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Inspiring Excellence in Nursing Education


Course Description

Total Hours: 63

The Foot Care Nurse (FCN) course is designed for nurses (RN’s, NP’s, RPN’s & LPN’s) new to foot care and for experienced Foot Care Nurses who wish to update their knowledge and skills. The course follows a comprehensive, advanced and diabetic nursing foot care curriculum. This curriculum is based on current Best Practice Guidelines and evidence-based practice, including competencies from the Canadian Association of Foot Care Nurses’ National Competencies for Advanced Nursing Foot Care in Canada (2017), which are integrated as exit competencies to the course.

This course has an online theoretical component (FCN Part 1) and an in-person clinical mentorship component (FCN Part 2), and is designed to prepare participants to function as a Foot Care Nurse within a health care team.

FCN Part 2 (Clinical) is the mentorship and clinical component of the FCN course where students practice their Foot Care Nurse skills. The curriculum for Part 2 was developed by Foot Care Kingston and is administered by Foot Care Kingston in Kingston and by select education partners across Canada. Each location uses the same standardized peer-reviewed education guidelines and this FCN Part 2 Course Outline. Please visit the FCN 2 (Clinical) page of the Foot Care Kingston website for a list of FCN Part 2 locations

Students can apply for FCN Part 2 at any time after having started FCN Part 1. For more information about registration, please refer to the FCN Part 2 Registration section at the bottom of this Course Outline.


Prerequisites

  • Applicants must start FCN Part 2 within 12 months of achieving a passing grade from FCN Part 1. Exceptions to the 12-month rule may be allowed in extenuating circumstances. Applicants are to contact their Part 2 location of choice to discuss their unique circumstances and for more detail.
  • Applicants must hold a current non-restricted Nursing Registration/License (temporary or full) from the territory or province in which they will be taking the course.
  • Applicants must carry and show proof of at least $2 million personal protective insurance (malpractice insurance).

Credit

Students meeting the minimum passing grade requirement will be provided with a Certificate of Completion from Foot Care Kingston.


Evaluation

Passing Grade: Students achieving a grade of 75% or higher are considered to have met the exit competencies for FCN Part 2 at an entry level. Marking distribution is as follows:

Percentage of total mark per activity

1. Attendance (10%)                                                    

2. Participation & Exercises (10%)

3. Final Test (10%)

4. Clinical Skills (70%)

___________________________

TOTAL (100%)

Attendance:  10% of the final mark is allotted to attendance. Students that attend the entire FCN Part 2 (Clinical) will be given the full 10%, which is up to 2% for each full day attended. Students will lose 1% from their final mark for missing up to a 1/2 day, or 2% for 3.5 - 7 hours missed.

A student may be removed from FCN Part 2 (Clinical) at the discretion of the Part 2 Lead Educator if the student's behaviour is deemed unsafe or unethical. Permission to re-enter the course will be discussed by the Lead Educator and/or FCN Part 2 Representative with the student, as appropriate.


Interpretation of Final Grades

Final Grade 75-100% (Pass)

  • Competent - Meets expectations for exit competencies.
  • Recommendation - Practice within an agency with an onsite mentor or an easily accessible mentor, for a minimum of two years.

Final Grade 0-74% (Fail)  

  • Not Competent - Does not meet exit competencies effectively or consistently.
  • Recommendation - The student cannot practice foot care. Recommended to get remedial assistance prior to applying for re-entry to the course.

FCN Part 2 Exit Competencies

This course emphasizes professional accountability through resourceful and self-directed learning. Exit competencies to be evaluated consist of the minimum set of skills and knowledge required to competently practice as a Foot Care Nurse. Skills and knowledge will be evaluated by the student, their peers and the Educator.

Evaluation is continuous and will consist of formative and summative methods, including step-by step guided-learning exercises and return demonstrations. There will be an emphasis on self-evaluation with the use of pre and post-tests and reflective practice.

The CAFCN’s National Competencies for Advanced Nursing Foot Care in Canada (2017) are used as exit competencies for FCN Part 2 with the exception of some business and practice-related competencies, which are outside the scope of the FCN course and will not be evaluated. To receive a passing mark, students will be expected to demonstrate the following competencies at an entry level, except for the yellow and green highlighted competencies. The competencies listed below are from pages 9-19 of the CAFCN’s National Competencies for Advanced Nursing Foot Care in Canada (2017).

  • A note about the 9 YELLOW highlighted ‘business-related’ competencies:

    ‘Business-related’ competencies are only briefly outlined in the curriculum and resources for Part 1 & Part 2 of the FCN course and are NOT regarded as exit competencies for the course. Foot Care Kingston’s team and affiliate Educators view ‘business skills’ as separate from ‘nursing skills’ and suggest these competencies be pursued after graduating from the FCN course. Note that when graduating from the FCN course, we recommend that nurses initially focus on learning and practicing advanced foot care nursing knowledge and skills in a team environment with onsite mentors &/or easily accessible mentors for at least 2 years, prior to considering private practice.
     
  • A note about 17 GREEN highlighted ‘practice-related’ competencies:

    These ‘practice-related’ skills are only briefly outlined at an introductory level in the curriculum and resources for Part 1 & Part 2 of the FCN course, and are NOT regarded as exit competencies for the FCN course. We recommend that FCN course graduates implement the green highlighted areas into their foot care practice and continuing education after graduating from the course.

ASSUMPTIONS (page 9)

CAFCN makes the following assumptions about the practice of advanced nursing foot care:

1. Advanced foot care nurses hold current registration with the appropriate nursing regulatory body and maintain their ‘good standing’ status on that register.

2. Advanced foot care nurses provide client-focused services within their respective nursing scopes of practice.

3. Advanced foot care nurses are responsible and accountable for maintaining and improving their competence to practice.

4. Advanced foot care nurses have completed an advanced nursing foot care program that supports the development of competencies for critical thinking and clinical judgment skills to provide safe, competent and ethical advanced nursing foot care.

5. Advanced foot care nurses promote optimal health, collaborating as integral members of the foot health team.

6. Advanced foot care nurses adhere to infection prevention and control and reprocessing practices, guided by best practice guidelines, evidence informed literature and manufacturer’s instructions.

7. Advanced foot care nurses recognize when clients’ needs are beyond their professional scope of practice or personal level of competence and refer to the appropriate professional.

8. Advanced foot care nurses practice independently and collaboratively within the health team in a variety of settings.

9. Advanced foot care nurses have a specialized body of knowledge of lower limb and foot health care.

10. Advanced foot care nurses apply evidence-informed principles when assessing, planning, implementing and evaluating clients’ needs for nursing foot care.

11. Advanced foot care nurses obtain informed consent from their clients or the client’s substitute decision maker before performing any procedure(s).

12. Advanced foot care nurses maintain all client information in confidence and in accordance with privacy legislation.

13.Advanced foot care nurses use their nursing knowledge base to support and advance the practice of nursing foot care.

14. Advanced foot care nurses assume leadership roles in their areas of practice, in the health team, and in the advancement of nursing foot care (provincially/territorially and nationally).

15. Advanced foot care nurses work within all relevant federal, provincial and territorial legislation.

KNOWLEDGE-BASED PRACTICE: THEORY AND APPLICATION (pages 10 & 11)

Nurses engaged in the specialty of advanced nursing foot care in Canada collaborate on, develop, promote and facilitate best practices for client-centered health. Further enhancing their nursing knowledge base, Advanced Foot Care Nurses integrate a specialized body of knowledge of lower limb and foot health into their daily practice.

THEORY Competent Advanced Foot Care Nurses:

1. have knowledge of anatomy and physiology, and pathophysiology of the lower limb.

2. have knowledge of terminology specific to advanced nursing foot care.

3. identify the components of a comprehensive lower limb health assessment.

4. understand the implications of biomechanics as it relates to mobility and health of the lower limb.

5. have knowledge of comorbidities and their effects on circulation, nerve function and structure of the lower limb.

6. identify psychosocial factors that impact lower limb health.

7. understand the profound effects of diabetes mellitus on lower limb health, including microvascular, macrovascular and neuropathic complications.

8. demonstrate knowledge of documentation required for advanced nursing foot care practice including, but not limited to, client consent, nursing foot care plan, charting, policies and procedures, auditing, and privacy legislation.

9. explain the principles of infection prevention and control as they relate to foot care practice, instruments and equipment.

10. have knowledge of the safe use, care and maintenance of critical and non-critical instruments for foot care.

11. maintain currency in reprocessing medical devices, reprocessing standards and guidelines specific to foot care.

12. understand the principles of personal and public safety in relation to the management of sharps. National Competencies for Advanced Nursing Foot Care in Canada

13. describe the relevant national guidelines for single use item disposal.

14. have knowledge of the safe use, care and maintenance of ultrasonic cleaner and autoclave units.

15. identify infection prevention and control best practices.

16. have knowledge of local community resources and practitioners available to support foot care clients.

17. understand communication planning, teamwork and analytical skills required for establishing and managing a nursing foot care business, service and/or program.

18. maintain awareness of regulatory standards for nurses in self-employment/business in each jurisdiction where the business operates.

19. maintain awareness of federal, provincial, territorial and municipal legislation and requirements for operating a nursing foot care business.

20. maintain awareness of, and contribute to, employer and facility policies and procedures related to nursing foot care practice.

21. have knowledge of basic ergonomic principles and workplace policies in the provision of nursing foot care.

KNOWLEDGE-BASED PRACTICE: APPLICATION (pages 11 -13)

Competent Advanced Foot Care Nurses:

1. identify and address factors that impact functionality and mobility of the lower limb.

2. provide nursing interventions for the common pathologies of the feet (e.g. corns, calluses, dystrophic nails, fungal infections, and other soft tissues pathologies).

3. perform client-centered foot health assessments, including but not limited to health history, psychosocial, physical, client knowledge, and environment.

4. choose from a range of evidence informed foot care assessment tools including but not limited to Doppler ABI, 10g Semmes-Weinstein monofilament, 128Hz vibrating tuning fork, Inlow’s 60-second diabetic foot screen, Diabetes Care Program of Nova Scotia Foot Risk Assessment Tool.

5. assess biomechanics, including but not limited to gait, strength, balance, footwear, assistive and off-loading devices, and physical environment.

6. use terminology specific to nursing foot care in all documentation.

7. complete foot care documentation in accordance with legal, ethical and professional requirements. National Competencies for Advanced Nursing Foot Care in Canada 

8. maintain health records in a secure and confidential manner, and in accordance with privacy requirements.

9. establish and annually review/revise policy and procedure documents to reflect current best practice guidelines.

10. obtain documented client consent for all nursing foot care plans and treatments.

11. maintain autoclave processing records to indicate that sterilization has taken place on every occasion.

12. adhere to best practices for cleaning, disinfection and sterilization of instruments and the workplace environment.

13. utilize Personal Protective Equipment (PPE) to prevent the transmission and spread of infection.

14. maintain the sterility of instruments up to the point of use.

15. use locking, secure, biohazard sharps containers to maintain personal and public safety.

16. clean and sterilize equipment according to manufacturer’s instructions and in accordance with Canadian Standards.

17. dispose of single use instruments according to relevant (national) guidelines and manufacturer’s guidelines.

18. safely use, care for and maintain ultrasonic cleaner and autoclave units for the purpose of critical instrument cleaning and sterilization.

19. use instruments required for foot care only for the purposes for which they are designed.

20. use instruments designed specifically for use on the human body and, specifically, feet (i.e. including rotary device and accessories).

21. differentiate between nursing foot care and treatments requiring sterile and/or clean instruments.

22. use a new set of instruments - disposable or sterilized - for each client interaction.

23. utilize enzymatic transport gel/spray for soiled instruments, and clean said instruments with an enzymatic cleanser, an ultrasonic cleaner, and then autoclave.

24. store sterile instruments as per best practice guidelines, and re-sterilize if sterile pouches are compromised.

25. perform mandatory biological indicator tests, spore tests, Class 5 indicator strips as quality control measures to ensure sterilization has taken place in the autoclave.

26. adhere to their obligation to sterilize critical instruments. National Competencies for Advanced Nursing Foot Care in Canada.

27. refer clients to supportive community resources, including but not limited to local walking clubs, service clubs, social services.

28. refer clients to appropriate health practitioners to ensure optimal care.

29. build networks of various health practitioners and resources to ensure clients’ holistic health needs are met.

30. comply with federal, provincial, territorial, and municipal laws and requirements for operating a business.

31. comply with all jurisdictional regulatory and professional standards, requirements and guidelines for operating a business.

32. establish and maintain insurance coverage for all operations and risks of the nursing foot care business.

33. follow and contribute to the development of employers’ policies and procedures for nursing foot care.

34. apply basic ergonomic principles and follow agency occupational health and safety policies in the provision of nursing foot care.

35. attend workshops, access community resources, review the extant literature and relevant government agency publications to maintain currency in reprocessing medical devices, reprocessing standards, waste disposal and guidelines specific to foot care.

RISK ASSESSMENT AND HEALTH PROMOTION (page 14)

Advanced Foot Care Nurses are committed to providing safe care to clients and to promoting the health of each individual client. They use their critical thinking and clinical judgment to identify potential risks and act to prevent negative health outcomes for the client. Advanced Foot Care Nurses educate clients to assist them in managing and averting risks to their lower limb health.

Competent Advanced Foot Care Nurses:

1. identify physical, psychosocial and environmental risk factors impacting lower limb health, including, but not limited to, ageing, developmental, and mental health.

2. recognize the role determinants of health can have in the development of complications in lower limb health.

3. use current evidence informed clinical practice standards and guidelines to identify risk factors for the client with diabetes mellitus in relation to lower limb health.

4. identify risk factors for ulceration, wounds and amputation, including, but not limited to, diabetes mellitus, peripheral vascular disease, peripheral arterial disease, neuropathy, skin changes, structural abnormalities (e.g. range of motion of ankle and toe joints, callus pattern, bony deformities) skin temperature (by touch), and evidence of infection.

5. recognize the benefits of health promotion, community resources and self-care management as they relate to advanced nursing foot care.

6. reduce risks and promote health by implementing client-centered teaching and resources.

7. utilize a validated, standardized assessment tool to assign risk stratification to clients and apply the relevant advanced nursing foot care interventions to ameliorate the risk.

QUALITY PRACTICE Advanced (page 15)

Foot Care Nurses participate in processes to promote quality practice. They engage in reflexive practice, policy development, and implementation of evidence-informed care. They are committed to continuous quality improvement in advanced nursing foot care. Competent Advanced Foot Care Nurses:

1. critically appraise their own nursing foot care practice to identify opportunities to enhance their clinical competence.

2. maintain competence through hours of practice and continuing education within the scope of advanced nursing foot care.

3. develop practice tools and participate in processes that measure care outcomes, including quality of life and client satisfaction with nursing foot care services.

4. evaluate advanced nursing foot care practice against evidence-informed data.

5. engage with colleagues and peers in providing and obtaining mutual mentoring and support to enhance quality of practice.

6. maintain accurate and auditable records of advanced nursing foot care practice, hours and related continuous learning activities.

PROFESSIONAL COMMUNICATION AND RELATIONSHIP (page 16)

Advanced Foot Care Nurses provide care to clients in the context of professional, therapeutic, business communications and relationships. They are conscious of maintaining boundaries in those relationships in every context of care to protect clients from potential harm or exploitation.

Competent Advanced Foot Care Nurses:

1. maintain professional boundaries in the provision of advanced nursing foot care to clients in all contexts of care.

2. choose interactions that provide therapeutic benefit for the client.

3. utilize client-centered communications in the provision of advanced nursing foot care.

4. use advanced nursing foot care knowledge to educate and support the client’s achievement of lower limb health.

5. document lower limb health care provided using current documentation systems.

6. provide support and education to individuals within the client’s identified support system.

COORDINATION AND COLLABORATION (page 17)

Advanced Foot Care Nurses are conscious of the need to coordinate care for their clients through collaborative networks and relationships which promote the lower limb and holistic health of each individual client.

Competent Advanced Foot Care Nurses:

1. communicate the roles and responsibilities of advanced nursing foot care to stakeholders and members of the health team.

2. research local resources available to support lower limb health for clients.

3. build relationships with other health care providers for the purpose of collaboration and coordination in the provision of lower limb health.

4. collaborate, coordinate and liaise with other health care professionals to provide comprehensive lower limb health services to clients.

5. communicate client information to other health professionals in a timely manner.

6. apply professional judgment to the delegation of care to other health care professionals.

7. address potential or actual conflict between health care team members through the use of professional respect, conflict resolution approaches and techniques, and by participating in joint decision-making.

ADVOCACY (page 18)

Advanced Foot Care Nurses seek to advance the practice of nursing foot care and to make advanced nursing foot care services accessible to all Canadians. They use their influence to support clients in advancing their health and to advocate for evidence-informed practice.

Competent Advanced Foot Care Nurses:

1. educate clients with regard to expectations, required credentials and competencies of advanced nursing foot care services.

2. advocate for resources to improve the quality of, and access to, advanced nursing foot care in Canada.

3. educate the public, government and stakeholders about the specialty of advanced nursing foot care.

4. enhance the evidence base of the specialty by contributing to and/or participating in advanced nursing foot care research.

5. represent the profession of advanced nursing foot care to various levels of government and health authorities.

6. provide mentorship and support opportunities for new and inexperienced advanced foot care nurse colleagues.

7. participate in professional development activities, such as attending local, provincial/ territorial and national advanced nursing foot care group meetings and events.

ETHICAL PRACTICE (page 19)

Advanced Foot Care Nurses are aware of the particular ethical challenges in their practice. They are committed to protecting the public and providing services in an environment of safe, competent, evidence informed clinical and business practices.

Competent Advanced Foot Care Nurses:

1. practice within, and adhere to, best practice guidelines, nursing standards, established procedures and policies for advanced nursing foot care.

2. accept responsibility for maintaining respect, empathy, trust, honesty and integrity in the relationship with clients of advanced nursing foot care.

3. adhere to the ethical practice of providing beneficence and non-maleficence in the practice, the relationship, and the business of advanced nursing foot care.

4. charge clients fees that are comparable with that of other advanced foot care nurses and health care providers who have similar competencies and provide similar services.

5. recognize actual or potential conflicts of interest in the practice of an advanced nursing foot care business.

6. endeavour to avoid potential or actual conflicts of interest in the operation of an advanced nursing foot care business.


Example of a Part 2 Lesson Plan (63 hrs)

Pre-Part 2 Assignments (~20 hours): Assignments will be assigned prior to attending Part 2 for students to prepare for the activities and practical skills required for Days 1 - 5 of FCN Part 2.
 
Mentorship (3 hours): Students will be required to complete 3 hours of mentorship, shadowing their FCN Part 2 Lead Educator or one of the FCN Part 2 Preceptors. 
 
Day 1 - 3 (24 hours): During this portion of the course, students will be guided to simulate step by step practical hands on skills on 1-2 volunteer clients/day, per student group. This portion of the course will be taught in a nursing lab or foot care clinical setting, and will cover all advanced nursing foot care skills required to complete FCN Part 2, including: risk assessments, treatment, development of individualized treatment plans, referrals and health education.
 
Day 4 & 5 (16 hours) - The final two days of the course will provide students with clinical experience in a foot care clinical setting with 4 volunteer clients/day, per student group.

FCN Part 2 Registration  

Tuition for Part 2 is not included in tuition for Part 1. We strongly encourage all interested students to apply for FCN Part 2 during their first month of participating in Part 1. The Part 2 component of the FCN course runs on a 'first come, first served basis' and requires a minimum number of students per class.     

Please visit the FCN 2 (Clinical) page of the Foot Care Kingston website for a list of Part 2 locations and location-specific Policies and Procedures Manuals. These Manuals provide the following details for your location of choice: 

  • Course Outline
  • Course Dates and Registration Deadlines
  • Contact Information
  • Location(s)
  • Education Team Biographies
  • Registration Requirements and Process
  • Tuition
  • Tuition Refund, Course Cancellation and Waitlist Policy
  • Instruments and Supplies
  • Privacy and Confidentiality Standards
  • Dress Code
  • Unique Facility-Specific Policies and Procedures
Students must read the instructions in the Policies and Procedures Manual for their Part 2 location of choice, for details on how to register for Part 2 of the FCN course. As part of the registration process, students are to contact their Part 2 location to request location-specific documents and forms that must be reviewed prior to registration. Once reviewed, students must list the name of these forms/documents below, complete the section at the bottom of the page and email a scan or clear copy of this page to their Part 2 location.
 

Name of location-specific form/document reviewed                                                                              Date document last updated

1. _______________________________________________________________________                 ______________________

2. _______________________________________________________________________                 ______________________

3. _______________________________________________________________________                 ______________________

4. _______________________________________________________________________                 ______________________

5. _______________________________________________________________________                 ______________________

6. _______________________________________________________________________                 ______________________

7. _______________________________________________________________________                 ______________________

8. _______________________________________________________________________                 ______________________

9. _______________________________________________________________________                 ______________________

10. _______________________________________________________________________                 ______________________

In signing this document, I confirm that I have read this FCN Part 2 Course Outline, reviewed the Policies and Procedures Manual for my location of choice, read all additional location-specific forms/documents listed above and read the Equipment Purchase Requirements.
 
 

___________________________________             ___________________________________            ____________________________________
Name                                                                  Signature                                                           Date