Nursing and Paramedic Contributions to Diabetic Foot Ulcer Prevention and Care: A Cross-Sectional Study in Saudi Arabia

Abstract

Diabetic foot ulcers (DFUs) are an important diabetes-related complication and may lead to infection, delayed recovery, hospitalization, and lower-limb amputation. Because nurses and paramedic personnel frequently interact with patients across outpatient, inpatient, and community settings, their contribution to screening, education, wound care, and referral may influence the course of diabetic foot disease.
Objective: To examine the contribution of nursing and paramedic services to DFU prevention and management and to describe their relationship with selected patient outcomes in Saudi healthcare facilities. Methods: A descriptive cross-sectional study was undertaken in selected Ministry of Health hospitals in Riyadh, Jeddah, and Dammam from January through June 2025. Five hundred and fifty adults with diabetes were recruited consecutively using a non-probability sampling approach. Information was collected with a structured questionnaire covering demographic and clinical characteristics, foot-care education, routine foot assessment, dressing procedures, wound-care protocols, specialist referral, and selected clinical outcomes. Data were analyzed using IBM SPSS Statistics version 26. Chi-square tests and independent-samples t-tests were used as appropriate, with statistical significance set at p < 0.05.
Results: The participants had a mean age of 56.4 ± 11.2 years; 508 (92.4%) had type 2 diabetes and 328 (59.6%) reported a history of DFU. Regular nursing foot assessment was reported by 344 participants (62.5%), while 302 (54.9%) had received foot-care education. Paramedic staff performed dressing procedures for 278 participants (50.5%), whereas 188 (34.2%) reported nursing-initiated specialist referral. Among patients receiving regular nursing care, complete ulcer healing within eight weeks was reported in 76.1%, compared with 52.4% among those without regular nursing care. The manuscript data also indicate lower recurrence and infection-related complications among patients receiving nursing involvement.Conclusion: Nursing and paramedic personnel represent important components of multidisciplinary diabetic foot care. Strengthening routine screening, patient education, standardized wound-care procedures, referral pathways, and continuing professional training may improve the organization and quality of DFU management in Saudi healthcare settings. Because of the cross-sectional design, the observed associations should not be interpreted as proof of causality.