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WOCNB WOCNCB-CFCN Certified Foot Care Nurse (CFCN)

Domain I: Assessment and Care Planning

Task 1: Obtain focused patient health history (e.g., current medications, co‐morbidities, health habits) through interviews, established medical records, and questionnaires in order to determine the patients current health and risk status.

- Medications
- Diseases affecting the lower extremities
(musculoskeletal, endocrine, neurological, vascular, integumentary, etc.)
- Health behaviors affecting lower extremities (smoking, diet, obesity, activity level, etc.)
- Active listening

Task 2: Perform focused lower extremity physical exams in order to determine current physical (e.g., vascular, neurological, skin integrity, musculoskeletal) and mental status.

- Methods for mental health exam
- Methods for pain exam
- Pain types (neuropathic, musculoskeletal, ischemic, etc.)
- Anatomy and physiology of the lower extremities (foot, nails, bone structure, etc.)
- Functional disabilities (gait, mobility, balance, visual, cognitive)
- Factors reflecting vascular status (temperature, hair growth patterns, pulses, blanching, capillary refill, dependent rubor, pallor, edema)
- Indicators of compromised skin integrity (fissures, ulcers, corns, calluses, dermatitis)
- Physical/musculoskeletal function of the foot (range of motion, deformities, strength)
- Neurological status of the lower extremities (sensory, motor, autonomic)
- Palpating pulses (dorsalis pedis, posterior tibialis)
- Using a Doppler
- Determining ankle brachial index (ABI)
- Performing monofilament, vibratory, and proprioception tests

Task 3: Develop an initial patient‐centered plan of care using health history and physical exam information to meet established foot care goals.

- Principles of patient‐centered care
- Normal and abnormal physical exam results
- Appropriate interventions (education, treatments, referrals)
- Cultural and ethnic differences affecting foot health
- Interpreting patient exam results
- Setting appropriate goals based on identified patient needs
- Planning interventions based on patient needs and goals

Task 4: Perform ongoing evaluation and modification of the patient‐centered plan.

- Principles of patient‐centered care
- Anticipated responses to current interventions
- Appropriate modifications based on responses to interventions
- Interpreting patient responses to interventions
- Modifying goals based on patient response
- Modifying interventions based on revised patient needs and goals

Domain II: Intervention and Treatment

Task 1: Perform skin care on feet and lower extremities using appropriate skin care products in order to promote optimal skin health and integrity.

- Integumentary system
- Skin cleansing principles
- Skin moisturizers (humectants, emollients)
- Barrier products (dimethicone, petrolatum, zinc‐based products, etc.)
- Topical medications
- Selecting and applying appropriate skin care products (cleansers, moisturizers, medications)

Task 2: Recommend treatment and/or provide care for dermatological conditions affecting the feet and lower extremities using appropriate skin care products in order to promote optimal skin health and integrity.

- Integumentary system
- Signs/symptoms of skin impairments/abnormalities (blisters, hyperkeratotic lesions, stasis dermatitis, fissures, verucca vulgaris, trauma, tinea pedis, paronychia, maceration, hemosiderosis, etc.)
- Skin cleansing principles
- Skin moisturizers (humectants, emollients)
- Barrier products (dimethicone, petrolatum, zinc‐based products, etc.)
- Topical medications
- Management of hyperkeratotic lesions
- Applying skin care products (cleansers, moisturizers, medications)

Task 3: Implement offloading interventions utilizing offloading products in order to promote optimal skin health and integrity and prevent further injury (e.g., ulceration, callous formation, deep tissue injury).

- Appropriate footwear (shoes, socks, hosiery, inserts)
- Offloading principles to reduce and/or redistribute pressure, friction, and/or sheer
- Offloading and padding products (orthotics, lambs wool, moleskin, felt padding, silicone products, etc.)
- Applying offloading and padding products
appropriately

Task 4: Perform nail care and debridement using appropriate instruments in order to promote comfort and optimize function.

- Nail anatomy
- Onychopathology (onychomycosis, onychocryptosis, paronychia, etc.)
- Personal protective equipment (PPE) guidelines
- Debridement techniques
- Instrument sterilization guidelines (cold sterilization, autoclave, etc.)
- Identifying free nail border (nail debris)
- Appropriately selecting and using equipment (rotary powered instrument, nippers, etc.) for nail care and debridement

Task 5: Identify lower extremity wounds (i.e., venous, arterial, neuropathic, traumatic, and pressure ulcers) and make wound care treatment recommendations and/or referrals that support the goals of care.

- Characteristics of wound types (venous, arterial, neuropathic, traumatic, pressure ulcers)
- National Pressure Ulcer Advisory Panel (NPUAP) pressure ulcer staging system
- Wagner grading system for diabetic foot ulcers 020503
- Principles of moist wound healing 020504
- Principles of basic wound care 020505
- Appropriate topical treatment to maintain periwound integrity
- Dressings for moist wound healing (containment of drainage, eliminate dead space, reduce bioburden, control odor, debridement, etc.)
- Compression therapy (indications and contraindications)
- Advanced wound therapy (electrical stimulation, bioengineered tissue, negative pressure wound therapy, hyperbaric oxygen therapy)
- Selecting and applying dressings
- Educating patients and caregivers regarding wound healing (infection, tobacco cessation, nutrition, optimal health choices, causative factors, etc.)

Domain III: Education and Referral

Task 1: Instruct patients and caregivers on foot care principles (e.g., hygiene, footwear, daily foot inspections) and disease, lifestyle, and/or age‐related processes to prevent complications, maintain optimal foot health, and encourage patient autonomy.

- Preventive skin care strategies
- Disease processes and conditions affecting feet and lower extremities (arterial disease, venous disease, neurological disease, diabetes, autoimmune, arthritis, trauma, etc.)
- Age‐related processes affecting feet and lower extremities
- Health habits affecting feet and lower extremities (activity level, exercise, obesity, diet, smoking, etc.)
- Assessing patient health literacy (learning style, readiness to learn, barriers to learning, current understanding, etc.)

Task 2: Collaborate with interdisciplinary healthcare professionals and make appropriate referrals to support patient‐centered goals of care.

- Available healthcare‐related resources
- Roles and responsibilities of specialized healthcare providers (vascular specialist/surgeon, endocrinologist, podiatrist, orthopedic surgeon, dermatologist, pedorthist/orthotist, pain management specialist, diabetic educator, wound care specialist, etc.)
- Health care delivery systems
- Communicating with members of the interdisciplinary team
- Navigating health care systems (identifying and accessing programs for specific lower extremity disease processes)