Wellness Promotion Wellness Promotion ProjectProject

Lois Bouren, RNLois Bouren, RNDeidre Dennison, RNDeidre Dennison, RN

Partnered with Interfaith Partnership for Partnered with Interfaith Partnership for the Homeless the Homeless

Worked in the Health & Wellness clinic Worked in the Health & Wellness clinic at the Sheridan Hollow Drop-In Center at the Sheridan Hollow Drop-In Center

Provided care to members of the Provided care to members of the community that included health teaching, community that included health teaching, screenings, and supportscreenings, and support

Foot Care as a Public Foot Care as a Public Health Concern for the Health Concern for the

HomelessHomeless Foot care amongst the homeless is of Foot care amongst the homeless is of

particular concern as a result of many particular concern as a result of many factors, including frequent walking, factors, including frequent walking, poor quality/fitting shoes, dirty/wet poor quality/fitting shoes, dirty/wet socks, public showers.socks, public showers.

We felt we could provide good We felt we could provide good information at a level that the patrons information at a level that the patrons could understand, as well as then could understand, as well as then provide screenings and referrals for foot provide screenings and referrals for foot carecare

LiteratureLiterature Limited studiesLimited studies Studies that were reviewed showed an Studies that were reviewed showed an

increased risk for foot issues such as increased risk for foot issues such as corns, bunions, fungal infections, and corns, bunions, fungal infections, and lower extremity pathology among the lower extremity pathology among the homeless due to a lack of proper hygiene homeless due to a lack of proper hygiene facilities and inability to lie down at nightfacilities and inability to lie down at night

Also, compounding factors such as PVD, Also, compounding factors such as PVD, diabetic neuropathy, and alcoholism add diabetic neuropathy, and alcoholism add to problemto problem

ImplementationImplementation Based on the amount of foot issues we saw Based on the amount of foot issues we saw

in the clinic, we decided to make a in the clinic, we decided to make a bulletin board and give a presentation bulletin board and give a presentation about PVD and foot issuesabout PVD and foot issues

Bulletin board was applied approximately Bulletin board was applied approximately one week prior to presentation in an effort one week prior to presentation in an effort to begin the dialogueto begin the dialogue

After presentation we took specific After presentation we took specific questions, offered foot care kits & new questions, offered foot care kits & new socks, as well as screenings in the clinicsocks, as well as screenings in the clinic

Foot Care: Foot Care: Protect your FeetProtect your Feet

Deidre Dennison RNDeidre Dennison RN

Lois Bouren RNLois Bouren RN

SUNYITSUNYIT

Peripheral Vascular Peripheral Vascular DiseaseDisease

Circulation problem that effects Circulation problem that effects blood vessels in the arms and legsblood vessels in the arms and legs

Narrowed blood vessels, usually Narrowed blood vessels, usually caused by plaque build-up,caused by plaque build-up,

like a hose plugged uplike a hose plugged up

with dirtwith dirt

Causes of PVDCauses of PVD

Body reacts to certain things that Body reacts to certain things that restrict blood flow to vessels of the restrict blood flow to vessels of the arms and legsarms and legs

Think clogged pipes!!Think clogged pipes!!

How does this happen??How does this happen??

Clogged Pipes!Clogged Pipes!

Internal/External CausesInternal/External Causes

External (outside External (outside the body):the body):Emotional stressEmotional stress

SmokingSmoking

Cold temperatures Cold temperatures

Injuries/InfectionInjuries/Infection

Internal (inside Internal (inside the body):the body):SmokingSmoking

High blood pressureHigh blood pressure

High cholesterol High cholesterol

DiabetesDiabetes

Heart DiseaseHeart Disease

Lifestyle Choices Lifestyle Choices

Choices that increase risk include:Choices that increase risk include:

SmokingSmoking

Poor Nutrition/OverweightPoor Nutrition/Overweight

InactivityInactivity

SymptomsSymptoms

No symptoms for some peopleNo symptoms for some people Pain/crampingPain/cramping Skin color changesSkin color changes Loss of hair on legs/feetLoss of hair on legs/feet AchinessAchiness FatigueFatigue Burning; pins and needlesBurning; pins and needles Sores that heal slowly or not at allSores that heal slowly or not at all

Color Changes…Color Changes…

Leg pain with activityLeg pain with activity

Sores that don’t healSores that don’t heal

PreventionPrevention

Quit smokingQuit smokingHealthy dietHealthy dietModerate exerciseModerate exerciseBlood pressure controlBlood pressure controlRegular visits with MDRegular visits with MD

Athlete’s FootAthlete’s Foot

Fungal infection on the skin of the Fungal infection on the skin of the feetfeet

Likes to grow in between toesLikes to grow in between toes Spreads easily Spreads easily

on shower floors,on shower floors,

locker rooms.locker rooms.

Symptoms &Symptoms &Treatment/Prevention of Treatment/Prevention of

Athlete’s FootAthlete’s Foot Burning, itching areas on feet, Burning, itching areas on feet,

between toesbetween toes Skin peels and cracksSkin peels and cracks Possible blisters, open areasPossible blisters, open areas

PainfulPainful Toes usually warm Toes usually warm

and discoloredand discolored Infection where the Infection where the

nail in beds the skinnail in beds the skin Occurs when shoes Occurs when shoes

are tight and nails are are tight and nails are longlong

Toe nail trimming is Toe nail trimming is

important!important!

Ingrown ToenailsIngrown Toenails

Heel Blisters Gone Bad!Heel Blisters Gone Bad!

Cracked HeelsCracked Heels

Can be painfulCan be painful Skin cracks Skin cracks BleedsBleeds Skin is very hardSkin is very hard DryDry Sometimes become Sometimes become

infectedinfected

Corns and CallusesCorns and Calluses Corn is a hard Corn is a hard

patch of thick dead patch of thick dead skin.skin.

Corns usually on Corns usually on toes or sides of foottoes or sides of foot

Callus forms any Callus forms any place there is place there is repeated frictionrepeated friction

Caused by rubbing Caused by rubbing and pressureand pressure

Painful!Painful!

Inspect feet dailyKeep feet clean & dryTry to choose bigger shoes if possibleGood shoe careClean, dry socksEarly treatmentAvoid going barefoot

Project Self-Evaluation: Project Self-Evaluation: What WorkedWhat Worked

Pictures worked wonders during the Pictures worked wonders during the presentation – kept clients engaged! presentation – kept clients engaged!

Keeping language simple and using Keeping language simple and using analogies (such as clogged pipes/hose analogies (such as clogged pipes/hose to illustrate stenosis)to illustrate stenosis)

Acknowledging there will be hand Acknowledging there will be hand outs at the end of the presentationouts at the end of the presentation

Great turn-out and feedback from Great turn-out and feedback from clients & staffclients & staff

Project Self-Evaluation: Project Self-Evaluation: What Could We Do What Could We Do

Differently Differently Earlier implementation of bulletin boardEarlier implementation of bulletin board Cholesterol checks using a portable Cholesterol checks using a portable

‘meter’, although the strips the Center ‘meter’, although the strips the Center had were difficult to use and required a had were difficult to use and required a large drop of bloodlarge drop of blood

Make more ‘referrals’ to the presentation Make more ‘referrals’ to the presentation directly to individuals throughout that directly to individuals throughout that weekweek

Hang signs regarding the topic and Hang signs regarding the topic and encouraging clients to attendencouraging clients to attend

ReferencesReferences Chen, B., Mitchell, A., & Tran, D. 2012. Podiatric Health

Needs of Homeless populations as a Public Health Concern Journal of the American Podiatric Society. Jan/Feb. 2012 Vol.102 No. 1.

Muirhead, L., Roberson, A., & Secrest, J. (2011). Utilization of foot care services among homeless adults: Implications for advanced practice nurses. Journal Of The American Academy Of Nurse Practitioners, 23(4), 209-215.

Schoon, P. M., Champlin, B. E., & Hunt, R. J. (2012). Developing a Sustainable Foot Care Clinic in a Homeless Shelter Within an Academic-Community Partnership. Journal Of Nursing Education, 51(12), 714-718.