S117. Personal Care: Nail Care
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Personal Care: Nail Care Policy
Aim and Scope of Policy
This policy describes {{org_field_name}}’s approach to the care of the person’s nails, as agreed from their needs assessment and individual care plan. The service considers that finger and nail care is an important part of personal care. Having healthy nails helps to maintain pride in one’s appearance, self-respect and dignity and, with toenails, comfort and mobility.
The policy is in line with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to provide safe, person-centred care that always maintains people’s dignity and respect.
Nail care involves cleaning, cutting and filing, which can be carried out as self-care or by others who are trained and competent in the procedures involved. Consent is always obtained for any nail care, which is proposed or provided and, where the person who uses services cannot give his or her consent because of mental incapacity, a decision to provide nail care might need to be taken following a best interests’ assessment and decision. Where nail care is provided, the service will always ensure that the person is treated with dignity and respect throughout the procedures and that his or her preferences and choices are always respected.
Policy Statement
Fingernail care
The service meets individual needs or requests for help with fingernail care in the following ways.
- People using care services who want to attend to their own nail care and should have or be provided with their nail cleaning and manicuring equipment. The service discourages sharing of nail cutters and files as an infection control measure. Equipment is appropriately cleaned after use.
- The needs assessment might indicate that a person needs to be supported to keep their fingernails clean either by prompting or the care worker actively cleaning the nails with the use of a nail brush or file to remove debris.
- The service will support people who want to have (and will pay for) a manicure from an outside beautician, helping with the arrangements where appropriate.
- Care staff who provide fingernail care by cutting and filing will have training in the procedures involved so that they have the necessary competence.
- All fingernail care activities will be carried out under the applicable health and safety measures, including back safety, posture, protective clothing, correct positioning and any manual handling involved.
Toenail care
The service considers that toenail care should be provided as part of general foot care and always following a medical or podiatric assessment of the treatment that is required. It might then meet needs or requests for help with toenail care in the following ways.
- If trained and competent, care staff might contribute to general foot hygiene and care, eg replacing plasters and dressings.
- They are expected to discuss with the person receiving their care any need to refer foot ailments and conditions, which they become aware of, for medical or specialist podiatric assessment.
- Their role regarding nail care will as a rule be restricted to filing if trained and competent in the procedure involved.
- In line with local procedures, they might, under the guidance and supervision of a qualified podiatrist or foot care specialist and after suitable training and assessed competence, carry out some nail cutting as well as filing.
- However, wherever available, the person will be encouraged to receive their toenail care from a trained chiropodist/podiatrist or it will arrange for this.
- Any toenail care provided will be carried out under the applicable health and safety measures, including back safety, posture, protective clothing, correct positioning and any manual handling involved.
- For people who use services suffering from Covid-19 they will be checked for signs of a skin condition known as “Covid toe” which has been reported and may be a side effect of the immune system’s response to fighting off the virus. Chilblain-like inflammation can occur on both the hands and feet but for those who have been vaccinated, the occurrence seems to be reduced.
Diabetes
Poorly controlled diabetes can lead to a range of foot problems. People who use services with diabetes may suffer from a variety of complications with their feet and require specialist assessment with the appropriate treatment and at least annual assessment.
Common issues include:
- diabetic foot ulcers which can take months or years to heal. These may lead to infections, sepsis, the need for limb amputations and even death
- gangrene can occur in very severe cases and caused when there is no longer sufficient blood supply to keep toes or feet alive and they begin to turn black. In some causes surgery can be performed to improve circulation, but in many cases surgical removal (amputation) is necessary
- care staff will not carry out toenail care, ie filing, with anyone with a diagnosis or history of diabetes without a full up-to-date podiatric assessment having been made — following the recommendations that people with diabetes should have an annual foot care review — and from which it has been confirmed that there are no complicating conditions
- the service recognising that people with diabetes will require specialist diabetic foot care, the availability of which and access to will depend on local policies and service provision.
Training
Care staff receive training in the finger and toenail procedures that they can carry out in their role from qualified beauticians/chiropodists/podiatrists.
The service encourages its care staff with a corresponding interest and involvement to complete unit HSC 2017, Provide Support for Foot Care, which is awarded at Diploma in Health and Social Care Level 2. [This unit is for care workers who provide foot care for individuals as specified by a podiatrist. It covers the practical treatment of feet as well as knowledge about common conditions of the feet]. Staff who complete this unit might also become “foot care champions” for the service, providing guidance, supervision and being a resource to colleagues.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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