What should the nursing assistant do first when dealing with a resident who has a visual impairment Lo 2 )?

Better patient outcomes usually come down to great communication.

Not assuming anything, being clear, empathetic, and speaking in layman's terms.

But, the challenge increases for eye health practitioners.

With 55 per cent of meaning communicated through body language, and only seven per cent through spoken word[1], it is imperative health professionals maximise their communication skills for blind and low vision patients.

Psychologist Courtney McKee, who herself has low vision, regularly sees clients who have had bad experiences in consulting rooms.

“Health professionals know their specialty so well, they can tell you the ins and outs of a condition, but sometimes forget how important good communication can be,” she said.

“Give the patient the control in a situation; address them, not their carer or family member; explain the examination process before you touch them; and provide good verbal instructions that they can understand.”

Caption: Psychologist Courtney McKee.

Here are simple tips to communicate better with blind and low vision patients:

Identify yourself Don't assume the person will recognise you by your voice. Eg. “Hi Donna, it’s Dr Smith. How’re you?” Similarly, say goodbye when you finish a conversation and indicate when you are leaving the room. Eg. “Hi Donna, I’m heading off now. See you soon.”
Talk to the patient, not their carer or family member Remember, they’re not deaf. Address the patient, and if they’re over 18, they should be the one making the decisions on their healthcare.
Continue to use body language This will affect the tone of your voice and give a lot of extra information to the person who is blind or has low vision.
Use everyday language Don't avoid words like "see" or "look" or talking about everyday activities such as watching TV or videos. Also use accurate and specific language when giving directions. For example, "the door is on your left", rather than "the door is over there".
Always ask first to check if help is needed Don’t assume you know better. Ask the patient if they would like some assistance. Don’t grab their arm, announce what you’re doing first. Eg. “Would you like to take my arm and follow me to the consulting room? I’ll walk you to the chair.”
Avoid situations where there is competing noise This is a good general consulting tip for sighted patients too. Noisy rooms are particularly distracting to patients as they can’t give their undivided attention. Tip: in particularly noisy environments, get the patient to repeat any directions you give so you are confident they have understood.
Announce what you are going to do When examining the patient, announce what they should expect. Eg. “Mrs Smith, I’m just going to use my hand to have a look at your left eye.”
Modify instructions to match the lived experience of the patient
For example, if the person has no central vision, they may not understand how to “look straight ahead”. So they may prefer you to direct them to move their eyes left, right, up and down until they are positioned correctly for the assessment.

After speaking to many patients going through consultations, Ms McKee said the best piece of advice she could give is refer people to support services early.

“Many say they wish their doctor had connected them with vision rehabilitation services early, either by speaking to them about these services directly, by training their reception staff to have this conversation, or by simply having written information (e.g. brochures) available in the waiting area.”

For more advanced help, the sighted guide technique is a good skill to learn when you greet people and assist them to move between the waiting room and your clinic room.

Vision Australia provides training in this skillset and can work with you and your reception staff.

Contact Vision Australia on 1300 84 74 66

For more tips in assisting patients with a vision condition, visit Vision Australia’s website information section.

[1] Mehrabian, A., & Wiener, M. (1967). Decoding of inconsistent communications. Journal of Personality and Social Psychology, 6, 109-114 & Mehrabian, A. (1968). Inference of attitudes from the posture, orientation, and distance of a communicator. Journal of Consulting and Clinical Psychology, 32, 296-308.

Community Eye Health. 2003; 16(45): 7–9.

PMCID: PMC1705868

Ophthalmic Resource Coordinator, Nurse Advisor, International Resource Centre, International Centre For Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT

Find articles by Sue Stevens

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As eye health workers, we give much attention to learning and teaching the importance of health education and the prevention and treatment of eye disease. Despite our gained knowledge, sadly, our efforts are not always successful and we are presented with the responsibility and challenge of caring for people who have to cope with visual impairment, perhaps for the rest of their lives. We have to understand their difficulties, recognise their abilities and learn how to cooperate and communicate with them in a social as well as hospital environment. It is often within the eye hospital itself that the lack in education of health workers and their understanding of the assistance needs of blind and visually impaired patients is all too evident.

Visually impaired and blind people come from all kinds of backgrounds. Many are elderly, some are young. They may be sportsmen and women, gardeners, farmers, chess players, teachers, typists, musicians, lawyers, housewives, computer programmers, physiotherapists, social workers, telephonists, parents……

Such people have many abilities and can achieve many things despite visual impairment or blindness, but there are times when they will appreciate and welcome practical assistance.

There are some general points to remember, which are really common sense and a matter of courtesy:

Always ask first before offering any help and do not be offended if it is refused. Some people have had very bad experiences of what a sighted person thinks is being helpful!
Be precise if giving instructions – giving directions by pointing and saying, ‘it is down there on the right’, is not much help and very thoughtless
The use of a white cane does not necessarily mean that a person is totally blind
In some countries a person is accompanied by a guide dog but the animal must never be distracted. Often it is the animal who receives attention and the owner ignored! Together they usually make a good working team and rarely need extra help
Once into a conversation, never leave without saying you are doing so. Do not allow the blind person the embarrassment of talking into the air!

Always treat a blind person normally; speak first and introduce yourself
Shake hands but only if a hand is offered
It is also politeness to look at him/her during conversation and adopt the same level of position, e.g., sit or stand
Do not be afraid of using normal language and include words like ‘look’, ‘see’, ‘read’, remembering that blind and visually impaired people have exactly the same vocabulary as sighted people
Explain noises and silences and do not shout
Do not expect or invite others to speak for blind people. Do not be afraid to ‘touch’ but be sensitive to cultural differences.

Always consider a person's age and any other disabilities
Never presume where the person wants to go. Ask for details of where and how he/she would like to be guided. It is not uncommon to see a person being propelled or steered, and at great speed! Go at their pace and, if there is space, walk side by side and always ‘hand to arm’
Trying to be helpful – but the patient would have felt more supported if the helper had walked alongside him
Photo: Sue Stevens
If there is a guide dog, but extra help is needed, approach and walk on the other side. The animal has been trained to understand that he is still in charge and responsible!
Give adequate room around obstacles and hazards and plenty of time for response if you need to say, “bend your head low to avoid this tree branch!”
Describe any sudden changes in the environment. It is also very important to explain changes in ground surfaces and especially when moving into wide open spaces, e.g., fields.

Tell your partner of the change in surroundings and then move your own guiding arm towards the middle of your own back
Your partner should automatically step in behind you, still holding your arm, and together you will be able to negotiate a narrow space.

It is important to take this manoeuvre (movement) very slowly; it is not an easy one to master
Tell your partner if the door opens towards you or away from you
Go through the door with your partner on the hinge side
Open the door with your guiding arm; your partner should place his/her hand against the door to feel the handle
He/she should then follow you through and close the door behind both of you.

Tell your partner whether the steps, stairs or slope go up or down. Going down is more difficult.
Allow your partner plenty of time to hold the handrail securely and judge the first step carefully
Go one step ahead and take a slightly longer stride on the last step to allow your partner space.

Never take risks!
Tell your partner if you are approaching a ‘kerb up’ or ‘kerb down’ (the step onto or off a pavement/sidewalk) and pause slightly before taking the step
Make sure you approach the kerb together – both facing, and at an equal distance from the kerb – taking extra care with rounded kerbs
Cross the road using the shortest distance and go straight across
Tell your partner if you are parting company after crossing the road and ensure they know which way they are facing.

Never propel or steer a blind or visually impaired person backwards into a seat!
Guide your partner to the seat and explain what type it is – e.g., upright chair, low sofa, armchair, stool
Ask them to let go of your arm and place their hand on the back or the seat of the chair
This is sufficient help as your partner will now be able to judge the height of the seat and will be able to sit safely and at his/her own pace.

Tell your partner if he/she is getting into the back or the front seat of a car and whether it is facing left or right
Place your guiding hand on the door handle and allow him/her to slide his/her grip hand down your arm to the door handle
With his/her other hand, the car roof can be noted and your partner will lower his/her head appropriately
At the end of the journey, get out of the car before your partner and help them out
Tell them if there are wider than average gaps to cross – this is particularly important when travelling by train!
Always lead your partner on and off public transport.
In rural areas, extra help may be needed when you and your partner have to negotiate getting on and off unstable modes of transport, e.g., carts, boats, etc.

The patient will expect eye health workers to know how to help them
Always apply all the principles mentioned above; be extra gentle and take time
Remember your patient is at the hospital because they cannot see well – sadly, an often seemingly forgotten point, even by the more senior or so-called experienced staff members!
Never be afraid to ask the patient's opinion about a situation specific to them and how they would like to be assisted
In the treatment room, always explain what you are going to do – and to which eye!
When providing written information, make sure it is in a readable size and font and pass it to an attending sighted carer for future reference
An unaccompanied patient who may be unable to hear, as well as having sight problems, may benefit from taped information to take away and share with family at home.

Eye health workers have a responsibility, and an important position, for teaching others about assistance to the visually impaired. But we must be seen to be practising what we teach. A community-based rehabilitation project in Uganda, some years ago, used a very appropriate and challenging means of raising awareness. They provided T shirts for the project team members with illustrations and slogans which read, ‘Don't pull me’ (front – see Fig. 9) and ‘Walk with me’ (back – see Fig. 10). Can you think of similar activities, perhaps?

The Royal National Institute for the Blind, UK.
Illustrations (Figs. 1–8) by Teresa Robertson.
My thanks are also due to the many visually impaired patients who have helped me to understand their needs and taught me how to help them.

Articles from Community Eye Health are provided here courtesy of International Centre for Eye Health