Role of the APN
Foot care is an integral part of optimal health maintenance; and historically a missed opportunity. Many nurses possess limited assessment skills and minimal clinical expertise in dealing with lower extremity care. Many are unaware that foot care is within the scope of nursing practice. Indeed, the ability to differentiate normal changes from pathological threat and detection of problems followed by initiation of appropriate care and ongoing patient education is integral with nursing and the promotion of health.
The value of the advanced practice nurse (APN) in providing expert knowledge, coupled with strong decision making skills, enables the APN to function in a number of roles. As a facilitator, the APN may coordinate teaching-learning opportunities that enhance reciprocal learning. The role of the advanced practice nurse in primary care is multidimensional. The American Nurses' Association's (ANA) former Council of Nurses in Advanced Practice defines the APN as (cited in Hickey, Ouimette, & Venegoni):
Nurses in advanced clinical practice have a graduate degree in nursing. They conduct comprehensive health assessments, demonstrate a high level of autonomy and expert skill in the diagnosis and treatment of complex responses of individuals, families, and communities to actual or potential health problems. They formulate clinical decision to manage acute and chronic illness and promote wellness. Nurses in advanced practice integrate education, research, management, leadership, and consultation into their clinical role and function in collegial relationships with nursing peers, physicians and others who influence the health environment (p.22). This definition clearly illustrates the multidimensional nature of the APN.
Clearly, the value of a standardized protocol for lower extremity assessment and care by nurses should not be minimized. In a study of 6 nurse practitioners, Fain & Melkus (1994) found documentation of foot exams in 23% of charts reviewed. Despite lack of written adherence, in a 1989 NIH survey, over 80% of primary care providers indicated performance of foot, neurological and circulatory exam in diabetic patients one or more times per year. Results of a 1990 study by Hempel suggest that use of a flow sheet and nurse-managed patient education clinic significantly enhances compliance and documentation to standards in a diabetic population.
Pelican et al. ( 1991 ) reports in the Journal of Gerontological Nursing, the inception of a nurse run well foot care clinic, with the development of an assessment tool, instructional videotape and informational brochure. Kelechi and Lukacs (1996), both Master's prepared nurses, recognizing foot care as an "integral part of the promotion and maintenance of health" (p. 722) have devised "comprehensive lower extremity assessment, hygiene and nursing interventions that address problems associated with toenails and skin. It also includes patient and/or caregiver education and the identification of complications that need to be referred to a physician or specialist." It is the purpose of this project to develop for practitioners an assessment and documentation protocol, along with a self-directed teaching-learning module to deliver foot care in a geriatric non-traditional setting.
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