CLINICAL GUIDELINES. Toe Nail Care. Matron s Forum May See main references

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1 CLINICAL GUIDELINES Title of guideline: Approving body and date ratified: Toe Nail Care Matron s Forum May 2011 Review date: May 2014 Supersedes: Author and job title: Directorate : Document derivation / evidence base: Review process: Distribution: N/A Alison Musgrove (Advanced Podiatrist: Diabetes) Tracey Warren (Practice Development Matron) See main references Nursing Practice Guidelines Group, Ward Sisters/Charge Nurses, Practice Development Matrons (PDMs), Clinical Leads, Matrons. Ward Sisters/Charge Nurses, PDMs, Clinical Leads, Matrons, Nursing Practice Guidelines Group (includes University of Nottingham representative), Clinical Quality, Risk and Safety Manager, Trust Intranet. This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using the guidelines after the review date. 1

2 Nottingham University Hospitals NHS Trust CLINICAL GUIDELINES Foot &Toe Nail Care INTRODUCTION Foot care is an integral part of a patient s daily hygiene requirements and as such is an essential aspect of nursing care. Foot health can be maintained with proper foot care, which includes comprehensive assessment of the feet, hygiene and nursing interventions that address problems associated with the toenails and skin. (Stolt, et al 2010). Foot care is essential for mobility, independent functioning and comfort. This guideline refers to ALL adult patients (including those with diabetes / peripheral vascular disease). All nurses and midwives (registered and non registered) are able to cut patients toe nails, however in some circumstance (listed below) a podiatry referral will be required. PODIATRY REFERRALS Referrals are accepted for: Conditions which may prevent rehabilitation e.g. callus causing pain Foot ulceration Ingrowing nails, which have lead to skin damage Severely overgrown nails, which cannot be managed by ward staff. Queens Campus: A Floor East Block ext Referrals via a Podiatry referral card available from the department. City Campus: Dundee House ext Referrals via NOTIS code PODIATRY EQUIPMENT LIST Gloves (non sterile) and Aprons Podiatry Set: Basic Care Set available from Bailey Instruments Order Code BSDP- 04 includes Nippers and Foot Dresser (file). Available from Supply Chain. Sharps Box Paper towel 2

3 PRINCIPLES OF CARE PRINCIPLE 1 Explain procedure to patient and obtain verbal consent If the patient lacks the capacity to consent then a mental capacity test and best interests decision should be completed and documented either by using NUH stock stationery NUH or in the patient s notes. 2 Wash hands and put on apron and non sterile gloves 3 Ensure patient is positioned comfortably and nails are easily accessible 4 Give assistance as necessary to wash feet prior to cutting nails. 5 Assess nails to ensure there are no complications that would require a podiatry referral. (See conditions for podiatry referral on page 2) Observe for skin pathologies that may require referral. RATIONALE To promote dignity, reduce potential anxiety and obtain consent To adhere to NUH Infection Control and NUH Glove Selection Guidelines For patient comfort, staff safety and to adhere to NUH Manual Handling To promote patient hygiene, dignity and comfort To ensure foot care is carried out by the appropriate healthcare professional. 3

4 6 Place paper towel under the patients feet 7 Filing Where possible nails should be filed using the foot dresser (file) from the basic care podiatry set to reduce the length and thickness of the nails 8 Cutting Use nail nippers from the basic care podiatry set. If right handed use left hand to hold the toe and with the left thumb add tension to pulp of the toe pulling the pulp down away from the nail plate Depending on the shape start at the lateral edge and make small nail cuts across the nail plate following the curved line of the end of the toe. (See Appendix 1 Photographs) 9 Nails should not be cut too short or down the side of the nail. 10 After clipping/filing, dispose of the nail trimmings in the paper towel and dispose of in clinical waste bin. Dispose of the equipment into the sharps bin. NB: Podiatry sets are single patient use only 11 Assist the patient as necessary to replace any socks /shoes/slippers and maintain a comfortable position 12 Remove and dispose of aprons and gloves. Wash hands. 13 Document procedure - recording which instruments (i.e. file/nippers or both) have been used. To collect nail clippings To safely reduce the length and thickness of the nails To safely reduce the length of nails To reduce risk of trauma and ingrowing toenails To adhere to NUH Infection Control To maintain patients comfort To adhere to NUH Infection Control Facilitate continuity of care and to adhere to NUH Health Record Keeping 4

5 Appendix 1: Photographs of procedure Use non dominant hand to hold the toe and with the thumb add tension to pulp of the toe pulling the pulp down away from the nail plate Start at the lateral edge and make small nail cuts across the nail plate following the curved line of the end of the toe 5

6 REFERENCES Howell M, Thirlaway S (2004) Integrating foot care into the everyday clinical practice of nurses. British Journal of Nursing (2004) 13(8) Malkin B, Berridge P (2009) Guidance on maintaining personal hygiene in nail care. Nursing Standard. 23(41) Nottingham University Hospitals (2010) Clinical Guidelines. NUH, Nottingham Nottingham University Hospitals (2007) Glove Selection Guidelines. Nottingham University Hospitals (2009) Infection Prevention and Control Control%20.doc Nottingham University Hospitals (2010) Manual Handling Nottingham University Hospitals (2010) Health Record Keeping olicy.doc Nottingham University Hospitals (2005) Mental Capacity (MCA) g_vulnerable_adults/safeguarding%20folder/07mental%20capacity%20act%2 0(2005)%20%20and%20Procedure.doc Stolt M, Suhonen R, Voutilainen P, Leino-Kilpi H (2010) Foot health in older people and the nurse s role in foot health care. Scandinavian Journal of Caring Sciences. 24(1) Authors: Alison Musgrove (Advanced Podiatrist: Diabetes) Tracey Warren (PDM) NPGG Link: For Review: 6

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