirical research focusing specifically on the knowledge and attitudes of nursing students towards diabetic ulcer care in Nigeria creates a critical knowledge gap. Understanding this landscape is essential for identifying the contributing factors to students' educational experiences and their subsequent impact on patient care. Without a comprehensive examination of these elements, targeted interventions to enhance nursing education and improve diabetic ulcer management may be inadequately designed and implemented. Hence the need for the study.

1.3 Objectives of the study

The primary objective of this study is to critically examine nursing students’ knowledge and attitude towards diabetic ulcer care and their contributing factors in Nigeria. Specific objectives of this study are to:

1. To evaluate the level of knowledge of nursing students regarding diabetic ulcer care in Nigeria.

2. To investigate the attitudes of nursing students toward diabetic ulcer care in Nigeria

3. To identify factors influencing the knowledge and attitudes of nursing students towards diabetic ulcer care in Nigeria

4. To offer recommendations for nursing education programs to enhance the preparedness of future nurses in managing diabetic ulcers

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the level of knowledge of nursing students regarding diabetic ulcer care in Nigeria?

      2. What are the attitudes of nursing students toward diabetic ulcer care in Nigeria?

      3. What are the factors influencing the knowledge and attitudes of nursing students towards diabetic ulcer care in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The level of knowledge of nursing students regarding diabetic ulcer care in Nigeria is low

Ha: The level of knowledge of nursing students regarding diabetic ulcer care in Nigeria is high.

1.6 Significance of the study

Holistic care, which encompasses the physical, emotional, social, and spiritual dimensions of patients, exemplifies a thorough approach to nursing that can significantly influence patient outcomes and enhance the overall quality of healthcare. Assessing the elements that affect this practice holds significant importance for various reasons. The research will establish a foundational reference for patients, healthcare institutions, nursing educators, and others involved in the field.

The individuals receiving holistic care are poised to benefit greatly from the findings of this study. Comprehensive methodologies have demonstrated their efficacy in enhancing patient involvement, contentment, and overall health results. The integration of diverse elements of care into nursing practice fosters a more holistic and compassionate treatment experience for patients. This comprehensive care approach can result in enhanced mental health, quicker recovery periods, and a more tailored healthcare experience.

This study provides valuable insights that are advantageous for healthcare institutions and administrators. A deeper comprehension of the elements that affect comprehensive care practices can inform policy formulation and the creation of strategies designed to assist nurses in their responsibilities. Establishing policies that tackle recognised obstacles and foster supportive elements can enhance care quality and operational effectiveness in healthcare environments.

The involvement of nursing educators and training programs is crucial in this research endeavour. The results can guide the development of curricula, ensuring that nursing education prioritises the principles of holistic care. Educators have the opportunity to weave these insights into their pedagogical approaches, equipping future nurses to embrace holistic practices from the very beginning of their professional journeys. Professional nursing organisations have the opportunity to utilise the findings to promote standards and guidelines that foster comprehensive care. The contributions of these organisations are essential in defining the standards of the profession, allowing them to leverage the study’s findings to advocate for best practices and cultivate an environment that emphasises holistic patient care.

Individuals involved in policy-making and healthcare reform possess a significant stake in the findings of this study. Understanding the elements that affect comprehensive care can guide policy-making and healthcare reforms focused on enhancing patient-centered approaches. By tackling systemic challenges and fostering nurturing environments for comprehensive practice, decision-makers can enhance the efficacy and empathy of the healthcare system.

This study serves as a valuable addition to the expanding corpus of knowledge within the domains of nursing and healthcare, offering significant insights for those engaged in research. The results provide a basis for additional inquiry, presenting novel pathways for exploration or development. Investigators may leverage the findings of this study to craft more focused enquiries, assess the efficacy of strategies intended to enhance comprehensive care, or examine the correlation between integrative practices and patient results. Furthermore, the research can illuminate deficiencies in current literature, steering subsequent investigations and enhancing the overall comprehension of holistic care within the nursing discipline.

1.7 Scope of the study

Broadly, this study focus is to critically examine nursing students’ knowledge and attitude towards diabetic ulcer care and their contributing factors in Nigeria. Empirically, the study will discuss the level of knowledge of nursing students regarding diabetic ulcer care in Nigeria, the attitudes of nursing students toward diabetic ulcer care in Nigeria and factors influencing the knowledge and attitudes of nursing students towards diabetic ulcer care in Nigeria.

Geographically, the study will be carried out in College of Nursing Sciences, UATH, Gwagwalada, FCT.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding an examination of nursing students’ knowledge and attitude towards diabetic ulcer care and their contributing factors in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around College of Nursing Sciences, UATH, Gwagwalada, FCT. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Holistic care: Holistic health refers to the provision of care to patients that are based on a mutual understanding of their physical, psychological, emotional, and spiritual dimensions.

Health status: Health status is a measure of how people perceive their health—rating it as excellent, very good, good, fair, or poor.

Diabetic ulcer: A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

---

---