OPHTHALMIC NURSING

ETHICS

A PRESENTATION ON DEALING WITH THE

RELATIONS OF OPHTHALMIC PATIENTS BY

GROUP SEVEN (7)

COURSE CODE: BOPN 311

DEALING WITH THE RELATIONS OF OPHTHALMIC
PATIENTS. (VISUALLY IMPAIRED)
INTRODUCTION
• A patient with visual impairment may be anxious or fearful about lost
sight. Relations of such patients as well may go through a state of
psychological, physical and emotional stress.

• Patients with visual impairment may be unable to perform their usual

activities of daily living, therefore may need to change their leisure or
general activities. Hence these patients need the maximum support of
their families or relations and coping strategies.
DEFINITION OF VISUAL IMPAIRMENT

• Visual impairment known as vision loss or blindness is a decreased

ability to see to a degree that causes problems not fixable by usual
means such as use of glasses.

• Some also include those who have a decreased ability to see because
they do not have access to glasses or contact lenses. World Health
Organization (2015).

• It is the functional limitation of the eyes. Conrad Stopples MD.

(2017).
CLASSIFICATION OF VISUAL IMPAIRMENT
Loss of vision can occur suddenly or develop gradually over time. The
types of vision loss include the following;

• Partial blindness: this may include colour blindness, photophobia,

diplopia, and night blindness among others. In partial blindness, the
individual is not able to see to some extent with one or both eyes or it
can involve certain parts of the visual field.

• Complete or Total blindness: it is a condition in which an individual

is not able to see anything at all from both eyes.
 CONT’D
The world health organization uses the following classifications of
visual impairment;

• Mild visual impairment; presenting visual acuity worse than 6/12.

• Moderate visual impairment; presenting visual acuity worse than

6/18.

• Severe visual impairment; presenting visual acuity worse than 6/60.

• No perception of light – this is considered total vision loss or

complete blindness.
 CAUSES OF VISUAL IMPAIRMENT

Visual impairment may be due to multiple reasons. It could result from

conditions affecting the eyes or conditions affecting the visual
processing centers in the brain. Some causes may include;
• Congenital.
• Infection of the eyes.
• Underlying diseases such as; diabetic retinopathy, hypertension.
• Trauma to the eye.
• Complications resolving from surgery.
• Uncorrected refractive errors.
 CONT’D

• Conditions affecting the eye such as cataract.

• Age related macular degeneration.
• Corneal clouding.
• Prematurity.
• Stroke.
• Amblyopia.
• Hereditary diseases of the eye such as glaucoma.
• Chemical poisoning from toxic agents such as manitol.
WHO ARE THE RELATIONS OF THE VISUALY
IMPAIRED PATIENT?

The relations of visually impaired patients are those caring for the
patient at home. Among them may include;
• Parents.
• Children.
• Siblings.
• Friends.
• Spouses.
• Neighbours.
• Care takers.
• Other family members.
CHALLENGES FACED BY RELATIONS DURING THE
CARE OF VISUALLY IMPAIRED PERSONS

When an individual loses his/her sight, their relations are also affected
as well. This may result in the relations facing certain challenges such
as;
• Depression.
• Financial challenges.
• Physical and psychological stress.
• Inadequate knowledge on how to care for the visually impaired
relation.
 CONT’D
Making yourself available to someone in need can cause emotional
strain.

Being there for someone can also damage provider’s attitude. Relations
can turn to see the patient as weak and needy and this can be harmful to
the relationship between them, especially if the patient was previously
self-reliant and independent. (Shumaker & Brownell 1984).

To overcome the challenges faced by both the patient and their

relations, there are a number of ways the ophthalmic nurse can help
through educating the visually impaired patient and their relations.
SIGNS AND SYMPTOMS OF VISUAL IMPAIRMENT
Visual impairment can range from mild to severe. Adults with visual
impairment may feel reluctant to seek health care; therefore, there is the
need for their relations to be made aware of the common signs and
symptoms associated with vision loss and encouraged to observe these
changes in the person’s behavior.

The following signs and symptoms may be observed;

• Severe sudden eye pain.

• Recurrent pain in or around the eye.
• Seeing flashes of light.
 CONT’D
• Seeing rainbow or halloos around light.
• Seeing a curtain coming down over one eye.
• Unusual even painful, sensitivity to light or glare.
• Swollen red eyes.
• Itching, burning or a heavy discharge in the eyes.
• They may be observed not looking directly at someone during a
conversation.
• Reaching in front of or beyond an object.
• Holding objects very close or very far to see them.
• Turning or tilting the head when the eyes are being used.
• Looking above, below or off to one side of an object, rather than directly at
it.
• Bumping into objects and having a lot or trouble seeing in the night.
 CONT’D
• Feeling for objects on the ground instead of looking with the eyes.
• Needs finger or maker to keep place when reading.
• May complain of blurred vision or seeing double.
• Squints, closes or covers one eye.
• Blinks excessively.
• May consistently show gross postural deviations when sitting.
• Complains of discomfort in tasks that demands visual interpretation.
• Rubs eyes during or after short period of visual activity.
• Request for more or different lighting.
COPING STRATEGIES FOR THE VISUALLY
IMPAIRED PATIENTS AND THEIR RELATIONS
Understanding the concept of the needs of the visually impaired and
how best to address them is very essential. Maslow’s (1954) five-stage
hierarchy of needs model serves as a useful basis for considering these
needs.
The model is underpinned by the theory of human motivation, which
has five classes of need arranged in hierarchical order from the most
basic up to the highest level. Gratification of needs is the key concept of
this theory. When a need is gratified at one particular level, the next
highest need emerges.
This theory translates into practice ways the ophthalmic nurse can help
relations meet the needs of both young and older patients with visual
impairment.
PHYSIOLOGICAL NEEDS

• The significant biological and physiological needs of patients with

visual impairment are those associated with eating and drinking. It is
obvious that a visually impaired patient will have difficulty with
feeding. The degree of a person’s visual impairment will determine the
degree of assistance required with eating and drinking.

• The ophthalmic nurse should ask the relation to cut up food into small
manageable portions before serving it to the visually impaired person
especially for a child. They should also ask the individual whether he/
she will need some assistance during meal. The individual should also
be informed where items such as cutlery, cup or glass and plate have
been placed on the table. If possible, let them feel for it.
 CONT’D
• Overfilling of cups or glasses, especially with hot fluids, should be
avoided so as to prevent any spilling and potential scalding of mouth
and lips. The level of the liquid should always be indicated to the love
one. With cool liquids this can be done by allowing the individual to
feel for the level of the liquid by placing his or her index finger just
inside the vessel.

• The personal hygiene of the visually impaired person is also very

important. Therefore there is the need for the relation to make
necessary arrangements in helping the love one out either by assisting
or supervising him or her and also ensuring privacy to prevent them
from feeling uncomfortable or embarrassed.
 CONT’D

• To ensure rest and sleep, relations should provide a low bed free from
creases. Also the light in the individuals room should be adjusted
according to his/her preference during sleep. A well ventilated room
should also be provided to enhance sleep.
SAFETY NEEDS
• According to Moore and Miller (2003), visual impairment in older
people has been associated with falls that often result in fractures,
dislocations, and lacerations. Limited mobility and difficulties in
carrying out the activities of living are also associated with visual
impairment.

• Undoubtedly, a love one with visual impairment experiences some

degree of disorientation as a result of lost sight. Escorting the visually
impaired person around his/her environment as and when required
will help meet the need for safety, promote some orientation and instill
a feeling of security.
 CONT’D
• The patient must always be asked sensitively whether help is required
and then be allowed to take the relation’s arm or hand. The care giver
should walk one step ahead, giving appropriate directions, and warn of
any impending obstacles along the route.

• When approaching a door, the relation should stand on the same side
as the door handle, open the door, step through and hand the door
handle to the love one, who then has control over closing the door.

• When negotiating a narrow space, the relation should place his/her

arm behind the back of the patient and should ask the visually
impaired person to walk behind. When approaching stairs, the guider
should be one step ahead of the love one, giving instructions as to
whether to step up or down.
 CONT’D
• Relations must take responsibility for instigating safety measures, such as good
lighting, placing a bedside locker on the side of the room of the individual, and
also, a call bell can be placed within easy reach. Appropriate supervision must also
be provided when the individual needs to visit the wash room.

• Relations must also assist the individual with taking of medications, checking of
blood sugar levels and administration of insulin in cases where the individual has
diabetes and ensuring that the visually impaired persons adhere to the review dates
especially with the ophthalmologist.

• Rearranging of items in the house is also necessary. All items that could be
harmful to the visually impaired person should be labeled and kept at safe places.
Relations must also teach their love ones with visual impairment basic things that
they can do on their own to prevent home injuries.
BELONGING NEEDS
• A compassionate and empathic approach is needed in establishing a
caring relationship with the visually impaired. Relations must note
that, older people with visual impairment may also have hearing
deficits and mobility problems. Patience and good listening skills are
essential when caring for them.
• These skills are especially important when communicating and
teaching the visually impaired person how to care for him or herself.
This may mean modifying practice; for example, it is vital for the
relation not to only call out the love one’s name when he or she is
about to be seen but also approaches the patient, so as to establish
contact.
• In the absence of vision, touch is the next most important sense. Thus,
when approaching the affected individual, the relation should
introduce him/herself by extending a warm, calm and welcoming
greeting. Loveridge (2000) suggests that touch can assist in developing
a therapeutic relationship.
ESTEEM NEEDS

• The visually impaired person will find it difficult navigating around the
environment they were previously used to due to loss of sight. It is therefore
necessary for their relations to reorient them around their immediate
environment.

• During this period, it is helpful to show them the layout of the house by
allowing them to ‘feel’ their way to areas such as the bathroom, toilets and
social area. This means placing their hands in contact with the physical
structures of the environment; for example, a wall or a piece of furniture.
This will help not only their orientation but also their balance. Walking aids
can also be provided to assist them when walking.

• More importantly, it helps to encourage some independence, which is

conducive to promoting confidence and maintaining self-esteem. Similarly,
the relations should make them aware or introduce them to any other person
or persons who come around, in order to establish social orientation and
acceptance.
 CONT’D
• When the relation approaches the visually impaired person to speak to him
or her, it is important to speak in a normal tone of voice, as this is non-
threatening. Often there is a tendency to speak loudly just because the
patient happens to have visual impairment.

• When there is the need for something to be done for the visually impaired
person, the relation should give advance warning of approaching by starting
to speak before reaching the bedside so as not to startle him/her. Similarly, a
verbal indication when leaving the room or side of the visually impaired
person minimizes the embarrassment of the person’s continuing a
conversation in the relation’s absence.

• Some people feel that their visual impairment has threatened their identity,
as they have to make a number of psychological, emotional, and intellectual
adjustments to their loss of sight.
 CONT’D
• Helping them to regain some control over their condition may be the way to
help to restore their self-esteem and confidence. For example, relations
helping, directing and teaching the visually impaired persons to take their
own medications safely and be able to perform some activities of daily
living with minimal or no assistance, signal their re-empowerment as
individuals.

• Confronting progressive visual loss means having to become more self-

aware and more knowledgeable about creating personal strategies for
maintaining an acceptable lifestyle.

• In view of this, relations of visually impaired persons can play the role of
helping them acquire information from health care facilities about low-
vision aids such as talking books, large-print reading materials, small hand-
held magnifiers, and telescopic devices which can facilitate their adaptation
to visual loss and the utilization of rehabilitation strategies.
 CONT’D
• Similarly, they helping the visually impaired persons to resume
general social activities, skills, hobbies and travelling can facilitate the
maintenance of family and peer contact.

• This often helps to prevent the onset of depression; a well-documented

psychosocial implication of visual impairment. Indeed, recent visual
loss is one factor that has been linked with difficulties in carrying out
daily activities, diminished sense of well-being, and depression
(Moore and Miller, 2003).
SELF-ACTUALIZATION NEEDS

• This stage refers to the need to find self-fulfillment and realize one’s
potential. For the patient who has visual impairment, this translates into
being able to optimize the current level of vision so as to be able to continue
to achieve personal growth and development and fulfill any personal
aspirations.

• Visual impairment can result in a loss of status, responsibility and a sense of

achievement. This can often disrupt roles and create economic demands and
stress within the patient’s family (Moore and Miller, 2003).

• The need for continued personal growth and self-fulfillment therefore

becomes significant. The nurse can help by encouraging the patient and
his/her relation to view any potential problems caused by visual impairment
as challenges and situations requiring solutions rather than as
insurmountable problems.
 CONT’D

• For example, patients with low vision who enjoy reading or need to
continue to read extensively as part of their job or study could be
informed that visual reading may be supplemented with speech output
devices such as spoken computer programs and books on audiotape.

• In addition, providing the family with information about the functional

implications of visual impairment will increase understanding of the
behavior and feelings of the family member with the visual loss.

• This will facilitate the individual’s continued personal growth, and is a

basis for the realizing of his or her potential.
CONCLUSION
Maslow’s five-stage hierarchy of needs model offers a means of raising
awareness of the care requirements of both young and older patients
with visual impairment. Using the model has highlighted the challenges
involved when planning and managing their care.

Meeting individual needs through effectively managed care by the

relations may help to make a difference to patients with visual
impairment.

Effective communication is instrumental in achieving this, and remains

the single most important aspect of nursing practice. Ophthalmic nurses
should be able to provide the effective communication and care
management skills required to meet the special needs of patients who
have visual impairment, their families and significant others.
REFERENCES

• Kasper, D. L., et al., eds. Harrison’s Principles of internal medicine,

19th Ed. United States: McGraw-Hill Education, 2015.
• Visual Impairment In The Elderly And What Care Givers Should
Know. A Literature Review by Henrietta Asante Edwin, 2013.
• Lehman, S. S. Cortical Visual Impairment In Children, 2012.
• Https//:www.medicineNet.com.
• Https//:www.visual impairment from KidsHealth.org.