All primary care nurses will be involved in foot care. Patients at high risk for foot ulcers need support and education during their primary care appointments. People at risk of foot ulcers include those diagnosed with diabetes, diabetic neuropathy, peripheral artery disease and structural foot deformity. A nursing assessment includes at least an annual foot assessment. The AHS Diabetic Foot Screening Tool offers an outline that will guide the nurse and patient in determining level of risk for ulcers. Diabetes Canada offers great patient self-management resources in order to do regular assessments at home. The nurse can review these with the patient and caregivers including signs to look for that may need medical attention. Simple self-management includes:
• a daily visual check of each foot including the bottoms and between the toes. A handheld mirror can help a patient look at each part of the foot.
• Clean, dry and moisturize feet
• Avoid soaking feet. This dries out the skin and increases chances of cracks
• Check shoes before putting them on in case a small object is present that can rub and cause an ulcer or blister
• Managing calluses and toenails to keep them neat and tidy It’s important to include family
and caregivers when teaching foot care self management.
If a patient is unable to perform regular checks, the nurse may consider assessing the patient’s feet at all primary care appointments. Foot and nail care for patients at low risk may also be managed by private nurses or agencies throughout the province. A foot care nurse in primary care will work with patients, caregivers and primary care providers as a resource for support, education and clinical care. They maintain the health of patients feet to prevent and heal. They provide education and navigation as required and will be a resource to healthcare providers whose patients are having difficulties with skin integrity. For people with moderate to high risk assessments, the nurse and primary care provider will refer the patient to specialized services. The AHS Diabetics Foot Care Clinical Pathway was created to manage patients requiring a higher level of care.
Both LPN's and RN’s can be trained in advanced foot care to manage low and some moderate risk patients. To practice legally, an LPN will need approval from CLPNA and have the certification added to their license before they're allowed to practice. CLPNA Basic & Advanced Foot Care. Certification can be completed at an organization offering training in Alberta. This can be at The Alberta Foot Care Academy, Norquest College or Edmonton Foot Care. Discuss your options with a Practice Consultant from your nursing governing body. Training includes a self-study component then in-person component which will allow for the nurse to watch and perform foot care to attain certification. Funding options are available to support this training. Check out The FredricksonMcGregor Grant for LPNs, ARNET for RNs and The RhPAP REAL program for rural providers. Tools needed to offer foot care services include a comfortable chair, nail nippers, files, 70% alcohol (to clean the nails prior trimming/filing), blacks file, probe, moisturizer (normally coconut oil), and PPE (mask, gown, gloves, eye protection). The AHS diabetic foot care pathway toolkit will guide a nurse's practice in basic and advanced foot care in order to offer quality patient care.