Nursing Footcare Newsletter

Working together to provide the best care!

November 2012 - Issue 8

This is an ongoing program. Dr. Julia takes only 4 students at a time for a full day of hands-on foot and nail care training.

This very popular program is offered at a facility near Seattle,Washington. Students come in from around the Country for this special opportunity.

Click Here for more information

Honor Roll!!

The following Nurses have passed their WOCN Foot and Nail Certification Test:

Patty Kuhn

Cheri Burrel
Yvonne Martineau
Nancy Reid
Pat Conway
Ted Green

Beverly Thrasher

Shirley Taylor

Judy Fine

Samantha Musser

Joan McMunn

Sergei Ucharalets

Lisa Hansen

Dianne Eccles

Tyree Fender

Donna Zeznock

Shawnie Tallman

Martina DeVillez

Sharon Thomas

Jule B. Monnens

Lauriann Galer

Vanessa VanDomelen

Ruth Moreland

Connie Delisio

Alicia Brown

Shelley Denison

Glorian McFadden

Luanne Houser

Carla Uribe

Congratulations!!

If you've passed, too, please let us know so we can list you here on the Honor Roll!!

Greetings!

Finally finished!!!

Many of you have asked me for information and resources to help you in your efforts to start your foot care practices. Well, I've been working on the project for about 6 months and I'm finally finished!!!

I just posted it on the RainierMedEd.com website. It's a long video program along with over 30 forms, Guidelines and Protocols. It's a complete program that covers everything from marketing your practice, to infection control issues, to banking and corporation and licensing issues. There is a charge for the program but it will more than pay for itself in helping you get started faster and in compliance with legal and medical issues.

I'm proud of the final product. I think it covers most of what you need to build a successful business. And I'm providing you with many of the forms and guidelines you need. You don't have to take the time to make anything up by yourself. Just take these and change them to fit your practice style.

You'll also get an entire section on marketing. How to approach other health care providers and facilities and how to reach out to the community. I even give you examples of marketing brochures and flyers! Like building any business, it will still take a lot of work. But you'll have a plan and the resources to guide you!!

I hope this makes it easier for you to

achieve your goals of adding foot care

to your nursing practices.

Your friend,

Dr. Julia

Dr. Julia Overstreet, DPM, FAPWCA

Podiatric Physician & Surgeon

Wound Care Specialist

High Risk Foot Care Specialist

DrJulia@RainierMedEd.com

New DVD Programs!!

"The Business of Foot Care"

"Lower Extremity Physical Examination"

RN doing foot care

Click Here for More Information

Feature Article

Tips for faster care and

a happier patient!!

The following is from an email that I received recently. It represents a VERY common concern. How do I work faster without sacrificing quality of care? And the concurrent issue of overuse of the curette also comes into play here. So below you will find the email I received and my answer. I hope it helps you, too.

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Incoming email:

I am having trouble keeping my first time home visits below 2 hours. I don't soak, rather spray clean the foot and meticulously clean (with curette) every toe before debridement. I am using either a Dremel or a medicool drill with a bud bit. Some folks are so hypersensitive that they can't seem to tolerate anything but the most gentle light touch of my curette and drill so I proceed rather gingerly. For $60 per home visit, I really need to get the care done in about an hour I think ( or I need to start charging more).

Do you have any practice recommendations?

My answer to her:
It definitely takes a while to get faster. Over time you should be able to have a visit be 30 or 45 minutes without a problem. While it takes time to get your manual skills faster, there are some things you can do from the start to be faster without sacrificing professionalism or quality of care.

You are already doing one thing right --- you are not soaking the feet prior to treatment. This can take as much as 20 minutes by the time you prepare the water, soak the feet and try to clean the bucket. Several things are wrong with this. First, it takes a lot of time! Most providers do this as a pampering effort for the patient, not for cleaning. I certainly clean the feet when they need it (see below). But I never soak them.

The most important reason is the risk of infection through cross-contamination. There is no way to properly disinfect the bucket between patients. That takes between 2 and 20 minutes of wet surface contact with a disinfection solution. You can't just spray it and wipe it out. You can be assured that if the patient gets an infection after your care and you document soaking the feet, you are liable for that infection due to the risk of cross-contamination. Even if the bucket belongs to the patient, you are still liable. Did the dog drink out of it at the last picnic?! You just don't know.

The only way around that is using a disposable trash bag to line the bucket between patients and documenting that. But you're still left with the issue of the time involved for the soak. I love to pamper my patients. But I do it with a wonderful foot massage after their treatment. That takes maybe one or two minutes. The patients love it, it doesn't increase the risk of infection and it teaches them the value of moisturizing their skin. So not soaking is safer legally and saves a lot of time in the visit.

Additionally, not everyone's feet need to be cleaned. I always do a careful inspection, especially between the toes. If cleaning is necessary, I use a simple hand sanitizer wipe to clean the feet. That takes less than a minute. I especially use it to do what I call "flossing" between the toes. The hand wipe sheet is thinner than a wash cloth and can be run back and forth between toes with less trauma. If it is a very dirty situation, I may take soap and water and a towel to clean better. But I never soak the feet. It more easily spreads infection and therefore creates a HUGE liability issue. Cleaning only when necessary and using a wipe or a towel is effective and time sparing.

A second issue you mention is curetting the nails to remove debris. From what you said, you are probably working too hard to clean the nails/foot before you start sanding or clipping. That's not really necessary.

I definitely don't spend any time cleansing or curetting around the nails before I clip or sand. That can take a lot of time and shouldn't be necessary if you do a careful sanding job. In talking with nurses currently providing foot care, I know that this is a common practice. They spend a great deal of time curetting under and around the nail to remove all debris and flaky buildup. This can take as much as 15 minutes and the patients HATE it!! Digging under and around the nails is painful! It makes us about as popular as the dentist! And in most cases, it really isn't necessary.

Yes, all of that debris needs to be eliminated. But my practice is to take all of the white "free distal edge" of the nail off. I do that either by cutting, sanding or both. So there's no reason to clean under the nail before I start. All of that will be gone once I cut or sand the free edge of the nail away. So why spend all that time and cause all of the discomfort to remove it with a curette!

Also, I never want to clean the cuticle area too much. The cuticle itself protects debris from getting down into the root and possibly causing infection. There's sometimes some flaky skin or build up of keratotic debris on the side and back of the nail but that is easily (and quickly) sanded away. You can also use the curette to remove it. Just be gentle.

The patients don't like too much done with the curette. This is one of the major complaints patients have about foot care. While you and I LOVE the curette because of it's versatility and effectiveness, it "pokes" the patients and makes a very uncomfortable experience for them. So they'll be much happier if you stop the unnecessary precleaning.

That will probably shave about 10 or 15 minutes more off of your time. And your patients will be MUCH happier with your care!

Final Thoughts...

As a wound care specialist I'm very aware of
cross-contamination and infection control. The risk of infection and the time involved in soaking feet eliminates soaking from my practice recommendations.

But I am very committed to patient pampering!! These wonderful seniors deserve our foot care as well as our grace and attention. I love listening to the stories of their lives past and present. They have so much to share. Many of them are never appreciated or respected in their lives today. Our efforts to make a connection with them and appreciate their stories is a gift to all concerned.

All of my patients get my professionalism, my personal concern, as well as a foot massage and a hug at the end of treatment!! Believe me, they don't miss the soaking!

Go out and pamper a senior today!!

Take care and keep clipping!