Nursing Centers Introduce Diabetic Foot Care Program

Denise Alston (right) consults with Janet Lynne Douglass (left) while assessing a patient’s foot at the College of Nursing’s Women and Family Healthcare Center.

A problem might stem from a blister that hasn't healed or a jagged toenail that was cut too haphazardly. For individuals with diabetes, proper foot care represents far more than good hygiene. It's essential in avoiding serious medical issues, even amputations, which can develop from seemingly minor complaints. That's why the USC College of Nursing has established a formal foot care program at their two health care centers to assure that patients with diabetes receive the type of attention they need.

The program started out as a research project undertaken by RN Denise Alston while she was working on her doctorate in nursing practice at the College of Nursing. After seeing several patients with diabetes come into the hospital for amputations, she asked herself,  "What could be done to prevent people from getting to this point?"

First Alston researched the issue to see what other health care providers were doing. She discovered that providers don't always take the time to examine feet when patients with diabetes seek medical care for other problems. "It doesn't always happen in the big picture of things," she said.

With the assistance of Janet Lynne Douglass, an advanced practice registered nurse with the College of Nursing, Alston put together a program to implement with patients. Following recommendations of the American Diabetes Association, the first step is an initial comprehensive exam. Because diabetes causes nerve damage in the feet, cuts or injuries can go unnoticed by patients. When feet lose their natural protective sensation, patients are more prone to infections and the normal healing process is impaired. Patients' feet are assessed for problems such as calluses or skin breakdowns, thickened or in-grown toenails, or excessive dryness. Testing is also conducted to determine if sensation has been lost and if the feet are receiving adequate blood flow.

If a problem is identified during the exam, patients are directed to the appropriate follow-up care, whether it's custom orthotic shoes or an appointment with a wound care specialist. "Certain situations require an immediate referral," Alston stressed about seeking prompt medical attention.

A key component of the foot care program is patient education. Patients receive thorough instruction on topics including daily foot hygiene, how to inspect their own feet for problems, and beneficial exercises. They also learn how a regular schedule of medical exams is crucial to maintaining good foot health. Though an individual without a history of foot complications requires an annual exam, that schedule increases in frequency for patients who have already experienced problems such as foot ulcers or amputations.

While Alston was the impetus behind the foot care program, she will no longer be working with patients in Columbia. After finishing the nurse practitioner program in May, she moved to California with her husband's new military assignment. Yet she left behind a tool that will continue to impact patients at the Children and Family Healthcare Center and Primary Care Partners. "Diabetic foot care is an important issue and nurses can play a vital role in this care," she said.

Reprinted from Connections newsletter, August 2008

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