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“The Spa at Stand Down”
Caring for our homeless veterans; An innovative nurse lead practice model for provision of foot and nail care at Stand Down Boston, MA.
Massachusetts Association of Public Health Nurses www.maphn.org
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.
Presenters
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
Learning Objectives
Vulnerable Populations
Leila Mercer
Massachusetts Association of Public Health Nurses
Homeless At Risk for Homeless Underserved Underinsured Medical Morbidities Mental/Physical Self-Care Deficits
Who are vulnerable?
Neuropathy Trauma Ulceration Faulty Healing Gangrene
Limb Loss
Inspection Proper shoes Calling the doctor Specialists
Amputation Prevention
Arteriosclerosis Chronic thrombophlebitis Persons with diabetes Peripheral neuropathies
Importance of foot care and…
Routine foot self-examination Routine nail care Early clinical interventions Teaching / Education
Intervention
Hammertoes Blisters Bunions Corns Calluses Spurs Ingrown nail Fungus
Common Foot & Nail Disorders
Extreme Nail Growth
Fungus & Foot Care
Before
After
Regulatory Elements of Foot Care Provisions
Amanda Stone
Massachusetts Association of Public Health Nurses
Board Certification with WOCN
Board Certification with WOCN
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
MassachusettsBoard of Registration in Nursing
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.
Massachusetts BORN
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.
Massachusetts BORN
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:
Massachusetts BORN
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.
Massachusetts BORN
“The Spa”Foot Care for Veterans
during Operation Stand Down
Kitty Mahoney
Massachusetts Association of Public Health Nurses
History of Stand Down in the US
Started in 2008◦ Two nurses◦ 1 tent◦ Few supplies, few instruments◦ Two day event
Operation Stand Down with MAPHN
2009-2011 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
2012-2014
2014
Two double tents and a floor area25 Nurses12 Foot Care Nurses in classServed 200-300 in one day.
Supplies for Nurses and Vets
Planning Stages of 2015•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
Stand Down with MAPHN Video
Event Planning, Volunteers & Sustainability
Caroline Kinsella
Massachusetts Association of Public Health Nurses
Event Planning
Attracting Volunteers
Sustaining Volunteer Efforts
Financial Sustainability & SupportEvolving…Started out with a sock collection and has grown to includePersonal care itemsFirst Aid KitsBoots/ShoesVaccinationsBlood Sugar ScreeningFoot Care items
Evolving…Organizational CommitmentDonations through MAPHN membershipDonations through Veteran OrganizationsDonations through MAOHN partnershipDonations through AAOHN allianceCorporate DonationsGrants
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
Logistics
Best Practices For Nurses Review competency
requirements Review “Tip Sheet”
prior to deploying
Durable Medical Supplies 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
Consumable Care Supplies
Sanitation Needs
Tent Provisions Actual lighting inside the tent
One reason why nurses need headlamps and PPE
Bringing it all together
Demobilization
QUESTIONS?
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