Massachusetts Association of Public Health Nurses

 Leila Mercer  Amanda Stone  Kitty Mahoney  Caroline Kinsella Disclosures:  Supportive funding for transportation and presentation expenses paid for by MAPHN.  There are no commercial interests to disclose.

 Explain the importance of foot care to vulnerable populations  Describe the history of the Public Health Nurses role in Stand Down events  List four elements needed for foot care provisions

Leila Mercer Massachusetts Association of Public Health Nurses

 Homeless  At Risk for Homeless  Underserved  Underinsured  Medical Morbidities  Mental/Physical Self-Care Deficits

 Neuropathy  Trauma  Ulceration  Faulty Healing  Gangrene

 Inspection  Proper shoes  Calling the doctor  Specialists

 Arteriosclerosis  Chronic thrombophlebitis  Persons with diabetes  Peripheral neuropathies

 Routine foot self-examination  Routine nail care  Early clinical interventions  Teaching / Education

 Hammertoes  Blisters  Bunions  Corns  Calluses  Spurs  Ingrown nail  Fungus

Amanda Stone Massachusetts Association of Public Health Nurses

Effective May 1, 2015 NEW ELIGIBILITY REQUIREMENTS for Foot Care Exam Initial (first-time) candidates must: Have a current RN License Hold a Bachelor’s Degree (or higher) - Effective January 1, 2015 Complete BOTH of the following: 1.Accumulate a minimum of 24 CE/CME credits (contact hours) specific to foot care. 2.Accumulate a minimum of 40 clinical hours under the direct supervision of an expert in foot care

 Date Issued: January, 1979  Dates Revised: July 15, 1992; September 25, 2002; March 9, 2011, December 10, 2014  Scope of Practice: Registered Nurse and Licensed Practical Nurse

 Purpose: To guide the practice of Registered Nurses and Licensed Practical Nurses whose practice incorporates foot care to meet nursing and client goals including, but not limited to, health promotion, client teaching, health risk reduction, and promotion of safety and comfort.

 Advisory: Foot care is an important component of nursing care. Nurses must apply evidence based principles when assessing, planning, implementing and evaluating an individual’s foot health care needs. Licensed nurses who incorporate foot care into their practice must recognize foot signs and symptoms that may represent conditions requiring treatment beyond their scope of practice and refer to appropriate members of the health care team for collaboration and orders for continued treatment. Nurses may perform nursing techniques and procedures related to foot care only after appropriate education and demonstrated clinical competency that includes adherence to standard precautions and principles of asepsis and infection control.  Clients must grant informed consent in writing or orally, with substantiating documentation by the nurse. In obtaining informed consent for a nursing intervention, the nurse will provide the client with information about foot care, including its intended benefits and potential risks. Collaboration and consultation between members of the health care team is essential. Documentation of consent, assessment information, plan of care, interventions and evaluation must adhere to current standards of practice.

 Foot care is considered a nursing intervention that includes, but is not limited to, the following components: ◦ Assessment of past medical history including Diabetes Mellitus, Peripheral Vascular Disease or Peripheral Neuropathy; ◦ Assessment of circulation; ◦ Assessment of skin integrity, foot and nail structure; ◦ Implementation of a plan of foot care that is consistent with recognized standards of practice that includes:

 Client education includes, but is not limited to the following:  Self care;  Appropriate footwear;  Nutrition;  Exercise;  Compliance with medical regimes; and  Reporting changes and/or problems to their primary care provider.

Kitty Mahoney Massachusetts Association of Public Health Nurses

 Started in 2008 ◦ Two nurses ◦ 1 tent ◦ Few supplies, few instruments ◦ Two day event

 MAPHN Metrowest Chapter adopted the event  Recruited other Chapters  Hosted sock collections  Started personal care item collections  Began to build partnerships with other nurses

 Foot Care Class  Diabetic Screening  Tetanus & Pneumonia Vaccinations  Shoes/Boots  Building Nurse Partnerships

Two double tents and a floor area 25 Nurses 12 Foot Care Nurses in class Served in one day.

Continued partnership with MAOHN National partnership with AAOHN Proposal to partner with AAOHM Drives for supplies year round Date determined by VA in May Promote event through MAPHN & partners Volunteer requests ongoing Recommendation to MAPHN to make “Service” a standing committee Proposals submitted to NACCHO and APHA Inventory Management

Caroline Kinsella Massachusetts Association of Public Health Nurses

Evolving… Started out with a sock collection and has grown to include Personal care items First Aid Kits Boots/Shoes Vaccinations Blood Sugar Screening Foot Care items Evolving… Organizational Commitment Donations through MAPHN membership Donations through Veteran Organizations Donations through MAOHN partnership Donations through AAOHN alliance Corporate Donations Grants

 Mobilization (ICS Structure) ◦ Getting the “stuff to the site” ◦ Multiple vehicles ◦ Nurses (personal) supplies ◦ Provisions for nurses (food, water)  Setting up ◦ JITT ◦ Station Assignments ◦ Inventory distribution ◦ Volunteer management  Demobilization ◦ Breakdown ◦ Provision inventory ◦ Mobile Stand Down Units

 Review competency requirements  Review “Tip Sheet” prior to deploying

 Raspers  Nippers  Curettes  Dopplers  *Brushes  *Brick files

 Files  Soap  Socks  Lambs-wool  Lotions  Powders  Cuticle Sticks  Chux  Gloves  Masks  Paper towels  Barbisol  Comfort Care Kit items

Actual lighting inside the tent One reason why nurses need headlamps and PPE