Nursing Foot Care: a wholistic approach

At McDermott Footcare, the first visit with a new client includes a concise assessment of pre-existing medical conditions. The reason is because pre-existing medical conditions are reflected in the health of the feet. It is important to consider what is happening to the entire body and not just the feet.

  • arthritis affects the joints in the feet resulting in pain, inflammation, swelling, calluses, and corns
  • a weakened immune system results in fungal and bacterial infections of the feet and toenails that are difficult to treat
  • steroids such as prednisone may cause brittle, thickened toenails
  • poor circulation to the extremities from conditions such as peripheral vascular disease and diabetes may result in pain, numbness, neuropathy, swelling, changes in the colour of the skin, bacterial and fungal infections of the feet and toenails, thickening of toenails, amputation

In nursing foot care, as in all medically-related care, a wholistic approach is best. Since care at McDermott Footcare is provided by a registered nurse, counselling and health teaching is provided as needed. Clients sometimes have health-related questions and they find the knowledge and advice of a registered nurse reassuring and helpful; this gives clients peace of mind.

A wholistic approach to nursing foot care must also recognize the importance of spiritual care. Honouring the person’s spiritual dimension, irregardless of their religious beliefs, is accomplished by treating clients with respect, being nonjudgmental, and actively listening to them.

In healthcare-related professions, it is easy to focus on the procedure that must be performed, the disease that must be treated, the diagnosis that must be addressed. But the persons we care for are so much more than the diagnosis with which they present. In order to give the best care, we must always take a wholistic approach and consider each person’s mind, body, and spirit connection.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

 

Advertisements

What To Look For In A Foot Care Nurse

Who is a certified foot care nurse?

Only currently registered, licensed Registered Nurses, Registered Practical Nurses and Licensed Practical Nurses who have completed a certification course in Advanced Nursing Foot Care  can practice nursing foot care.  In Ontario, Canada, the public can access information on the College of Nurses of Ontario (CNO) website verifying the current standing of an RN or RPN to practice nursing in Ontario.  A certified foot care nurse should be able to produce a certificate of completion in Advanced Nursing Foot Care.  Don’t hesitate to ask to see it.

What services can I expect?

  • Obtain a medical/nursing history and be able to make correlations between medical conditions and medications as they apply to the overall health of the feet
  • Assessment of the feet
  • Toenail cleaning, clipping, filing
  • Removal of ingrown toenails
  •  Corn and callus reduction
  • Padding of tender areas
  • Foot massage
  • Assessment and recommendations for footwear
  • Assessment and recommendations for skin conditions such as tinea pedis and cellulitis

Who benefits from nursing foot care?

  • diabetics
  • people with rheumatoid arthritis
  • individuals with vision problems
  • individuals with mobility problems
  • anyone who is unable to self-treat conditions such as fungal and thickened toenails, corns, calluses, athlete’s foot (tinea pedis)

Payment and Coverage?

For Canadian veterans, nursing foot care is covered by the Department of Veterans Affairs (DVA).  Ask the foot care nurse if she/he is a DVA Provider.

There is a fee for service for certified nursing foot care services.  Some private insurance providers will cover a portion of the fee.  Nursing foot care services are an allowable income tax deduction.

Always obtain a receipt for payments made.  Make sure the foot care nurse includes their nursing license/registration number on the receipt.

Other Questions to Ask the Foot Care Nurse?

  1. How do you clean your instruments?  In Ontario, Canada, the Ministry of Health and Long-Term Care mandates that foot care instruments are to be sterilized by autoclave.  No other method of cleaning/disinfecting will thoroughly sterilize instruments.  Some foot care nurses still do not sterilize by autoclave.  Before the first visit, ask if their instruments are autoclaved.
  2. Frequency of visits?  Typically, visits are scheduled for every 6 weeks.  This may vary depending on individual clients.

Where to find a foot care nurse?

  • online – some certified foot care nurses have online listings, blogs
  • home healthcare agencies may provide certified nursing foot care as in-home visits or in clinics
  • your doctor may be able to make a referral
  • in Ontario, Canada, Community Care Access Centres (CCAC) have listings of certified foot care nurses
  • word of mouth

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Advocating for Those Who Can’t

Even though my business is  nursing foot care, I am a registered nurse and when something isn’t right with one of my clients, I need to address it.  While doing foot care for one of my McDermott Footcare clients, I noticed that the symptoms of her chronic medical condition were more pronounced.  I convinced Mrs. X to make an appointment with her doctor then I wrote the doctor a note outlining my observations and concerns.  This is something I do for my clients when I see a change in their health status.  It usually works well.

Two days later, Mrs. X phoned to tell me that the doctor’s response was “well, we all know you’re deteriorating.”  At the present stage of my client’s condition, there are medications that will ease her symptoms but none were prescribed.  I was hoping the doctor would finally give her a prescription, but he didn’t.   Mrs. X didn’t question the doctor, but she was disappointed.

Registered nurses are bound by very strict laws of client/patient confidentiality.  Even though I wanted to talk to her family about the doctor’s response, I couldn’t since Mrs. X didn’t give me her permission.  The only thing I could do was urge her to tell them what happened and ask them to talk to the doctor with her and on her behalf. 

Sometimes, the people we love need our help when dealing with difficult issues such as illness.  They may not know how to discuss their concerns with the doctor.  Or they are so overwhelmed that they don’t know what to ask.  It’s up to family members or trusted friends to step in and advocate for them.  You’ll still need to get their permission if they are capable of making their own decisions.  

If you don’t like the answers your relative or friend is getting, there are some things you can do to help.

  • be aware of what is happening to them medically
  • do your research about the medical condition and current treatment options
  • if they are of sound mind, you need to get their permission first before you can discuss the issues with the medical team
  • offer to take them to the doctor
  • if you don’t like what you’re hearing, ask questions and don’t leave until you get answers
  • discuss the treatment options you’ve researched with the medical team
  • if your loved one does not have a Power of Attorney for Care and for Property (2 separate documents), talk to them about naming a P of A now before they need one.  The same goes for a Living Will and Last Will and Testament.   Having these documents before you need them gives everyone peace of mind.

In my experience, what happened to my client is not the norm.  The majority of doctors would have begun treating her symptoms by now.  But don’t you think that one story like hers is one too many?

Foot Care and the Sandwich Generation

“Mom has an ingrown toenail.  Can you come and see her?” 

“My uncle has diabetes.  Do you do foot care on diabetics?”

McDermott Footcare is often contacted by people in Toronto and the GTA who would like a foot care nurse to come and care for a relative’s feet –  mom, dad, uncle, aunt, grandparent – someone they love.  The people who call  McDermott Footcare are busy juggling kids, jobs, lives, but they are also extremely committed to providing the best care for at least one elderly relative.  This is the sandwich generation – responsible for their own immediate family on the one hand and elderly relatives on the other. 

 The internet is full of articles and resources on this phenomenon.  Just Google “sandwich generation Toronto” and you’ll get too many sites for me to link on this blog. 

I am a member of the Sandwich Generation.  My balancing act consists of 8 kids ranging from grade school to a university graduate on one side of the scale and my mom, who is almost as much work, on the other side.  Before dad passed away from complications of Parkinson’s Disease, he was on the scale too.   I still haven’t managed to find the right balance and I know I’m not alone.

People who contact me on behalf of a relative share the common trait of being  dedicated to improving  mom’s and dad’s comfort and well-being.  One daughter schedules her mother’s  foot care appointments over her lunch hour so she can come home from work when I visit her mom.   A son whose father has recently been admitted to a long- term care facility insists that McDermott Footcare be allowed to continue caring  for his dad even though the facility  has their own foot care nurse.   Someone schedules visits for aunt, mom and dad to be seen all at the same time – that’s organized!  Others make sure that visits are regularly booked.   Of course, I look after my mom’s feet.

It’s not easy.   Some days we can’t tell right from left.  Unexpected events can be challenging.    But lovingly giving back to the people who gave so much for us makes everything worthwhile.

 

Tea, Cookies and Potpourri

On Thursday, Dec. 8, I spent a wonderful afternoon making Christmas potpourri and having tea and cookies with a lovely and lively group of seniors.  We were at a community resource centre.   McDermott Footcare had been invited to come and see what they’re all about.

Amidst tea served in porcelain cups, hot mulled cider and an abundance of Christmas cookies, we crafted our individual potpourri.  The resource room smelled of Christmas – cloves, ginger, cinnamon.  Kimberley Davies, Community Relations Manager of Amica at Bayview, guided us through our craft projects.

Some of the seniors reminisced about Christmases past, childhood winter adventures and a simpler time.   For me, that was the best part of the afternoon – getting to know the guests and listening to their stories. 

Thank you to the staff of the community resource centre for your hospitality.  Most of all, thank you to Jack, John, Lorna and the other guests who shared part of your lives with me over afternoon tea, cookies and potpourri.  What a great reminder that foot care is not just about feet 🙂

Why I Became A Foot Care Nurse

 It’s funny how seemingly random, unrelated events all come together to influence a major career decision.  Former patients, past incidents, personal circumstances all played a role in getting me where I am today.

As an RN working in both acute care and continuing care, I often cared for patients with different conditions.  My focus was always on the medical issues, the post-op complications, the controlled chaos of a busy unit.  Even though I sometimes encountered patients with foot issues, I was unprepared to do anything about them.  Even if I did feel compelled to address their overgrown nails and other problems, I didn’t have the time.

I still remember the first time I saw onychogryphosis nails (toenails that look like curled ram’s horns).  I was a brand new RN working on an orthopedic floor and I was so shocked I stared at the patient’s feet.  I didn’t know nails could do that! They were extremely fungal as well.  That disturbing image has stayed with me all these years. 

Fast forward to about 5 years ago.  My dad had Parkinson’s Disease.  He only allowed my mom to care for him and refused all of my pleading to bring in home care.  Dad’s feet were not as bad as that onychogryphotic patient of years ago, but he needed foot care badly.  Unfortunately, he refused all efforts to have his feet problems addressed and we were powerless to convince him otherwise.

On Christmas Day one year before he passed away, dad slipped and fell on the ice after Christmas Day Mass and ended up in the Emergency Room.  As I was prepping him to be seen by the doctor on call, I took off his socks and he became very upset.  He begged me to cover his feet because he was ashamed of  their appearance. 

When dad was in palliative care in the hospital, two weeks before he died, mom overheard a nurse remark on the awful condition of his feet.  She was certain my dad was neglected at home because his feet were horrendous.  The nurse’s unfair assessment hurt my entire family, most of all my mom.

After dad passed away, I convinced mom to let me hire a foot care nurse for her.  She hesitated at first, even argued and yelled at me the morning of the nurse’s first visit, but eventually she began to enjoy the wonderful care.  I was always present when mom was having her foot care appointments and would watch with fascination while the nurse did her thing.

So what do all these experiences have to do with my career move?  I needed a change from my increasingly demanding job as a visiting nurse in community.  While I loved my work seeing patients in their homes, the pace and hours of my job left me with little time and energy for the most important people in my life, my family.  I wanted to work; I needed to work, but I needed balance most of all.  So, I handed in my resignation despite that fact that I had no other position to go to.

After much thought, and even more prayer, I felt that foot care nursing was something I should pursue.  I went back to school and realized that I really enjoyed my course.  Because I was striving for balance between my professional and personal life, I decided that my best course of action was to be an RN in independent practise – start my own nursing business – as a foot care nurse.

I am very much aware of all the foot care episodes of the past when I visit my clients.  I remember all the patients who would have benefited from foot care; dad’s shame when his feet were exposed; mom’s initial reluctance and eventual pleasure from good foot care. 

My dad has taught me to be aware that some people are embarassed when they first show me their feet.  Many clients are certain that I have never seen anything worse!  (oh yes, I have) Feet are very intimate and people need to feel they won’t be judged if they place this part of their body in my hands.  A level of trust develops between my client and myself as I spend 30 minutes or more talking and listening to them as I do their foot care.  Many times, I will be the only person they see that day.  I may be the only one  to remind them to take their pills, make sure they eat on time and just ask them how they are. 

I enjoy my work – I really do.  The people who hire me,  either for themselves or for a family member, seem to like my work.  They arrange regular foot care visits with me every 4 to 7 weeks. That’s a pretty good indicator!  It’s a privilege to be allowed into clients’ homes and an even greater privilege to be asked to care for their feet.

 

About Nursing Foot Care

 In the world of foot care options, nursing foot care is a trusted, professional, convenient choice for discerning healthcare consumers.   Among the various alternatives available, only Registered Nurses possess considerable nursing knowledge and expertise  in order to provide timely,  holistic care which considers the well-being of the entire person.

As a Registered Nurse specializing in foot care, I hold a Certificate in Advanced Nursing Foot Care from an accredited educational institution.  As well, I update my skills and knowledge through continuing education for Foot Care Nurses.  The College of Nurses of Ontario, the Canadian Nurses Association and the Registered Nurses Association of Ontario regulate my practice as a Certified Foot Care Nurse and require that I adhere to Standards of Practice that apply to Registered Nurses,  Certified Foot Care Nurses and Registered Nurses in independent practice.

As a Certified Foot Care Nurse, I believe in the importance of quality foot care as an integral aspect of my clients’ health.  I recognize that my clients may face certain challenges that make it difficult for them to care for their own feet.  Changes in vision, flexibility, hand strength, coordination and mental acuity may make personal foot care onerous. 

 Conditions such as diabetes, rheumatoid arthritis, osteoarthritis, vascular disease and other degenerative conditions affect the health of the feet.  These conditions will often cause pain, nerve damage, skin problems, as well as circulation deficits.  All of these affect the health  and appearance of the feet as well as a person’s ability to use them.  I am able to address, in a non-invasive way, problems which  may develop.  I typically address concerns regarding thickened and fungal nails, corns, callouses, bunions, nerve and circulation deficits, athlete’s foot and other matters.

As a Registered Nurse, I strive to prevent further foot problems for my clients and to address current issues.  To that end, part of my care consists of providing  clear and simple health teaching which allows my clients or their families to better care for their feet between nursing visits.  If needed, I can also make referrals to other healthcare providers.

Clients who regularly receive nursing foot care express an increased sense of comfort and well-being.  The health and appearance of the feet are restored so that the client may once again participate in social activities and activities of daily living because their feet no longer cause discomfort,  pain and embarassment.  The client or their family is empowered and satisified.