“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?