KOKOMO, Ind. — Plastic wrap, a cheap tube of lipstick, and a little plastic foam can be used in a pinch to prevent a diabetic person from losing a foot due to a wound.
Dea Kent, interim family nurse practitioner track director at Indiana University Kokomo, demonstrated the technique during a summer class, office procedures for the advance practice nurse. It’s just one of the hands-on activities offered, including several she developed during the COVID-19 pandemic when she taught the class virtually.
“A lot of it was innovation birthed out of necessity last year,” she said. “We had to come up with simulations with items the students could get easily. It worked well. By the time clinicals started again, the providers they work with said they were stellar.”
She had used avocados to teach wound management before and added using oranges or grapefruit to practice scrape biopsies; chicken thighs, hot dogs, and banana peels for suturing; and art clay to make hands to practice removing fishhooks correctly.
“Last summer we saved all the bananas and citrus fruit of the world,” she said with a laugh.
In this class, students partnered up to practice diabetic offloading, or minimizing or removing weight placed on the foot to allow wounds to heal, especially those caused by poor circulation in the feet because of diabetes.
As primary health care providers, she said, family nurse practitioners can recognize these kinds of wounds and refer a patient to a specialist. However, most times the patient will wear the same shoes between the referral and the appointment, risking additional damage to the foot. Her goal was to show them how they could use items they might find in their clinic to minimize the risk.
Working in pairs, one student wrapped the other’s foot with plastic wrap, then outlined and colored in a place a wound could be on the foot with the lipstick, slipped a surgical shoe over it, and had the patient stand up and put weight on it, rubbing like he or she was squishing a bug.
After removing the shoe, the lipstick left a transfer inside it, which could be cut out to leave a hole for the wound, removing pressure from it inside the shoe.
Kent also provided foam pads, which could be stuck inside the shoe to make the hole deeper, for a larger wound. If no surgical shoes are available, she said, they could cut into the patient’s existing shoe if necessary.
“If it’s going to be a matter of amputation or a new pair of Converse, a new pair of Converse is OK,” she said. “Remember, the sole purpose of all of this is to prevent an amputation.”
Miranda Mitchell carefully used a pair of surgical scissors to cut foam to place in a surgical shoe for classmate Jake Barnes, fitting it in for him to try on.
“I like learning hands-on, because you can visualize it better if you are doing it yourself, rather than reading about it,” she said.
Kelly Jones said she showed her husband, who fishes, the art clay hand she made, and the technique she learned on that hand to remove a fishhook.
“The dough gave a good simulation of how the skin would be damaged if you just pulled the hook out with a barb,” she said. “You see why you don’t want to do that to your patient and hurt them further trying to take it out.”
Michele Lawson noted that she works with a medically undeserved population and has enjoyed learning new ideas for treatment when resources aren’t available, like the diabetic offloading.
“I like that this idea could even be done with a regular shoe,” she said. “Sometimes you have to make do with what you have.”