Dilemmatic of Management of Wound Care of Diabetic for Risk Amputation in Rural Areas: A Case Report
Abstract
Diabetic wounds are one of the most challenging complications faced by individuals with diabetes. These wounds not only pose serious physical threats, such as infection and limb loss, but also cause significant psychological distress. One ethical dilemma commonly encountered in diabetic wound care involves decision-making about treatment options, especially when patients request amputation due to pain or economic burden, while healthcare providers aim to preserve the limb through advanced wound care techniques. This situation requires careful consideration of both medical and ethical aspects to ensure patient-centered care. The objective of wound care in such cases is not only physical healing but also improving the patient’s psychological well-being. When care is holistic and empathetic, patients are more likely to engage in treatment positively and without fear, especially during painful procedures such as dressing changes. This case highlights a 55-year-old man with a 20-year history of uncontrolled diabetes and a chronic, infected wound on his right leg. The patient's initial desire for amputation was addressed through a multidisciplinary approach using the TIME method Tissue management, Inflammation control, Moisture balance, and Epithelial advancement. The structured, ethical, and compassionate care helped the patient reconsider amputation, demonstrating that rural nurses and health teams can resolve ethical dilemmas and support better patient outcomes.
References
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.) (4th ed.). American Nurses Association.
Beauchamp, T., & Childress, J. (2019). Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. In American Journal of Bioethics (Vol. 19, Issue 11, pp. 9–12). Routledge. https://doi.org/10.1080/15265161.2019.1665402
dr. Alvin Nursalim, S. (2021). Bisakah Penderita Diabetes Berobat dengan BPJS? Https://Www.Klikdokter.Com/Info-Sehat/Diabetes/Bisakah-Penderita-Diabetes-Berobat-Dengan-Bpjs?Srsltid=AfmBOooGKGVR8rVd3OcU_FQ4EVzs2ZcBrjzou3FRzecqYxfFGUwgraPI.
Fearns, N., Heller-Murphy, S., Kelly, J., & Harbour, J. (2017). Placing the patient at the centre of chronic wound care: A qualitative evidence synthesis. In Journal of Tissue Viability (Vol. 26, Issue 4, pp. 254–259). Tissue Viability Society. https://doi.org/10.1016/j.jtv.2017.09.002
Gupta, S., Srivastava, A., Malhotra, R., Chadha, M., & Aggarwal, A. N. (2023). Wound Assessment Using Bates Jensen Wound Assessment Tool in Acute Musculoskeletal Injury Following Low-Cost Wall-Mounted Negative-Pressure Wound Therapy Application. Indian Journal of Orthopaedics, 57(6), 948–956. https://doi.org/10.1007/s43465-023-00861-2
Hadrianti, D., Saherna, J., Arji, A., Pratama, Z., Putri, A., & Khaliza, N. (2024). Geriatric Depression Scale (GDS) sebagai Pengkajian Status Psikologis pada Lansia. Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM), 7(3), 1236–1246. https://doi.org/10.33024/jkpm.v7i3.13387
Holbert, M. D., Griffin, B. R., McPhail, S. M., Ware, R. S., Foster, K., Bertoni, D. C., & Kimble, R. M. (2019). Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: Study protocol for a randomised controlled trial. Trials, 20(1). https://doi.org/10.1186/s13063-018-3057-x
Laopoulou, F., Kelesi, M., Fasoi, G., Vasilopoulos, G., & Polikandrioti, M. (2020). Perceived Social Support in Individuals with Diabetic Foot Ulcers: A Cross-sectional Survey. Journal of Wound, Ostomy and Continence Nursing, 47(1), 65–71. https://doi.org/10.1097/WON.0000000000000614
Lembaga Kebijakan Pengadaan Barang/Jasa Pemerintah (LKPP). (2022). MELOLIN MELOLIN Low Adherent Dressing Pads. Https://E-Katalog.Lkpp.Go.Id/Katalog/Produk/Detail/58652359?Lang=id&type=general.
Pemerintah Provinsi Jawa Timur. (2010). Peraturan Gubernur Jawa Timur Nomor 4 Tahun 2010.
Polikandrioti, M., Vasilopoulos, G., Koutelekos, I., Panoutsopoulos, G., Gerogianni, G., Alikari, V., Dousis, E., & Zartaloudi, A. (2020). Depression in diabetic foot ulcer: Associated factors and the impact of perceived social support and anxiety on depression. International Wound Journal, 17(4), 900–909. https://doi.org/10.1111/iwj.13348
Teare, J., & Barrett, C. (2002). Using quality of life assessment in wound care. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 17(6), 64, 59—60, 67—8. https://doi.org/10.7748/ns.17.6.59.s54
Tim Pokja SDKI DPP PPNI. (2016). Standar Diagnosis Keperawatan Indonesia (SDKI) (1st ed.). DPP PPNI.
Tim Pokja SIKI DPP PPNI. (2018). Standar Intervensi Keperawatan Indonesia (SIKI) (1st ed.). DPP PPNI.
Tim Pokja SLKI DPP PPNI. (2018). Standar Luaran Keperawatan Indonesia (SLKI) (1st ed.). DPP PPNI.
West Coast Wound Care. (2024). Types of Wound Dressings and When to Use Them. Https://Westcoastwound.Com/Types-of-Wound-Dressings-and-When-to-Use-Them/#:~:Text=Non%Adherent%20%20dressings%20are%20%20designed,Skin%20grafts%2C%20and%20donor%20sites.
Copyright (c) 2025 Indonesian Journal of Global Health Research

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.



