Which method would the nurse use to provide instructions to a group of visually impaired patients

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Five strategies for patient education success
1. Take advantage of educational technology
2. Determine the patient’s learning style
3. Stimulate the patient’s interest
4. Consider the patient’s limitations and strengths
5. Include family members in health care management
The value of patient education resources

DO identify yourself, especially when entering a room. Don't say, "Do you know who this is?"
DO speak directly to the individual. Do not speak through a companion. Unless they are hard of hearing, they can speak for themselves.
DO give specific directions like, "The desk is five feet to your right," as opposed to saying, "The desk is over there."
DO give a clear word picture when describing things to an individual with vision loss. Include details such as color, texture, shape and landmarks.
DO touch them on the arm or use their name when addressing them. This lets them know you are speaking to them, and not someone else in the room.
DON'T shout when you speak. They can't see but often have fine hearing.
DON'T be afraid to use words like "blind" or "see." Their eyes may not work, but it is still, "Nice to see you."

DO introduce yourself and ask the person if he needs assistance.
DO provide assistance if it is requested.
DO respect the wishes of the person who is blind.
DON'T insist upon trying to help if your offer of assistance is declined.

DO use words such as "straight ahead," "turn left," "on your right."
DON'T point and say, "Go that way," or, "It's over there."

DO allow the person you are guiding to hold your arm and follow as you walk.
DO move your guiding arm behind your back when approaching a narrow space so the person you are guiding can step behind you and follow single-file.
DO hesitate briefly at a curb or at the beginning of a flight of stairs.
DO tell the person you are guiding whether the steps go up or down.
DO allow the person you are guiding to find the handrail and locate the edge of the first step before proceeding.
DON'T grab the person you are guiding by the hand, arm, or shoulder and try to steer him.
DON'T grab the person's cane or the handle of a dog guide's harness.
DO refer to Sighted Guide Techniques for more information.

DON'T pet, feed, or distract a guide dog. They are not pets; they are working companions on whom a Blind person depends.
DO treat Blind people as individuals. People with visual disabilities come in all shapes, sizes, and colors. They each have their own strengths and weaknesses, just like everyone else.

Last Revised: August 3, 2022

Preventing re-hospitalization is a huge responsibility, especially in consideration of costly penalties that are levied for early readmissions. To accomplish this, nurses need to constantly improve patient teaching and education prior to discharge. Some of the things nurses can do to advance patient education include:

Delegate more responsibilities to support staff and be more focused on patient education.
Begin educating patients with every encounter from admission.
Find out what the patient already knows. Correct any misinformation.
Feed patients information in layman’s terms. Utilize visual aids as often as possible.
Question their understanding of the care, and plan for the next lesson.
Use return demonstration when administering care. Involve the patient from the very first treatment.
Ask the patient to tell you how they would explain (step-by-step) their disease or treatment to their loved one.
Make sure the patient understands the medications as you administer them. Make sure they understand how and when to refill medications.
Provide patients with information about signs and symptoms of their condition that will require immediate attention.

Five strategies for patient education success

Teaching patients is an important aspect of nursing care. Whether teaching a new mom how to bathe a newborn baby or instructing an adult who is living with a chronic heart disease, a successful outcome depends on the quality of the nurse’s instruction and support. Consider these five strategies.

1. Take advantage of educational technology

Technology has made patient education materials more accessible. Educational resources can be customized and printed out for patients with the touch of a button. Make sure the patient’s individualized needs are addressed. Don't simply hand the patient a stack of papers to read, review them with patients to ensure they understand the instructions and answer questions that arise. Some resources are available in several languages.

2. Determine the patient’s learning style

Similar information may be provided by a range of techniques. In fact, providing education using different modalities reinforces teaching. Patients have different learning styles so ask if your patient learns best by watching a DVD or by reading. A hands on approach where the patient gets to perform a procedure with your guidance is often the best method.

3. Stimulate the patient’s interest

It's essential that patients understand why this is important. Establish rapport, ask and answer questions, and consider specific patient concerns. Some patients may want detailed information about every aspect of their health condition while others may want just the facts, and do better with a simple checklist.

4. Consider the patient’s limitations and strengths

Does the patient have physical, mental, or emotional impairments that impact the ability to learn? Some patients may need large print materials and if the patient is hearing impaired, use visual materials and hands on methods instead of simply providing verbal instruction. Always have patients explain what you taught them. Often people will nod “yes” or say that they comprehend what is taught even if they have not really heard or understood. Consider factors such as fatigue and the shock of learning a critical diagnosis when educating patients.

5. Include family members in health care management

Involving family members in patient teaching improves the chances that your instructions will be followed. In many cases, you will be providing most of the instruction to family members. Families play a critical role in health care management.

Teaching patients and their families can be one of the most challenging, yet also rewarding elements of providing nursing care. First-rate instruction improves patient outcomes dramatically.

The value of patient education resources

For further resources that will strength your organization’s patient-teaching, let Lippincott Advisor help. Our best-in-class, evidence-based decision support software for institutions includes over 16,000 customizable patient teaching handouts and content entries.

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