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Volume 34, Issue 6,
, Pages 491-497
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 Although some of the basic foot care activities of nurses reported using were outdated, the majority of foot care activities were consistent with recommendations in foot care literature.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.
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:
What kind of basic foot care activities nurses perform in the home care of older people?
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.
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
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
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
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
- C. Turner et al.Nurses' knowledge, assessment skills, experience, and confidence in toenail management of elderly people
- E. MittyNursing care of the aging foot
- J.A. Campbell et al.What happens when older people are discharged from NHS podiatry services?
- M. Thomas et al.The population prevalence of foot and ankle pain in middle and old age: a systematic review
- J.E. Dunn et al.
Prevalence of foot and ankle conditions in a multiethnic community sample of older adults
Am J Epidemiol
- A.L.M. Barr et al.
Foot and leg problems are important determinants of functional status in community dwelling older people
- C.L. Hill et al.
Prevalence and correlates of foot pain in a population-based study: the North West Adelaide Health study
JFoot Ankle Res
(2008)(Video) Nursing Foot Care - Toenail Clipping Fundamentals
- A.E. Helfand
Foot problems in older patients: a focused podogeriatric assessment study in ambulatory care
JAm Podiatr Med Assoc
- L. Griffith et al.
Population attributable risk for functional disability associated with chronic conditions in Canadian older adults
- 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
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
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
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?
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
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
2021, Scandinavian Journal of Caring Sciences(Video) Advice for nurses wanting to enter into foot care
Self-care planning and sanitary education in the prevention of the diabetic foot
2021, Applied Sciences (Switzerland)
Home-based nursing care competencies: A scoping review
2021, Journal of Clinical Nursing
Foot problems in patients in acute care: A point-prevalence survey
2020, Journal of Wound, Ostomy and Continence Nursing
Research articleRelationship between BMI and physical performance among older adults
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 465-468
Our objective was to examine the relationship between body mass index (BMI) and physical performance in community-dwelling older adults. This was a descriptive and association study, based on secondary data derived from a population-based epidemiological research involving 316 older adults. The BMI was thus classified: <22.0kg/m2, underweight; 22.0≤BMI≤27.0kg/m2, adequate; >27.0kg/m2, overweight. Physical performance was assessed based on “chair stand”, “pick up a pen” and walking tests. Associations between BMI and performance at each test were tested by Cox regression for survival analysis with multiple modeling adjusted by gender and age, adopting a significance level of 5% (α=0.05). Individuals with underweight (βadjusted=0.64; p=0.004), performed poorly in the “chair stand” test when compared to individuals with adequate weight. The BMI was a predictor of good physical function, with underweight being more of a limiting factor than overweight.
Research articleCSII and MDII for intensive diabetes management: Impact perceptions of older adult patients and their significant others
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 469-476
To investigate impacts of multiple daily insulin injections (MDII) and continuous subcutaneous insulin infusion (CSII) on disease management and patient lifestyle by patients and significant others (SOs).
Older patients (>50years) and their SOs will perceive differences in satisfaction between CSII and MDII impact on diabetes management and lifestyle.
Patient and paired SO completed parallel instruments framed by sociotechnical systems theory and the life patterns model. Alpha=.901–.940.
Whites reported greater satisfaction with CSII and non-Whites with MDII. Both reported increased independence. CSII scored significantly higher than MDII. Age did not reduce positive impacts. CSII enhanced independence of SOs but 38.6% of SOs did not know how to suspend CSII for hypoglycemia; 47.3% of patients believed SOs would not know.
Neither age nor diabetes type contraindicate using CSII in older patients. CSII is perceived more impactful on disease management and lifestyle. Education of SOs needs emphasis.(Video) Foot Care Nurse Resource Manual Suggestions for CFCN or Nail Techs
Research articleOutcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: A randomized controlled trial
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 445-452
This single-blind, prospective, randomized controlled trial was designed to evaluate the effects of a culturally responsive health promotion program for elderly Korean (CHP-K) survivors of gastrointestinal (GI) cancers. The program consisted of 8 weeks of Qi exercise and face-to-face counseling on physical and psychological factors. A total of 63 Korean GI cancer survivors, aged ≥65 years, who had completed their active cancer treatment, were recruited from a cancer center in South Korea. Outcomes included the amount of exercise, body weight, BMI, the Patient Generated Subjective Global Assessment scale, the M.D. Anderson Symptom Inventory, and self-efficacy and self-esteem scales. Repeated measures MANCOVA revealed a significant difference over time between the groups (Wilks' Lambda F1,62=5.361, p=0.007). Univariate RM-ANCOVA for each outcome measure revealed statistically significant differences between groups. These results suggested that the participation in the CHP-K may have enhanced the health of elderly Korean GI cancer survivors.
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 509-516
Dementia caregiving is stressful and can result in negative health outcomes. Understanding the intermediate dynamic changes in caregiving may help nurses target interventions. The purposes of this study were to measure short-term changes in sleep, mastery, and stress in dementia caregivers and to explore their impacts on caregiver depression and health. Seventy-four caregivers were measured at baseline, 4, and 8weeks for changes in global mastery, caregiver mastery, sleep quality, perceived stress, depression, and health. Over the 8weeks, changes were observed in sleep, mastery, stress, and health measures, indicating support for the dynamic and complex nature of dementia caregiving. Sleep and perceived stress made unique contributions to depression, but the contributions to health varied. Clinical implications for nurses are to assess caregivers frequently and reinforce successful interventions periodically as caregiving evolves.
Research articlePharmacotherapy and over-the-counter drug use among elderly in Belgrade, Serbia
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 486-490
From November 2012 to January 2013, 480 seniors were recruited at the Pubic Health Center in Belgrade, Serbia. The patients' records were validated by four independent investigators. Data on over-the-counter (OTC) drug use were collected through a questionnaire. Polypharmacy, an intake of ≥5 prescribed medications, reported in 10.4% of seniors, was associated with cardiovascular (odds ratio [OR]=3.07; 95% confidence interval [CI]=1.12–8.39) and endocrine diseases (OR=2.25; 95% CI=1.05–4.84) as well as with the number of treated chronic conditions (OR=2.45; 95% CI=1.75–3.44). The most frequently used OTC drugs were analgesics (metamizole, diclofenac and acetaminophen) and vitamins (vitamin C and vitamin B complex). The number of treated chronic conditions was associated with use of OTC drugs (OR=1.17; 95% CI=1.01–1.36). Multiple chronic conditions correlated with multiple OTC drug use (ρ=0.125, p=0.019). Our analysis indicated that the prevalence of polypharmacy and OTC drug use in the elderly are comparable to those in industrialized countries.
Research articleSlowing progression of early stages of AD with alternative therapies: A feasibility study
Geriatric Nursing, Volume 34, Issue 6, 2013, pp. 457-464
This pilot study identified the feasibility and efficacy of the effect of combining healing touch (HT) and body talk cortices (BTC) on the progression of Alzheimer's disease (AD). Both HT and BTC elicit the relaxation response and support cognitive function from two different perspectives. A two-group, repeated measures design was used. Subjects (n=22), 65 or older with early stage (less than four) AD, residing in the community (n=2) or in care agencies (n=20), were assigned to either the HT-BTC group (n=12) or the control group (n=10) randomized by residence. The treatment group received, 6 months of weekly HT and performed the BTC technique daily. The usual medical regimen for all subjects was continued. The control group had no additional interventions. Both groups were assessed at baseline, 3 and 6 months. The groups did not differ significantly at baseline on cognitive reserve, age, gender, and ethnicity, nor on the outcome variables (cognitive function, mood, & depression). Adherence (76%) to the BTC protocol, the major feasibility problem, related to memory deficits. Significant interactions occurred regarding cognitive function and mood. Significant improvements in cognitive function (p=.008), mood (p=.001), and depression (p=.028) were observed in the treatment group which is not the usual course of AD. A decline in cognitive function occurred in the control group typical of AD's usual course. Although the number of subjects in this pilot study was small, and there were feasibility challenges with recruitment and adherence, important trends were noted suggesting areas for future study.(Video) Advanced Foot Care Nurse and Wellness YouTube channel!
Copyright © 2013 Mosby, Inc. All rights reserved.
- Wear Compression Socks. Compression socks help improve circulation of blood flow and oxygen. ...
- Stretch Your Feet Whenever Possible. ...
- Keep Toenails Trimmed. ...
- Adopt Hot and Cold Water Therapy. ...
- Maintain a Healthy Body Weight. ...
- Soak Feet in Epsom Salt.
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.
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.
- Check them daily for cuts, sores, swelling, and infected toenails.
- Give them a good cleaning in warm water, but avoid soaking them because that may dry them out.
- Moisturize them every day with lotion, cream, or petroleum jelly. ...
- Avoid wearing tight-fitting shoes. ...
- Skip the flip-flops and flats.
Here's what they had to say about caring for hardworking feet.
- Wear Compression Socks. ...
- Find the Right Shoes. ...
- Use an Insole. ...
- Switch It Up. ...
- Start Rolling. ...
- Practice Good Foot Hygiene.
- 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.
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.
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.
- Cutting or removing corns and calluses.
- Trimming, cutting, or clipping nails.
- Hygienic or other preventive maintenance, like cleaning and soaking your feet.
People who suffer from diabetes need to take extra care to protect their feet from infection. Diabetes raises the amount of sugar in the blood. High sugar levels can damage the nerves in the feet causing a condition called peripheral neuropathy.
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.
Foot care nurses are specially trained in the provision of foot care and provide nail cutting, nursing assessments, callus treatment, information and support that assists patients in maintaining healthy feet.
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.
- Wash wisely. ...
- Treat your feet nicely. ...
- Inspect your nails regularly. ...
- Soak your feet. ...
- Clean under your nails. ...
- Apply lotion to your hands and feet. ...
- Trim your nails. ...
- Treat hangnails.
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.
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.
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.
- Wear comfortable footwear.
- Incorporate foot stretches into your routine.
- Take sitting breaks.
- Enjoy a foot bath.
- Try some foot care products.