Nurses' foot care activities in home health care (2022)

Table of Contents
Geriatric Nursing Abstract Introduction Section snippets Setting Participants Discussion Conclusion References (42) Geriatr Nurs Geriatr Nurs Foot Pain Prevalence of foot and ankle conditions in a multiethnic community sample of older adults Am J Epidemiol Foot and leg problems are important determinants of functional status in community dwelling older people Disabil Rehabil Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health study JFoot Ankle Res Foot problems in older patients: a focused podogeriatric assessment study in ambulatory care JAm Podiatr Med Assoc Population attributable risk for functional disability associated with chronic conditions in Canadian older adults Age Ageing Onset and persistence of disabling foot pain in community-dwelling older adults over a 3-year period: a prospective cohort study JGerontol A Biol Sci Med Sci Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study BMC Musculoskelet Disord Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK Rheumatology What determines the use of homecare services by elderly people? Health Soc Care Community Prevalence of blindness and low vision in an Italian population: a comparison with other European studies Eye Do ‘low-risk’ older people need podiatry care? Preliminary results of a follow-up study of discharged patients Br J Pod Can elderly diabetic patients co-operate with routine foot care? Age Ageing The geriatric hand: correlation of hand-muscle function and activity restriction in elderly Int J Rehabil Res Foot pain and disability in older persons: an epidemiologic survey JAm Geriatr Soc Foot Health Training Guide for Long-term Care Personnel Guidelines on Provision of Basic Foot Care by Nurses Modelling deterioration of foot health in older people following discharge from NHS podiatry services Foot Cited by (10) The effect of foot care protocol applied to older people on foot health problems and foot care behaviours: a randomised controlled trial in a nursing home Self-care planning and sanitary education in the prevention of the diabetic foot Home-based nursing care competencies: A scoping review Evaluation of the development process and effects of a foot care program with educational tools for nurses and care workers as in-home service providers Foot problems in patients in acute care: A point-prevalence survey Foot care knowledge and practices among Japanese nurses and care workers in home care and adult service center: A cross- sectional study Recommended articles (6) FAQs Videos
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Geriatric Nursing

Volume 34, Issue 6,

November–December 2013

, Pages 491-497

Abstract

This study described the basic foot care activities performed by nurses and factors associated with these in the home care of older people. Data were collected from nurses (n=322) working in nine public home care agencies in Finland using the Nurses' Foot Care Activities Questionnaire (NFAQ). Data were analyzed statistically using descriptive statistics and multivariate liner models. Although some of the basic foot care activities of nurses reported using were outdated, the majority of foot care activities were consistent with recommendations in foot care literature. Longer working experience, referring patients with foot problems to a podiatrist and physiotherapist, and patient education in wart and nail care were associated with a high score for adequate foot care activities. Continuing education should focus on updating basic foot care activities and increasing the use of evidence-based foot care methods. Also, geriatric nursing research should focus in intervention research to improve the use of evidence-based basic foot care activities.

Introduction

Foot problems are common among older people and are a substantial predictor of disability. Every third older person has one or more foot problems,1, 2 including foot pain,3, 4 skin and nail disorders, and toe deformities.5 Foot problems are a notable determinant of disability,6 threatening independent living at home. The incidence of these problems increases during aging.7 Foot problems burden the health care system widely, and therefore should be prevented. Musculoskeletal problems, including different foot problems, have been demonstrated to be a major cause of consultations in primary care among older people.8, 9 Furthermore, foot problems are one important reason why older people seek home care.10

Foot care activities can be provided by the patient him/herself, a nurse or a foot care-professional (e.g. podiatrist). Among older people, it is important to support foot self-care as long as possible. However, the ability to care for one's feet decreases with aging.11 Visual impairments,12 inability to bend due to e.g. breathing problems,13 inability to reach down to the feet,14 weakness in the hands due to arthritic conditions,13 diminished manual dexterity15 or foot pain16 are impediments to safe foot self-care. For these reasons, home care nurses need to evaluate older people's foot care ability, and if needed, assist them in regular basic foot care.

Foot problems in older people need various kinds of care. Some problems, such as thickened toenails or corns, which are difficult for nurses or older people to care for by themselves, need professional (e.g. podiatrist) care.17 In contrast, minor foot problems, including dry skin or long and healthy toe nails, are conditions which can be cared for by nurses. Basic foot care is part of routine nursing care consisting of care of normal skin and nails of the feet including feet washing, cutting and filing non-pathological toenails and application of moisturizers.18 Moreover, regular foot assessment is an important part of foot health promotion in older people.19, 20 For example, a nurse-based foot care program is effective in preventing diabetic foot-related complications.21

Nursing care protocols focusing specifically for foot care are scarce. When analyzing nursing foot care regulations across the world a clear consensus is lacking and the regulations vary between countries. In the United States nurses in general protect the public health, safety and welfare with nursing interventions (e.g. State of Delaware22). In order to provide foot care practices a registered nurse or a licensed practical nurse can take in addition to their formal training as a nurse, a specialized education to become a foot care nurse.23 In Canada, registered nurses, registered nursing assistant, licensed nursing assistant, licensed practical nurse or registered practical nurse can provide basic foot care after completing an educational program to foot care.24 Instead, in Australia, registered nurses, enrolled nurse and assistants in nursing may provide basic foot care if they are employed by a hospital, nursing home or community health centre.18 Moreover, in Finland health care professionals caring for patients are all registered health care professionals25 and they are allowed to produce nursing care to which they are educated. The nursing care consists of a comprehensive patient care including inspection of foot health and caring of minor foot problems. Severe and major foot problems and pathologies are cared and treated universally by foot therapists, podiatrists or physicians.26

Existing research of nurses performing basic foot care practices when caring for older people is mixed. The majority of the research seems to focus on diabetic foot care,21 whereas there has been relatively little research on basic foot care in healthy older people or on the prevention of foot problems especially in home care. Despite the limited research evidence, it is possible to draw some conclusions on nurses' basic foot care activities. In general, nurses seem to recognize foot health problems and the need for foot care, but are uncertain about their skills27 and their role in foot care.28 For example, nurses are not confident about cutting toenails and fear damaging the patient's feet,29 owing to lack of knowledge29 and experience of correct techniques to use or lack of the appropriate equipment.27 In addition, cutting toenails is not considered as among responsibilities of nurses.27, 29 Some successful educational programs aimed at improving nurses' foot care skills have been implemented.28, 30 Development of an action plan and a 3-h training session for nursing staff in the assessment and care of foot problems among patients in an acute medical ward improved nurses' skills at identifying foot problems and defining the type of care needed to remedy them.28 Moreover, an in-service education program where nurses received a demonstration on foot assessment, care techniques and patient education developed nurses' foot care practices and confidence in assessing foot health.30

The purpose of the present study was to describe the basic foot care activities performed by nurses and factors associated with these in the home care of older people. The nurses were registered nurses, public health nurses and licensed practical nurses. The specific research questions were:

1.

What kind of basic foot care activities nurses perform in the home care of older people?

2.

What background factors are associated with the basic foot care activities performed by nurses in the home care of older people?

The study has two ultimate goals. The first is to promote foot health in older people and enhance the quality of basic foot care by developing interventions to improve the foot care performed by nurses in home care. The second is to find ways, from a foot care perspective, how relatives or nurses can support older people to live safely at home for as long as possible.

(Video) Provide Foot Care CNA Skill NEW

Section snippets

Setting

A cross-sectional descriptive survey design with a structured questionnaire was used. The sample consisted of home care nurses from nine home care agencies in five Finnish municipalities in Southwest Finland (total 393000 inhabitants). These home care agencies cover both rural and urban areas and supply regular home care services to approximately 6000 inhabitants altogether.31 All home care nurses in the nine agencies (N=651) were invited to participate in the study.

In Finland, home nursing

Participants

Altogether 322 nurses with a mean age of 41 years (range 19–62, SD 11.3) responded to the questionnaire (response rate 50%, Table1). The majority of the nurses were licensed practical nurses (LPN, n=260, 80%) and the others either registered nurses (RN, n=35, 11%) or public health nurses (PHN, n=20, 6%). Many of the nurses had worked in health care for between 6 and 15 years (n=127, 40%), almost as many for less than 6 years (n=121, 38%) and a smaller proportion for over 15 years (n

Discussion

The majority of the nurses in home care used foot care activities to promote foot health in older people. However some inadequate foot care activities were also found. In all, the results highlight the need to update nurses' foot care activities. Some of the nurses implemented outdated foot care activities, such as washing the feet with soap. The recommended care nowadays is to avoid soap and instead wash the feet with warm water only.40 On the sum-variable level, the number of adequate foot

Conclusion

The foot care activities of nurses are adequate, although some activities were outdated. The results revealed that longer working experience in the current work, referring patients with foot problems to a podiatrist or physician and, nurse-led patient education in wart and nail care explained a high level of adequacy of foot care activities. In order to prevent foot problems in older people and to promote their foot health, nurses could benefit from continuing education targeted at updating

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  • C.L. Hill et al.

    Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health study

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    (Video) Advanced Foot Care Nurse and Wellness YouTube channel!

  • A.E. Helfand

    Foot problems in older patients: a focused podogeriatric assessment study in ambulatory care

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  • L. Griffith et al.

    Population attributable risk for functional disability associated with chronic conditions in Canadian older adults

    Age Ageing

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  • E. Roddy et al.

    Onset and persistence of disabling foot pain in community-dwelling older adults over a 3-year period: a prospective cohort study

    JGerontol A Biol Sci Med Sci

    (2011)

  • K. Jordan et al.

    Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study

    BMC Musculoskelet Disord

    (2010)

  • H. Menz et al.

    Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK

    Rheumatology

    (2010)

  • H. Stoddart et al.

    What determines the use of homecare services by elderly people?

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  • C. Cedrone et al.

    Prevalence of blindness and low vision in an Italian population: a comparison with other European studies

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    Do ‘low-risk’ older people need podiatry care? Preliminary results of a follow-up study of discharged patients

    Br J Pod

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  • F.J. Thomson et al.

    Can elderly diabetic patients co-operate with routine foot care?

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  • N.A. Incel et al.

    The geriatric hand: correlation of hand-muscle function and activity restriction in elderly

    Int J Rehabil Res

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  • F. Benvenuti et al.

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    JAm Geriatr Soc

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  • A.E. Helfand

    Foot Health Training Guide for Long-term Care Personnel

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  • Guidelines on Provision of Basic Foot Care by Nurses

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  • J.A. Campbell

    Modelling deterioration of foot health in older people following discharge from NHS podiatry services

    Foot

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    FAQs

    How do nurses take care of their feet? ›

    Tips for Nurses to Take Care of Their Feet
    1. Wear Compression Socks. Compression socks help improve circulation of blood flow and oxygen. ...
    2. Stretch Your Feet Whenever Possible. ...
    3. Keep Toenails Trimmed. ...
    4. Adopt Hot and Cold Water Therapy. ...
    5. Maintain a Healthy Body Weight. ...
    6. Soak Feet in Epsom Salt.
    May 28, 2019

    Why is foot care important for residents? ›

    Poor foot health can impede work performance and even result in lost time from work. And with poor foot health, you're less likely to engage in physical activity. The result is a higher risk of disease, such as heart disease and diabetes, reduced endurance and loss of muscle mass.

    What does a diabetic foot nurse do? ›

    Diabetes Nurses play their educating role in the field of prevention of diabetic foot, foot care and preventing from foot injury. In care dimension, nurses responsible for early detection of any changes in skin and foot sensation, foot care, dressing and apply novel technology.

    How do you take care of your feet after work? ›

    Take Care of Your Feet

    Make sure you have comfortable shoes and/or insoles, consider purchasing a cushioned mat, wear compression socks, take breaks throughout the day or change positions often, and soak your feet at night. All of these steps will help your feet feel better and not have sore feet after work every day.

    How do I take care of my feet? ›

    Basic Care
    1. Check them daily for cuts, sores, swelling, and infected toenails.
    2. Give them a good cleaning in warm water, but avoid soaking them because that may dry them out.
    3. Moisturize them every day with lotion, cream, or petroleum jelly. ...
    4. Avoid wearing tight-fitting shoes. ...
    5. Skip the flip-flops and flats.
    May 12, 2021

    What are the benefits of good foot care? ›

    Good foot care has benefits such as:
    • reducing pain.
    • increasing mobility and physical activity.
    • increasing self-esteem and confidence.
    • increasing and supporting social contact, sport and exercise.
    • reducing the risk of trips and falls.

    Why is foot care important for seniors? ›

    Elderly patients who have poor circulation in their feet are more likely to unknowingly sustain an injury, which can lead to an infection and if not properly cared for, amputation. Wearing moisture wicking socks and closed toe shoes can protect a patient's foot from injury.

    What is the importance of providing foot care to older adults? ›

    It is extremely important to maintain proper foot care among the elderly as problems in the feet can be indicative of larger health issues. Trimming the toenails straight across can be essential in preventing ingrown toenails and wearing shoes that fit properly may help to avoid hammertoe and bunions.

    What is included in foot care? ›

    Routine Foot Care
    • Inspecting the feet.
    • Cleansing the feet.
    • Trimming cuticles and ingrown or fungal nails.
    • Treating corns, calluses or other lesions.
    • Performing massage to enhance circulation.
    • Applying topical medication/ointments and dressing.

    Why is foot care so important for diabetics? ›

    Good foot care (healthy skin, nail care, and proper footwear) is very important for anyone with diabetes, because you have a greater risk of having problems with your feet (such as skin that is dry and cracked, sores, changes in foot shape).

    How do you control diabetic feet? ›

    Some people with diabetes wear therapeutic shoes or shoe inserts to help prevent wounds or sores. Washing your feet every day in warm water, not hot. Dry them thoroughly afterward, including between the toes. Then apply lotion to the tops and bottoms of the feet, but not between the toes.

    How do nurses keep their feet from hurting? ›

    In addition to the shoe itself, shoe inserts or orthotics are good solutions for helping nurses avoid or relieve foot pain. Inserts can be purchased over the counter and typically provide added relief for pain caused by nurses standing on their feet for extended periods of time.

    How can I help my workers feet? ›

    Making the effort to care for your feet can help you stay comfortable and productive throughout your shift.
    ...
    Here's what they had to say about caring for hardworking feet.
    1. Wear Compression Socks. ...
    2. Find the Right Shoes. ...
    3. Use an Insole. ...
    4. Switch It Up. ...
    5. Start Rolling. ...
    6. Practice Good Foot Hygiene.
    Aug 7, 2018

    How can I take care of my hands and feet at home? ›

    Top Ten Tips for Caring for Your Hands and Feet
    1. Wash wisely. ...
    2. Treat your feet nicely. ...
    3. Inspect your nails regularly. ...
    4. Soak your feet. ...
    5. Clean under your nails. ...
    6. Apply lotion to your hands and feet. ...
    7. Trim your nails. ...
    8. Treat hangnails.
    Feb 11, 2021

    Why is the foot important? ›

    Good foot health is essential for an active life. With 26 bones, 33 joints and over 100 muscles, ligaments and tendons, your feet are incredibly complex. And they serve as the foundation for your entire body in terms of support, balance, posture, and overall well-being.

    How can I clean my feet at home? ›

    If you decide to use this method:
    1. Prepare a footbath with warm water.
    2. Squeeze in lemon juice from one lemon. You can also leave pieces of lemon peel in the water.
    3. Soak your feet for up to 15 minutes.
    4. Use a foot brush to scrub dead skin off your feet.
    5. Wash and dry your feet completely.
    Oct 1, 2018

    How often should foot care be done? ›

    Schedule a regular time, 10 minutes, once a week is sufficient. If you have impaired circulation or diabetes (medium or high risk), it's recommended that you check your feet every day.

    Why is hand and foot care important? ›

    Hand and foot care is highly important to increase one's life quality as well as concerning personal health and aesthetic. It is very important for circulatory and nervous system that hand and foot care is carried out under sterile and hygienic conditions without disturbing the person or causing pain.

    How do you take care of elderly feet? ›

    How to care for aging feet
    1. Wash and thoroughly dry your feet for good hygiene.
    2. Wear a fresh clean pair of socks and change them daily.
    3. Keep the insides and outsides of your shoes clean.
    4. Rotate your shoes — don't wear the same pair two days in a row.
    5. Wear properly fitted shoes.

    How do elderly people clean their feet? ›

    Pay attention to things such as ingrown toenails, nail fungus, corns, calluses and skin ulcers. 2 – Wash the feet daily with a mild, moisturizing soap, and rinse with warm water (about 37 degrees). Dry the feet delicately but thoroughly with a clean towel, taking care to also dry between the toes.

    Why do nurses check your feet? ›

    We check your legs and feet to look for swelling. People with heart or liver disease may have fluid back-up in their legs, but it can also be a sign of infection or blood clots. We also check the pulses in your feet and look for any skin problems.

    What are common foot problems in older adults? ›

    Aging feet need special care as the risks for chronic foot problems increase. These conditions often include corns, calluses, nail disorders, bunions, and hammertoes, to name a few. Systemic foot conditions associated with aging patients include arthritis, gout, and diabetes.

    How can you decrease foot pain or distress during foot care? ›

    1. Keep feet clean. Depending on whether your older adult bathes on their own or needs help, their feet may only get washed once in a while during the week. ...
    2. Moisturize feet. ...
    3. Trim nails. ...
    4. Monitor sores. ...
    5. Get properly fitting footwear. ...
    6. Get medical attention when needed. ...
    7. Address pain. ...
    8. Promote circulation.

    What does Medicare considered routine foot care? ›

    Routine foot care includes: Cutting or removing corns and calluses. Trimming, cutting, or clipping nails. Hygienic or other preventive maintenance, like cleaning and soaking your feet.

    What is a routine foot disorder? ›

    Routine foot care includes, but is not limited to, the treatment of bunions (except capsular or bone surgery thereof), calluses, clavus, corns, hyperkeratosis and keratotic lesions, keratoderma, nails (except surgery for ingrown nails), plantar keratosis, tyloma or tylomata, and tylosis.

    Can diabetics use foot peels? ›

    Diabetic patients or those with immune deficiency should stay away from any of these products. Diabetics may have Neuropathy (loss of sensation) and using a product like this may actually cause more harm, such as ulcerations which can lead to amputations,” he wrote.

    Why foot care is needed by some individuals? ›

    Good footcare really matters to people and regular personal footcare can help individuals to remain active, mobile and independent. Foot problems can lead to discomfort, pain, infection, ulceration and an increased risk of falling in older people.

    Why can't diabetics cut toenails? ›

    Myth: People with diabetes can't cut their own toenails

    Don't cut them straight across, curved down the sides, or too short. Remember, your nails are there to protect your toes.

    What are the common foot problems? ›

    Common foot problems
    • Athlete's foot. Itchy, stinging, and burning feet and toes may be signs of athlete's foot. ...
    • Blisters. Raised pockets of fluid on your feet are known as blisters. ...
    • Bunions. A bump on the side of your big toe may be a bunion. ...
    • Corns. ...
    • Plantar fasciitis. ...
    • Heel spur. ...
    • Claw toe. ...
    • Mallet or hammer toe.

    What are 3 things you should never do to the feet of someone with diabetes? ›

    Avoid soaking your feet, as this can lead to dry skin. Dry your feet gently, especially between the toes. Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection.

    What are the nursing interventions must be addressed to patient to prevent diabetic foot? ›

    Instruct the patient to avoid walking barefoot. Encourage use of comfortable, well fitting shoes that allow the feet to breathe and offer adequate support. Wear loose fitting socks made of natural fibers and change them daily. Protect the patient's feet from hot and cold extremes.

    Why do diabetics feet swell? ›

    Without treatment, high glucose levels can damage the lining of smaller blood vessels. This damage can result in poor blood circulation. This poor circulation can cause fluid to build up in the feet and ankles, resulting in swelling.

    Are nurses on their feet all day? ›

    Nurses, as well as other healthcare professionals, are very often on their feet for hours on end—after all, a typical nursing shift in a hospital can last upwards of 12 hours.

    How do I stop my feet from hurting when I stand all day? ›

    7 Tips To Relieve Foot Pain From Standing All Day
    1. 1) Fill a plastic water bottle with water and freeze it. ...
    2. 2) Try soaking your feet in salt water.
    3. 3) Use a tennis ball to “self massage” your feet. ...
    4. 4) Give yourself a foot massage by manually stretching your toes and foot muscles. ...
    5. 5) Wear proper shoes.
    Feb 26, 2018

    How long do shoes last for nurses? ›

    The authors recommend replacing your nursing shoes every 6 months due to structural break-down that can contribute to foot pain, even if the shoes look exactly the same as they did when you bought them.

    How do I stop my feet from hurting at work? ›

    How Can I Prevent Foot Pain at Work?
    1. Wear comfortable footwear.
    2. Incorporate foot stretches into your routine.
    3. Take sitting breaks.
    4. Enjoy a foot bath.
    5. Try some foot care products.
    Apr 16, 2021

    Videos

    1. Foot Care Nurses Forum: Dialogue and Discussion (May 28, 2020)
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