As a Christian Advanced Practice Registered Nurse (APRN), I find providing foot care to my patients to be one of the most satisfying aspect of my position. I work at a Federally Qualified Health Center; many of my patients have severe mental illness or very low health literacy. Sure, I encourage a healthy diet, adjust medications, and encourage smoking cessation, but many of my patients cannot provide for their own foot care. Many have poorly fitting secondhand shoes that cause painful calluses, or they may be too obese to reach their feet, or they may not have the money to purchase nail clippers or have a safe place to keep personal hygiene items. Often, as a result of aging, vision is a reason individuals cannot adequately inspect or care for their feet.
As the population in North America ages and chronic comorbidities such as diabetes and vascular disease are increasingly diagnosed, foot care by skilled healthcare providers is more essential than ever. Merely inspecting a patient's feet may be insufficient when the patient cannot take care of their own feet. Regular foot care is essential to reduce the risk of infection and injury that could lead to amputation and greater mobility limitations. Attending to patients' foot care is also well within the range of holistic, integrated care.
Several years ago, I enrolled in a week-long foot care course for nurses offered by the University of Wisconsin. After this course, I became a Certified Foot Care Specialist (CFCS) by the American Foot Care Nurses Association. This certification is available to all levels of nursing, from licensed practical nurses through APRNs.
Some of my patients see a podiatrist regularly for their foot care, but many others do not. Most of my patients are accompanied to their clinic appointments by a caseworker, someone who may help them shop for groceries, manage their money, search for employment, and navigate the healthcare system. Referring a patient who presents with painful feet due to very long, curling toenails to a podiatrist involves several steps that may be overly complicated to navigate for someone with mental illness or intellectual disability. Caseworkers may be overworked and, due to the perceived low priority, the patient may be left to navigate the health system alone when it comes to foot care. Dealing with the insurance coordinator, scheduling the appointment, and managing the public transportation system may be overwhelming to the patient.
For example, the caseworker may have a patient with a cardiology appointment that day, so the caseworker decides that the cardiology appointment takes precedence over the podiatry appointment. Nurses who are willing to gain skill and offer their foot care services to patients can help patients maintain their health and independence without the necessity of specialty care.
Foot care, specifically washing feet, is mentioned several times in the Bible. In Bethany, after Jesus resurrected Lazarus, Lazarus' sister, Mary, anointed Jesus' feet with oil and dried his feet with her hair (John 12:1-3). Then, John 13:1-12 describes how Jesus washed the feet of his disciples. In recent times, Pope Francis washed the feet of inmates during Holy Week (Watkins, 2019).
Providing foot care to patients with severe mental illness or intellectual disability is a humbling experience. This nursing care requires a personal touch, using our hands when sometimes it seems that our hands rarely leave our digital devices. Most of my patients live alone and suffer from isolation—they have few opportunities to be touched. After I wash their feet, I apply soothing lotion and trim their toenails and calluses, if needed. The patients are always grateful!
- What have you learned from your experience providing care for those with severe mental illness?
- Describe your comfort level in providing foot care. What factors decrease your comfort level? How do you compensate when you become aware of this issue?
- What do you recall being taught in nursing school about foot care?
- What might make performing foot care a rewarding aspect of patient care?
- Did a specific patient come to mind when reading this article? If this intervention occurred early in your career, how might you respond differently now?