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Palliative Podiatry?

Discussion in 'Introductions' started by PodFelicity22, Oct 20, 2009.

  1. PodFelicity22

    PodFelicity22 Welcome New Poster

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    The public hopsital that I work at has been allocated palliative care hours for podiatry. It's only 0.1 EFT but I would like to have an impact on these palliative care patients. The Podiatry department has a good reputation among hospital staff and I don't want to compromise this by just cutting toenails for these patients.
    Is there another hospital out there that is providing podiatry services to pall care? If so, what is your role?

  2. Tuckersm

    Tuckersm Well-Known Member

    Hi felicity,

    We provide services to our Pall care facility, and nail care is part of it. These clients often have significant peripheral oedema making ingrown nails common. We also provide information etc. on pressure relief, and treat the associated pressure ulcers, but usually less agressively.
    Not all Pall Care patients are end of life, so footwear issues (again associated with oedema) are also addressed.
  3. cwiebelt

    cwiebelt Active Member

    Hi Felicity,

    At the hospital i work in we also provide services to palliative care clients, yes a lot of this is basic nail care and callus debridmant. I provide some basic tips for the carer or nusing staff eg suggest off loading the foot if confined to bed, use of moisturiser cream if skin is dry this i know is basic but still important.
    We have tried to educate both family, doctors and nusing staff which we see also is our role so as to provide a service to the client and those providing care to the client.
    we have given brief presentations to the medical staff, which has been a useful forum.

  4. cornmerchant

    cornmerchant Well-Known Member

    Hi Felicity

    As a Pod in private practise, a large part of my work is palliative. Unlike many pods, particularly NHS based 'specialists" I consider this "cut and come again" work, as it is often described, to be equally as important as other branches of the profession.

    It is not just nail cutting- far from it! As already pointed out, education re foot wear, pressure relief, creaming of dry skin , all the problems associated with aging, may be basic but nevertheless important to maintain mobility and prevent breakdowns/pressure sores. Often we may be the ones to pick up ulcers, ischaemia, cellulitis......to name just a few examples that come to mind from my own experiences.Many of my palliative cases are in fact high risk patients who are not seen by the NHS or find appointments too infrequent or very difficult to get to owing to mobility problems.

    Hope this helps, and you are able to make a difference!

  5. admin

    admin Administrator Staff Member

    Just to clarify the original posters question:

    Are you talking about palliative care (ie the cut and come again) or are you talking about providing podiatric care to patients who are in hospital for palliative care of their medical condition?
  6. Tuckersm

    Tuckersm Well-Known Member

    From Dept of Health
  7. cornmerchant

    cornmerchant Well-Known Member

    With resoect, I think that the meaning of "pallaitive care" in relation to podiatry has a slightly different connotation-routine maintenance maybe would better describe it. Maybe Felicity actually meant care of terminally ill patients?

  8. admin

    admin Administrator Staff Member

    Thats what I was trying to clear up.

    Interestingly, the Wikipedia definition of "palliative care" does fit that of the routine 'cut and come again' podiatry: "Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure."

    Palliative care

    Palliative care[1] is an interdisciplinary approach to specialized medical and nursing care for people with life-limiting illnesses. It focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness. The goal is to improve quality of life for both the person and their family.[2][3] Evidence as of 2016 supports palliative care's efficacy in the improvement of a patient's quality of life.[4][5]

    Palliative care is provided by a team of physicians, nurses, physiotherapists, occupational therapists, speech-language pathologists[6][7] and other health professionals who work together with the primary care physician and referred specialists and other hospital or hospice staff to provide additional support. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. Although it is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided across multiple settings including in hospitals, at home, as part of community palliative care programs, and in skilled nursing facilities. Interdisciplinary palliative care teams work with people and their families to clarify goals of care and provide symptom management, psycho-social, and spiritual support.

    Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected (as often happens in late-stage cancers). For example, tumor debulking can continue to reduce pain from mass effect even when it is no longer curative. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies.

    Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat pain related to an influenza infection.

    1. ^ "NCI Dictionary of Cancer Terms". National Cancer Institute. 2011-02-02. Retrieved 15 July 2014.
    2. ^ Ferrell B, Connor SR, Cordes A, et al. (June 2007). "The national agenda for quality palliative care: the National Consensus Project and the National Quality Forum". J Pain Symptom Manage. 33 (6): 737–44. doi:10.1016/j.jpainsymman.2007.02.024. PMID 17531914.
    3. ^ "Get Palliative Care". Retrieved 21 November 2014.
    4. ^ Kavalieratos, Dio; Corbelli, Jennifer; Zhang, Di; Dionne-Odom, J. Nicholas; Ernecoff, Natalie C.; Hanmer, Janel; Hoydich, Zachariah P.; Ikejiani, Dara Z.; Klein-Fedyshin, Michele; Zimmermann, Camilla; Morton, Sally C.; Arnold, Robert M.; Heller, Lucas; Schenker, Yael (22 November 2016). "Association Between Palliative Care and Patient and Caregiver Outcomes". JAMA. 316 (20): 2104–14. doi:10.1001/jama.2016.16840. PMC 5226373. PMID 27893131.
    5. ^ Hoerger, Michael; Wayser, Graceanne; Schwing, Gregory; Suzuki, Ayako; Perry, Laura (28 September 2018). "Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials". Annals of Behavioral Medicine. doi:10.1093/abm/kay077. PMID 30265282.
    6. ^ Chahda, Laura; Mathisen, Bernice A.; Carey, Lindsay B. (2017). "The role of speech-language pathologists in adult palliative care". International Journal of Speech-Language Pathology. 19 (1): 58–68. doi:10.1080/17549507.2016.1241301. PMID 27762632.
    7. ^ Krikheli, Lillian; Mathisen, Bernice A.; Carey, Lindsay B. (2018). "Speech–language pathology in paediatric palliative care: A scoping review of role and practice". International Journal of Speech-Language Pathology. 20 (5): 541–53. doi:10.1080/17549507.2017.1337225. PMID 28665209.
  9. PodFelicity22

    PodFelicity22 Welcome New Poster

    Thanking everyone for their input.
    I am more than happy to provide the 'cut and come again' service, but I wanted to look at podiatry as a more holistic approach to palliative care (that being pod tx for patients in palliative care of existing medical condition). Not all pall care patients are old and immobile so I am looking at being part of a medical team that is able to improve a persons quality of life. Is this something where podiatrists can offer other therapies? (acupuncture for pain relief, massage??)
    This podiatry dept has a strong representation for diabetic foot wounds, amputation management, pressure care and preventative care, all of which has been hard work to not be known as just 'the pedicurist'.

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