Janet Marsden
Preserving vision and promoting visual health in older people
Reduction in vision is not inevitable but a manageable consequence of getting older. Some physiological and disease processes associated with ageing may reduce vision and, in some cases, this reduction in vision cannot be treated. Much of it can be prevented, however. Prevention of visual loss is one of the keys to the maintenance of independence in older people. This article describes the main visual conditions associated with ageing and considers what can and should be done by the older person and their network of friends, relatives and carers to ensure that vision is maintained by the early detection and treatment of eye problems and that independence is maintained by putting strategies in place to help the person manage any untreatable vision loss.
How to care for a patient’s eyes in critical care settings
Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic complications that can result from corneal exposure in this patient group. Regular, evidence-based eye care should be part of routine nursing practice for patients who are critically ill. Reflective activity ‘How to’ articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice? 2. How you could use this resource to educate your colleagues in eye care of the unconscious patient?
How to assess vision
Rationale and key points An objective assessment of the patient’s vision is important to assess variation from ‘normal’ vision in acute and community settings, to establish a baseline before examination and treatment in the emergency department, and to assess any changes during ophthalmic outpatient appointments. » Vision is one of the essential senses that permits people to make sense of the world. » Visual assessment does not only involve measuring central visual acuity, it also involves assessing the consequences of reduced vision. » Assessment of vision in children is crucial to identify issues that might affect vision and visual development, and to optimise lifelong vision. » Untreatable loss of vision is not an inevitable consequence of ageing. » Timely and repeated assessment of vision over life can reduce the incidence of falls, prevent injury and optimise independence. Reflective activity ‘How to’ articles can help update you practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when assessing people holistically. 2. How you could use this article to educate your colleagues in the assessment of vision.
How to perform irrigation of the eye
Rationale and key points This article aims to help nurses to understand the importance of performing irrigation immediately following chemical injury to the eye, and outlines the most effective technique. It is essential that irrigation of the eye is understood and performed correctly. ▶ Chemical injury to the eye is an ophthalmic emergency. It presents a serious risk to the patient’s vision and may cause blindness. ▶ The length of time the chemical remains in contact with the eye determines the severity of the injury. ▶ Immediate irrigation of the eye is essential to minimise preventable loss of vision. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you would ensure immediate irrigation following chemical injury to the eye in your clinical area. 2. How you know when you have irrigated the eye for long enough, if you have previously performed this procedure, and how reading this article might influence your practice. Subscribers can upload their reflective accounts at: rcni.com/portfolio .
How to examine an eye
Rationale and key points This article aims to assist nurses to perform a systematic external examination of the eye with the minimum of equipment. The eyes form a complex anatomical system, about which nurses often lack confidence. ▶ Eye problems are a relatively common reason for presentation to emergency departments and primary care. ▶ The nurse requires a knowledge of the underlying anatomy and physiology to perform an eye examination. ▶ Nurses in non-specialist settings should be able to assess the integrity of the eye and decide whether specialist referral and examination is required. ▶ Eye examination requires few elements of equipment and should be systematic. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. What further knowledge and skills you require to enable you to explain to the patient what might be occurring when they have an eye problem. 2. How you will gain this knowledge. Subscribers can upload their reflective accounts at: rcni.com/portfolio .
Eye Emergencies: The Practitioner’s Guide (Second edition)
The revised edition of this book continues to offer a comprehensive guide for ophthalmic nurses, those working in urgent care settings and all clinicians caring for patients with undifferentiated eye problems.
Systematic Approaches to a Successful Literature Review
THIS TEXT takes a different approach to literature reviews to many of the more established texts. The authors have written it in the light of the popularity of the term ‘systematic review’ – which does tend to make the literature reviewer wonder what is meant by an unsystematic review – and unpicks this term for the reader, in a helpful and structured way.
Correct administration of topical eye treatment
Although eye treatment is an important aspect of patient care, nurses may not always be aware of the implications of inadequate treatment of ophthalmic conditions. Topical eye treatments, including eye drops and ointments, are governed by the same controls as medication administered by other routes. The authors discuss eye treatment, the nurse’s role in safe administration of medication and patient compliance with therapy.
Educational preparation for ENP roles
This paper reports on a study undertaken to obtain a ‘snapshot’ of ENP education and training and to consider related issues. Questionnaires were distributed to delegates at the 2001 RCN A&E Nursing Association annual conference.
Treating corneal trauma
Corneal trauma, although generally superficial can also be an intensely painful and distressing experience. This article will show how accurate assessment and careful consideration of the available treatment options can maximise patient comfort and optimise healing.
The effects of systemic illness on the eye and vision
Patients present to the A&E department with a multiplicity of simple and more complex problems. Many systemic illnesses give rise to ocular symptoms and eye problems which are part of a systemic problem. These may be discovered accidentally during comprehensive physical examination, or may manifest as part of the patient’s presenting problem or as a single presenting problem which can aid in identifying the systemic disease. It is important that A&E personnel are aware that apparent eye problems may be linked to significant systemic pathology.
Ocular burns
Burns to the eye and surrounding structures present to the A&E department from domestic and industrial sources. Ocular burns may be divided most commonly into chemical, thermal and radiation; chemical burns in particular can be devastating to the eye and to the patient’s potential for vision. The degree of injury is dependant on the type of substance involved, but most importantly, on the length of contact time.
Painless loss of vision
There are many causes of painless loss of vision, however, it is difficult to...
The use of eye drops and ointments in A&E
Ophthalmic patients present to the A&E department with a wide range of...
Care of patients with minor eye trauma
The majority of eye injuries are superficial in nature and transient in their...
Systematic eye examination in A&E
This article gives a description of the techniques and equipment needed in order to...