The human touch: OHSU School of Nursing foot soak & listening clinics

The air is filled with the smell of eucalyptus, peppermint, and lavender. Soft conversations can be overheard, 

“We’re not going to fix it in one week, but if you come see us every week, we can turn that around.” 

“Are you sleeping outside right now?” 

“If you want to, I’ll get you connected with them.” 

The OHSU School of Nursing foot soak clinics are anything but clinical. Rachel Richmond, M.S.N., R.N. who is the Clinical Assistant Professor for the OHSU School of Nursing campus in Ashland oversees this program, which is part of a larger Street Nursing community outreach public health initiative. She and her nursing students hold these clinics at the OHRA Center and the OHRA Shower Trailer every Thursday. It all started 8 years ago when Rachel, and Patricia Schein, the Medical Director for Outreach Programs at La Clinica, were inspired by a speaker at Boston Healthcare for the Homeless about a foot soak clinic in Boston and decided to start their own.  

Rachel shares, “We don’t wear scrubs. We don’t wear name badges. We are meeting people human to human. We always sit below the level of our patients by design. It says, ‘You are a human who deserves dignity and respect.’ We are purposefully reversing the power structure that typically exists in healthcare settings. Patients say to me all the time ‘I’m kind of isolated in the community.’ We talk about everything with them. Sometimes it’s about trauma, sometimes it’s about their favorite kind of music.” 

The term clinic is used loosely– it’s more about the therapeutic listening and building a connection. The foot soaks are just a place to meet people where they are. Rachel says “My goal of doing this as a nurse educator is to address bias and stigma around people who are unhoused as they enter the healthcare system. People jump to conclusions about people who are unhoused or struggle with substance use disorder.” 

The approach is called “street as classroom”. The idea is that if you immerse students in the culture of unhoused folks, they can shift their biases and open their eyes to the systems in place that are keeping people homeless. The foot soak clinics are part of a larger community outreach program that includes medical appointment advocacy, site visits to parks and camps on the Greenway, and more. Each term, 6-8 students deeply immerse in the street nursing program. The long-term vision is to bring street nursing teams to all six OHSU campuses and create an “intersectionality of homelessness” curriculum that every nursing graduate would complete. In a recent study completed, it was found that students experience a shift in their personal bias about people who are unhoused after just one shift at a foot soak clinic.  

OHSU School of Nursing student Alyssa with a guest.

Billy is a street minister of 32 years, a resident of Ashland, and a foot clinic patient. When asked how he felt before and after visiting Rachel and her team, he said, “Before? Like crap. After? Like I’ve been in heaven.” Billy shared that he had gotten housed 4 years ago, but unfortunately is living outside again after being evicted during the pandemic.  

Foot soaks include essential oils, Epsom salts, wound care, and conversation. For some people living in the rough, the foot soak clinic might be the only human touch they experience. The biggest issues seen by Rachel’s team are trench foot and hypothermia. With recent grant funding, they were able to buy new boots to distribute to their patients. Also, the company Bombas donates a large volume of socks to programs like the OHSU street nursing team and OHRA. Rachel says “Your feet are your home. Especially if you’re living outside and collecting cans and bottles.” Many people living on the street also experience something that Rachel refers to as ‘tri-morbidity’ – a physical health condition, a mental health condition, and substance use disorder. 

Alyssa is currently one of the students deeply immersed in the street outreach program. She’s the youngest person in her class at 22 years old. This street outreach program was her first choice of the placement options this term. In just 7 weeks, the program has had a profound impact on her. She shares, “It’s been very eye-opening. You walk past people who are homeless every day and you just don’t stop and look. You don’t think about it. People see them as just an extension of the sidewalk.” 

Since working with this program, Alyssa has also learned more about the other resources available to unhoused patients – like Max’s Mission, the free meals for people who are unhoused, and OHRA. “I know so much more about the community that I’ve lived in my whole life.” Alyssa says, “I think it’s important for healthcare providers to know about community resources so they can provide information.” Rachel calls Alyssa ‘Superwoman’.  

When asked what she loves about the foot soak clinics, Rachel explains, “Just meeting Billy and other friends on the street. It’s such a gift to hear all these stories every week. We are so lucky to peek into people’s worlds and make these friendships. Seeing the shift in these students when they spend a full term with me, and how they interact with this marginalized group of people – it’s amazing.” 

Rachel and her team of street nurses are a force of good in this community. Their program is creating meaningful change right now for people who are experiencing homelessness. Beyond that, they are seeking to educate the healthcare workers of tomorrow and dismantle the bias that exists towards people who are unhoused — creating a brighter future. 

Written by OHRA



April 13, 2023