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Certified Foot care Nurse- CFCN National Competencies Standards
Advanced Foot care Nurse Competencies Standards as per the Foot care Nurse Certification Board. Please find attached the new IPAC foot care practice standards in health care settings that is now advocated Canada wide
A foot care nurse organization, a division of the National Association of Holistic Health Practitioners a not for profit organization that promotes the highest standards of the certified foot care nurse - CFCN in Canada
The certified foot care nurse - CFCN is able to:
- Identify what Basic and Advanced Nursing Foot Care is and the role of the nurse in providing foot care treatment within the nurse scope of practice.
- Describe the basic pathophysiology of diabetes including characteristic signs and symptoms as per the Canadian Diabetes Association clinical practice guidelines 2013 and Diabetes Canada 2018..
- Able to distinguish between the major types of diabetes in terms of; Etiology, prevention, defining characteristics of incidents, and prevalence in regards to foot care
- Describe the effects of nutrition, exercise on blood glucose and good foot hygiene on the feet
- Identify the risk factors, which contribute significantly to the micro vascular, and neurological complications of diabetes
- Identify the use of A1C count monitoring, regarding prevention of complications of diabetes.
- Describe presenting symptoms, potential causes, diagnostic methods, and treatment plans related to problems that may be present with feet.
- Describe the role of the multidisciplinary team in referring clients with diabetic ulcers and amputation to wound care nurses or a specialist.
- Describe strategies to prevent foot problems and complications
- Identify common foot and nail disorders of the diabetic foot
- Identify common foot and nail disorders of the geriatric client
- Identify common conditions of the feet such as corns, calluses, warts, ulcers, hallux valgus, tissue changes, and nail changes (including rams horns and infections).
- Provide foot care treatment including: onychomycosis, onycholysis, onychogryphosis, onychorrehxis,, onychauxis, onychoclavus,paronychia and treatment prevention of nail disorders such as onychocryptosis or ingrown nail.
- Provide foot care treatment and reprocessing of critical foot care tool as per IPAC Canada Infection practice control reprocessing critical foot care 2019
- Describe and apply corrective padding to metatarsal and planter surface of the foot
- Describe and apply packing to nails for example, to prevent ingrown nail or onychocryptosis.
- Identify the use of the using urea based cream on a non diabetic clients feet
- Describe and identify safe use of tools when cutting the diabetic finger and toenails.
- Describe and identify safe use of tools when cutting the nails of the elderly and diabetic client,
- Identify safe nail and callus care for the diabetic, safe use of the foot files, and disposable tools.
- Use and Identify the importance of single use disposable set of tools when providing nail care to high risk clients including diabetics and elderly clients.
- Use the preferred autoclave method to sterilize reusable foot care tools
- Dispose of single use tools and accessories used in foot care treatment including; disposable emery nail file, foot file with disposable abrasive pads, orange stick, sanding emery band for cordless electric drill or rotary tool, disposable monofilament for testing neuropathy,
- Identify use of a disposable plastic liners in foot bath or foot basin for a non diabetic client, and place all soiled items in a sealed plastic bin liner until safe disposal .
- Identify techniques including; nail cutting using ingrow nail scissors, nail nippers, black file, nail debris evacuator, use of various corn remover tool to remove seeded, soft, and hard corns..
- Use of nail clipper, disposable foot file, foot file with disposable abrasive pads to remove thicken calluses
- .Use of disposable paper towel or used as a barrier under foot care tools prior and after performing a foot care treatment.
- Use of cordless electric drill or rotatory tool that is safe for use on humans with disposable sanding band to debride diabetics and elderly client"s thicken nails. Whenever possible use of a nail dust extractor during treatment
- Identify the safe use of protective equipment when providing foot care treatment including; face goggles with light attached, disposable face shields, N95 Mask, hairnets/bouffant hat, disposable plastic apron and latex free gloves.
- Identify and use safe protective barrier under client feet on footstool such as use of disposable paper towel, disposable pad or examination paper,, and equipment to prevent the spreading of virus, bacterial and fungal spore. Place items in a seal plastic bag until disposal.
- Identify use of wearing a lab coat or scrub with disposable plastic apron as a barrier when providing foot care. Dispose plastic apron and remove lab coat or scrub immediately after foot care and prior to leaving the work area.
- Identify the rational for not having client's feet on your lap when providing basic or advanced foot care as many spores and fugal can be transfer to foot care nurse and environment
- Perform foot care treatment with client's feet resting on a foot stool that can be clean with hydrogen peroxide wipes after treatment.
- Perform foot care treatment sitting on an adjustable chair, with lumbar support the chair must be made from material that can be cleaned with hospital grade cleaner such as a hydrogen peroxide type wipes after treatment..
- If client is not ambulatory provide treatment using a barrier such as a disposable barrier beneath client's feet to decrease spread of bacteria,viruses,or spores If fungal nail is present
- Identify and place a disposable plastic liner in client's basin when soaking a client's feet and disposing plastic liner after use in a seal plastic disposal bin.
- Identify and use of nondrying products and disposable basin liner when soaking the non-diabetic feet.
- Identify the safe use of disposable mono filament when assessing for sensation
- Perform the Diabetes Lower Extremity Amputation Prevention Program (LEAPS) risk and management categories for the feet as per the Diabetic foot screen
- Perform diabetic foot assessment as per the Registered Nurses Association of Ontario (RNAO) best practice in assessing the diabetic foot updated 2011.
- Identify the safe use of the rotary tool or electric drill with disposable abrasive band use to file thicken or Onychogryphotic nail when providing basic and advanced foot care treatment
- .Identify the safe use of disposable foot files with a disposable abrasive pad to file or debride calluses
- Provide foot care treatment with single use disposable foot care tools when providing foot care treatment in client's home, in a hospital setting, or any clinical setting whereby reprocessing of tools cannot be done effectively.
- Identify the use of safe non perfume products such as callus softener to apply to high risk clients such as the elderly and the diabetics to soften calluses
- Identify and use a disposable spatula to remove cream and lotion from container prior to application. When necessary used a single use product.
- Identify the use of a disposable ruler to measure any potential wound that may be noted when debriding a callus and refer client to medical doctor or wound care specialist.
- Provide information on the safe disposal of sharps in the sharps container
- Use sharps container to dispose of sharps and single use foot care tools
- Provide a checklist on foot care and resources to clients from the Diabetic Association website’s professional section to educate the client about the importance of foot care
- Provide support as a change agent in assisting the diabetic and elderly client in maintaining foot care that enhanced comfort and wellness
- Identify the effects of non- prescription remedies commonly used by people with diabetes for foot care in treating fungal nail.
- Discuss and implement safe infection control practicies as per Health Canada, IPAC Canada 2019,, CSA standards in use of foot care tools and foot care Infection Control Standards.
- Discuss the findings and implications of the current major research to practice in implementing effective infection control in the clinical setting relating to fungal spores, bacteria, and viruses
- Identify and provide foot care treatment with sterilized tools up to point of care
- Identify the importance of cleaning the organic matter off from foot care tools using anti bacterial soap prior to sterilization of tools
- Identify the rational of washing and cleaning organic matter from foot care tools with an antibacterial agent or cleaning solution that breaks down protein and placing in a seal container prior to transporting foot care tools to another location for sterilization of tools.
- Assess the relationship between social and socioeconomic support systems, environment, daily living diabetes, and foot care.
- Identify the rational for using hydrogen peroide type wipes to clean surface area, plastic tools box, and reusable equipment prior and after use.
- Identify the rational for using an autoclave or steam sterilization in reprocessing of reusable tools used in foot care treatment of high risk clients.
- Identify the limitations of effective reprocessing of reusable foot care tools using the chemisterilant method.
- Identify potential psycho social strengths and barriers to diabetes self-care
- Identify the impact of diabetes on life events including; interpersonal relations, vocation, education, and recreation
- Identify the use of assessment tools including ABI doppler, mono filament tool to check for nerve damage and foot complication
- Identify the rational for using a disposable ruler to measure any mark or spots noted beneath a callus in the high risk clients during foot care treatment.. When noted to not debride callus to the point of opening the area, and to the refer client to other primary health care professional to address an ulcer if noted..
- Identify potential destabilizing effects of stress on blood glucose, and approaches to self- care/foot care.
- Discuss the impact of cultural background and beliefs on adaptation to diabetes and self-care and foot care practices
- Identify possible feelings of attitudes held by the person with diabetes at various stages in the life cycle in relation to foot care hygiene and describe appropriate interventions
- Identify aspects of assessment, education, and management that are unique to the elderly and the diabetic
- Identify the role of the foot care nurse in advocacy regarding care and treatment in preventing amputation and foot ulcers
- Describe and apply cognitive behavior type intervention strategies and self-management teaching strategies when working with diabetic clients with respect to managing foot health.
- Provide a copy of a diabetic foot screen for the diabetic client to give to their doctor or physician. Results of decreased sensation noted on their diabetic foot screen are to follow up regarding mono filament testing. Be able to devise an educational treatment plan for the client with calluses, corns, and fungal nails.
- Be able to refer clients to other primary health care provider including: Wound care nurse, Chiropodist or Physician, to address foot care related issues including ingrown toenail and foot ulcers.
- Identify aspects of assessment, education, and management that are unique to children and/or adolescents with diabetes with respect to foot care
- .Describe potential chronic complications of diabetes in terms of pathology, associated risk factors, frequency, recommendations for screening, prevention, management, and foot care education
- .Identify the resources and information on starting a foot care business in Canada, or working in private practice as a certified foot care nurse or Foot care nurse CFCN.
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Foot Care Nurse Certification Board
A typical High risk client foot that a Certified Foot care nurse CFCN would treat
Disposable PPE used by the Certified Foot care nurse includes, goggles with light, face shied, disposable plastic apron, latex free gloves, N95 mask
Common tools and products uses in basic and Advanced nursing foot care
Some common tools, supplies and products used by the Certified Foot care Nurse - CFCN.
Mono filament testing to check for decrease sensation in the Diabetic and elderly foot
An example of a high risk client foot that is treated by Certified Foot care Nurses CFCN
Common nail nippers and tools used in advanced nursing foot care