a nurse gives a presentation regarding eye health

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Care of Patients with Eye and Vision Problems

Chapter 49 Care of Patients with Eye and Vision Problems M. Linda Workman Learning Outcomes Safe and Effective Care Environment 1. Use aseptic technique when performing an eye examination or instilling drugs into the eye. 2. Apply the principles of infection control when caring for a patient with an eye infection. 3. Orient the patient with reduced vision to his or her immediate environment. 4. Ensure that all members of the health care team are aware of a patient’s visual limitations and need for assistance. Health Promotion and Maintenance 5. Teach all people, especially those older than 40 years, to have an annual eye examination including measurement of intraocular pressure. 6. Teach patients and family members how to correctly instill ophthalmic drops and ointment into the eye. 7. Teach the patient and family how to alter the home environment for patient safety. Psychosocial Integrity 8. Teach patients and family members about what to expect during procedures to correct vision and eye problems. 9. Provide opportunities for the patient and family to express concerns about a change in vision. 10. Refer the patient with reduced vision to local services for the blind. 11. Teach the patient with reduced vision about techniques for performing ADLs and self-care independently. Physiological Integrity 12. Explain the consequences of increased intraocular pressure (IOP). 13. Identify common actions, conditions, and positions that increase IOP. 14. Prioritize educational needs for the patient after cataract surgery with lens replacement. 15. Prioritize educational needs for patients with primary open-angle glaucoma. 16. Describe the mechanisms of action and nursing implications of drug therapy for glaucoma. http://evolve.elsevier.com/Iggy/ Answer Key for NCLEX Examination Challenges and Decision-Making Challenges Audio Glossary Audio Key Points Concept Map Creator Concept Map: Glaucoma Review Questions for the NCLEX® Examination Vision is affected by many factors and problems. Some problems occur gradually, such as cataracts, and others can result from an acute insult or illness. Even when reduced vision is temporary, the patient must make some changes in function or lifestyle. Eyelid Disorders The eyelid is composed of thin skin attached to small muscles. It protects the eye surface and spreads tears. Problems can occur with changes in the structure, function, or position of the eyelid. Lid structure may also be altered by age. Blepharitis Blepharitis, an inflammation of the eyelid edges, occurs most often in the older adult and those with dry eye syndrome (see the Keratoconjunctivitis Sicca section, p. 1056). Reduced tear production often leads to bacterial infection of the eye, because tears inhibit bacterial growth. Patients usually have itchy, red, and burning eyes. Seborrhea (greasy, itchy scaling) of the eyebrows and eyelids is often present. Greasy scales and mattering may be seen where the eyelashes exit the eyelid. Blepharitis is controlled with eyelid care using warm, moist compresses followed by gentle scrubbing with dilute baby shampoo. Instruct the patient to avoid rubbing the eyes, because if infection is present, this action can spread the infection to other eye structures. Entropion and Ectropion An entropion is the turning inward of the eyelid causing the lashes to rub against the eye. Entropion can be caused by eyelid muscle spasms or by scarring and deformity of the eyelid after trauma. It occurs often among older adults because of age-related loss of tissue support. The patient usually reports “feeling something in my eye.” Pain and tears may also be present. The eyelid is turned inward, and the conjunctiva is red. Corneal abrasion may result from constant irritation. Surgery corrects eyelid position by either tightening the orbicular muscles and moving the eyelid to a normal position or by preventing inward rotation of the eyelid. After surgery, the eye is covered with a patch and the patient is discharged a few hours later. Demonstrate instillation of eyedrops, and evaluate the patient’s ability to instill the drops. Instruct the patient to leave the patch in place until he or she is seen by the ophthalmologist and to report any pain or drainage under the patch. Teach the patient or family member how to clean the suture line with a cotton swab and the prescribed solution. A small amount of antibiotic ointment may be applied ( Fig. 49-1 ). Chart 49-1 describes how to apply ophthalmic ointment. Chart 49-2 lists information on common ophthalmic drugs for eye inflammation and infection. FIG. 49-1 Application of ophthalmic ointment. Chart 49-1 Best Practice For Patient Safety & Quality Care Instillation of Ophthalmic Ointment • Check the name, strength, and expiration date of the ointment to be instilled. Be sure it is an ophthalmic (eye) preparation and not a general topical ointment. • Check to see whether only one eye is to receive the drug or if both eyes are to receive the drug. • If both eyes are to receive the same drug and one eye is infected, use two separate tubes and carefully label each tube with “right” or “left” for the correct eye. • Wash your hands and put on gloves. • Explain the procedure to the patient. • Have the patient sit in a chair, and you stand behind the patient. • Ask the patient to tilt the head backward, with the back of the head resting against your body and looking up at the ceiling. • Gently pull the lower lid down against the patient’s cheek, forming a small pocket. • Hold the tube (with the cap off) like a pencil, with the tip pointing down. • Rest the wrist holding the tube against the patient’s cheek. • Without touching any part of the eye or lid with the tip of the tube, gently squeeze the tube and release about a – to -inch thin strip of ointment into the pocket you have made with the patient’s lower lid. Start at the nose side of the pocket, and move toward the outer edge of the pocket. • Gently release the lower lid. • Tell the patient to close the eye gently (without squeezing the lids tightly). • With the patient’s eye closed, gently wipe away any excess ointment with a tissue. • Tell the patient that sight in that eye will be blurred while the ointment is present in the eye and that he or she should not drive or operate heavy machinery until the ointment is removed. • Remove your gloves, and place the cap back on the tube. • Ask the patient to keep the eye closed for about 1 minute. • Wash your hands again. • To remove ointment from the eye, wear gloves if drainage is present. • Then ask the patient to close the eye; wipe the closed lids with a clean tissue from the corner of the eye nearest the nose outward. If you are wiping the same eye twice, use a different area of the tissue or use a new one. Chart 49-2 Common Examples of Drug Therapy Eye Inflammation and Infection DRUG NURSING INTERVENTIONS * † RATIONALES Topical Anesthetics Proparacaine HCl, or proxymetacaine (AK-Taine, Alcaine, Ocu-Caine, Ophthetic) Tetracaine HCl, cocaine HCl (Pontocaine) Remind the patient not to rub or touch the eye while it is anesthetized. Touching may injure the eye. Patch the eye if the patient leaves the facility before the anesthetic wears off. The use of a patch prevents injury, such as corneal abrasion. Instruct the patient not to use discolored solution. Discoloration is a sign of altered drug composition. Teach the patient to store the bottle tightly closed. Air may cause drug contamination and oxidation. Topical Steroids Prednisolone acetate (Ocu-Pred, Ophtho-Tate ) Prednisolone phosphate (Inflamase) Dexamethasone (Dexair, Dexotic, Maxidex) Betamethasone (Betnesol) Fluorometholone (Fluor-Op, Liquifilm) Tell the patient to shake the bottle vigorously before use. Drug is a suspension; shaking is required to distribute the drug evenly in the solution. Teach the patient to check for corneal ulceration (pain, reduced vision, secretions). Steroid use predisposes the patient to local infection. Warn the patient not to share eyedrops with others. Disease transmission is possible when sharing eyedrops. Anti-Infective Agents Gentamicin (Genoptic, Gentak Alcomicin ) Tobramycin (Tobrex) Ciprofloxacin (Ciloxan) Erythromycin (Ilotycin) Chlortetracycline (Aureomycin) Sulfisoxazole (Gantrisin) Ofloxacin (Ocuflox) Levofloxacin (Quixin) Teach the patient the importance of using the drug exactly as prescribed, even if he or she needs to use it hourly. Bacterial and fungal eye infections worsen rapidly and can lead to blindness if not treated adequately. Teach the patient how to clean exudate from the eyes before using drops. Cleansing decreases the risk for contaminating the drug and increases contact of the conjunctiva with the drug. Reinforce the importance of completing the prescribed drug regimen. Adherence is critical to maintain a therapeutic level of drug. Antibiotic-Steroid Combinations Tobramycin with dexamethasone (TobraDex) Neomycin sulfate with polymyxin B sulfate and dexamethasone (Maxitrol) This is the same as for the general anti-infective agents alone and for the steroids alone. This is the same as for the general anti-infective agents alone and for the steroids alone. Topical Antiviral Agents Trifluridine (Viroptic) Vidarabine (Vira-A) Teach the patient to refrigerate the drug and protect it from light. Drug stability is affected by warm temperatures and light. Teach the patient to assess for itching lids and burning eyes. Sensitivity to these drugs is common. Antifungal Agents Amphotericin B Natamycin (Natacyn) Teach the patient to assess for itching lids and burning eyes. Sensitivity to these drugs is common. Nonsteroidal Anti-Inflammatory Agents Flurbiprofen (Ocufen) Diclofenac (Voltaren) Bromfenac (Xibrom) Ketorolac (Acular) Teach the patient to check for bleeding in the eye. These drugs disrupt platelet aggregation. Teach the patient not to wear soft contact lenses during therapy with these drugs. These drugs interact with contact lens materials and increase the risk for infection. * When instilling eyedrops, teach patients to use nasal punctal occlusion to reduce the risk for systemic absorption and side effects. † When more than one topical ophthalmic drug is prescribed, teach patients to separate the instillation of each drug by at least 5 minutes.  Nursing Safety Priority Drug Alert Check the route of administration for ophthalmic drugs. Most are administered as eye instillation route, not the oral route. Administering these drugs orally can cause systemic side effects in addition to not having a therapeutic effect on the eye. An ectropion is the turning outward and sagging of the eyelid, which often occurs with aging, caused by muscle relaxation or weakness. This lid position reduces the washing action of tears, leading to corneal drying and ulceration. Patients often have constant tears and a sagging lower eyelid. Surgery can restore lid alignment. After surgery, the eye is covered with a patch and the patient is discharged. Nursing care is the same as for an entropion. Hordeolum A hordeolum, or stye, is an infection of the sweat glands in the eyelid (external hordeolum) or of the eyelid sebaceous gland (internal hordeolum). A red, swollen, tender area occurs on the skin surface side of the eyelid. The most common causative organisms are Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus. The hordeolum usually affects only one eyelid at a time. Vision is not affected. Small, beady, swollen areas may be on the skin side of the eyelid or on the conjunctival side of the eyelid. Pain occurs as the hordeolum fills with purulent material. Management includes applying warm compresses four times a day and an antibacterial ointment. When the lesion opens, the pus drains and the pain subsides. Nursing interventions include instructing the patient how to apply compresses. Chart 49-3 describes the proper technique for application of an eye compress. Chart 49-3 Patient and Family Education Preparing for Self-Management: Application of an Ocular Compress • Wash your hands. • Fold a clean washcloth into fourths. • Soak the washcloth with running tap water that is warm to your inner wrist. (If cool compresses are needed, follow the same steps using cold running tap water.) • Place the cloth over your closed eye. • Keep the cloth in place with minimal pressure until the cloth cools (or warms, if cool compresses are prescribed). • Refold the washcloth so that a different “fourth” will be held against the eye. • Resoak the cloth with running tap water. • Repeat applications three times for as many times each day as prescribed by your health care provider. After compresses have been applied, instill antibiotic ointment. Advise the patient that ointments may cause blurred vision, and teach him or her to remove the ointment from the eyes before driving or operating machinery. To remove the ointment, teach the patient to close the eye and then gently wipe the closed eyelid from the nasal side of the eye outward. Chalazion A chalazion is an inflammation of a sebaceous gland in the eyelid. It begins with redness and tenderness, followed by a gradual painless swelling. Later, redness and tenderness are not present. Most chalazia protrude on the inside of the eyelid. The patient has eye fatigue, light sensitivity, and excessive tears. Management includes applying warm compresses four times a day, followed by instillation of ophthalmic ointment. If the chalazion is large enough to affect vision or is cosmetically displeasing, it may be removed surgically. After surgery, antibiotic ointment is instilled and the eye is covered with a patch. Best practices for application of a nonpressure eye patch are described in Chart 49-4 . Chart 49-4 Best Practice for Patient Safety & Quality Care Application of an Eye Patch Nonpressure Eye Patch 1. Assemble the equipment: • Eye patch • Skin preparation pad • Nonallergenic paper tape 2. Explain the procedure to the patient. 3. Wash your hands. 4. Apply a skin preparation to the patient’s forehead and cheek. 5. Instruct the patient to close both eyes gently. 6. Place a patch over the closed eyelid. 7. Apply tape from the cheek to the middle of the forehead in a diagonal line. 8. Cover the patch with overlapping pieces of tape. Pressure Eye Patch 1. Assemble the equipment: • Two eye patches for each eye requiring treatment • Skin preparation pad • Nonallergenic paper tape 2-5 Follow corresponding steps under Nonpressure Eye Patch. 6. Fold one eye patch in half, place it over the closed eyelid, and apply a second eye patch (unfolded) over the folded one. 7, 8 Follow corresponding steps under Nonpressure Eye Patch. Instruct the patient to leave the eye patch in place for about 6 hours and then remove the patch and apply warm, wet compresses. Antibiotic eyedrops are instilled after use of the compresses. Teach him or her to immediately report increasing redness, purulent drainage, or reduced vision to the ophthalmologist. Keratoconjunctivitis Sicca Pathophysiology The lacrimal system moistens the eye surface with tears and removes tears from the eye. Problems arise from reduced tear production, infection, or inflammation in the lacrimal system. Keratoconjunctivitis sicca, or dry eye syndrome, results from changes in tear production, tear composition, or tear distribution. Drugs (e.g., antihistamines, beta-adrenergic blocking agents, anticholinergic drugs) also can reduce tear production. Diseases associated with decreased tear production include rheumatoid arthritis, leukemia, sarcoidosis, and Sjögren’s syndrome. Radiation or chemical burns to the eye also decrease tear production. Injury to cranial nerve VII inhibits tears. Eye dryness may follow vision-enhancing surgery. Dry eye syndromes are much more common in women than in men ( Pullen & Hall, 2010 ). Patient-Centered Collaborative Care The patient has a foreign body sensation in the eye, burning and itching eyes, and photophobia (sensitivity to light). The corneal light reflex is dulled. Tears contain mucus strands. Management depends on symptom severity. Cyclosporine (Restasis) eyedrops may be prescribed to increase tear production. Artificial tears (HypoTears, Refresh) also can be used to reduce daytime dryness. A lubricating ointment (Lacri-Lube SOP, Refresh P.M.) is used at night. If the dry eye syndrome is caused by an abnormal eyelid position, surgery may be needed.  NCLEX Examination Challenge Health Promotion and Maintenance Which precaution is most important for the nurse to teach a client who is prescribed to use an ophthalmic ointment? A. “Keep the tube in the refrigerator to make the ointment easier to control when you squeeze the tube.” B. “Wear gloves when you apply the ointment to prevent absorbing the drug through your skin.” C. “Patch your eye at night to prevent ointment from getting on your bedding or in your hair.” D. “Do not drive with ointment in your eyes.” Conjunctival Disorders The conjunctiva is a thin mucous membrane that covers and protects the eye. Because of its location, the conjunctiva is subject to trauma and infection. Hemorrhage Conjunctival blood vessels are fragile and can break with increased pressure during sneezing, coughing, or vomiting. Hemorrhages may also occur with hypertension, trauma, or blood clotting problems. The small, well-defined area of hemorrhage is bright red under the conjunctiva. The patient is usually concerned about its appearance although no pain or visual impairment occurs with the hemorrhage. It resolves within 14 days without treatment. Conjunctivitis Conjunctivitis is an inflammation or infection of the conjunctiva. Inflammation occurs from exposure to allergens or irritants. Infectious conjunctivitis occurs with bacterial or viral infection and is readily transmitted from person to person ( Saligan & Yeh, 2008 ). Allergic conjunctivitis manifestations are edema, a sensation of burning, a “bloodshot” eye appearance, excessive tears, and itching. Management includes vasoconstrictor and corticosteroid eyedrops (see Chart 49-2 ). Teach women to avoid using makeup near the eye until all symptoms have subsided. Bacterial conjunctivitis , or “pink eye,” is usually caused by Staphylococcus aureus or Haemophilus influenzae . Manifestations are blood vessel dilation, mild edema, tears, and discharge. The discharge is watery at first and then becomes thicker, with shreds of mucus. Cultures of the drainage are obtained to identify the organism. Drug therapy with topical antibiotics is prescribed to eliminate the infection. Nursing interventions focus on preventing infection spread to the other eye or to other people. Document the amount, color, and type of drainage. Remind the patient to wash his or her hands after touching the eye and before using eyedrops. Warn him or her not to touch the unaffected eye without first washing the hands and to avoid sharing washcloths and towels with others. Instruct women to discard eye makeup and applicators used at the time the infection developed to avoid the possibility of recontamination. Trachoma Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis. It scars the conjunctiva and is a common cause of preventable blindness worldwide. The incidence is highest in warm, moist climates where sanitation is poor. The incubation period is 5 to 14 days, and at first the disease resembles bacterial conjunctivitis. Manifestations include tears, photophobia, and eyelid edema. Follicles form on the upper eyelid conjunctiva. As the disease progresses, the eyelid scars and turns inward, causing the eyelashes to damage the cornea. Cultures are used to identify the causative organism. A 4-week course of oral or topical tetracycline (Achromycin, Apo-Tetra ) or erythromycin (Apo-Erythro-EC , E-Mycin, E.E.S.) is given. Azithromycin (Zithromax) can be used once per week for 1 to 3 weeks. Nursing interventions focus on infection control. Teach the patient to wash the hands before and after touching the eyes. Teach him or her to keep washcloths separate from those of unaffected people and to launder them separately.  Nursing Safety Priority Action Alert Teach patients who are prescribed antibiotic eyedrops or ointments to complete the entire course of antibiotics. Stopping antibiotic therapy too soon promotes infection recurrence and development of antibiotic-resistant bacteria. Corneal Disorders For a sharp image to be focused on the retina, the cornea must be transparent and intact. Corneal problems may be caused by irritation or infection (keratitis) with ulceration of the corneal surface, degeneration of the cornea (keratoconus), or deposits in the cornea. All corneal problems reduce the refracting power of the cornea, and some can lead to blindness. Corneal Abrasion, Ulceration, and Infection Pathophysiology A corneal abrasion is a scrape or scratch of the cornea that disrupts its integrity. This painful condition can be caused by a small foreign body, trauma, or, most commonly, contact lens use. Other conditions that promote loss of corneal integrity include malnutrition, dry eye syndromes, and some cancer therapies. The abrasion allows organisms to enter, leading to corneal infection. Bacterial, protozoal, and fungal infections can lead to corneal ulceration, which is a deeper disruption of the epithelium. This problem is an emergency because the cornea has no separate blood supply and infections that can permanently impair vision develop rapidly. Use of homemade contact lens solutions and the use of large-volume solution containers that can easily become contaminated have led to a sharp rise in the incidence of corneal ulcers infected with Pseudomonas aeruginosa and fungi. Patient-Centered Collaborative Care The patient with a corneal disorder has pain, reduced vision, photophobia, and eye secretions. Cloudy or purulent fluid may be present on the eyelids or lashes. Wear gloves when examining the eye. The entire cornea may look hazy or cloudy with a patchy area of ulceration. When fluorescein stain is used, the patchy areas appear green. Microbial culture and corneal scrapings can help determine the causative organism. Anti-infective therapy is started before the organism is identified because of the high risk for vision loss. For culture, obtain swabs from the ulcer and its edges. For corneal scrapings, the cornea is anesthetized with a topical agent and a physician or advanced practice nurse remove samples from the center and edge of the ulcer. Antibiotics, antifungals, and antivirals are prescribed to reduce or eliminate the organisms. Usually, a broad-spectrum antibiotic is prescribed first and may be changed when culture results are known. Steroids may be used with antibiotics to reduce the inflammatory response in the eye. Drugs can be given topically as eyedrops, injected subconjunctivally, or injected IV. Chart 48-4 in Chapter 48 lists best practices for instilling eyedrops. The nursing priorities are to begin the drug therapy, to ensure patient understanding of the drug therapy regimen, and to prevent infection spread. Often, the anti-infective therapy involves instilling eyedrops every hour for the first 24 hours. Teach the patient how to apply the eyedrops correctly. (See Chart 48-2 in Chapter 48 .) Use sterile saline eyedrops to demonstrate the technique, and obtain a return demonstration. If the patient cannot safely self-apply the drugs, teach a family member how to do it. If the eye infection occurs from a corneal abrasion or ulcer, only one eye is affected. Teach the patient not to use the drug in the unaffected eye. In addition, teach him or her to wash hands after touching the affected eye and before touching or doing anything to the healthy eye. If both eyes are infected, separate bottles of drugs are needed for each eye. Teach the patient to clearly label the bottles “right eye” and “left eye” and not to switch the drugs from eye to eye. Also teach him or her to completely care for one eye, then wash the hands, and using the drugs for the remaining eye, care for that eye. Teach the patient not to wear contact lenses during the entire time that these drugs are being used because the eye then has fewer protections against infection or injury. In addition, the drugs can cloud or damage the contact lenses. Stress the importance of applying the drug as often as prescribed, even at night. Stopping the infection at this stage can save the vision in the infected eye. Also instruct the patient to make and keep all follow-up appointments; usually the patient is seen again in 24 hours or less. The type of anti-infective used and the frequency of application may change when the organism is identified and the infection is responding to the therapy. Drug therapy may continue for 3 or more weeks to ensure eradication of the infection. Warn women to avoid using makeup around the eye until the infection has cleared to prevent spread of infection. Instruct patients to discard all open containers of contact lens solutions and bottles of eyedrops because these may be contaminated. Patients should not wear contact lenses for weeks to months until the infection is gone and the ulcer is healed. Keratoconus and Corneal Opacities Pathophysiology The cornea can permanently lose it shape, become scarred or cloudy, or become thinner. When these conditions occur, refraction is reduced and images are not focused sufficiently for useful vision. Keratoconus, the degeneration of the corneal tissue resulting in abnormal corneal shape, can occur with trauma or may be an inherited disorder ( Fig. 49-2 ). Inadequately treated corneal infections and severe trauma can damage and scar the cornea and lead to severe visual impairment that can be improved only by surgical interventions. FIG. 49-2 Profile of a normal cornea and one with keratoconus. Patient-Centered Collaborative Care For a misshaped cornea that is still clear, surgical management involves a corneal implant that adjusts the shape of the cornea. The device approved for this procedure is the Intacs corneal ring. With this procedure, the shape of the cornea is changed by placing a flexible ring in the outer edges of the cornea (outside of the optical zone). The procedure is performed on both eyes during one surgery under local anesthesia. Improvement to best vision is immediate. Overcorrection or undercorrection of refraction is possible. However, removal, replacement, or adjustment of ring tightness can enhance satisfaction. In addition, replacements can be made if the patient’s vision changes further as a result of aging. Because the ring is applied to the cornea outside of the optical zone, the risk for corneal clouding or scarring is lower than with other surgical eye procedures. Surgery to improve clarity for a permanent corneal disorder that obscures vision is a keratoplasty (corneal transplant), in which the diseased corneal tissue is removed and replaced with tissue from a human donor cornea. This process improves vision by removing corneal deformities and replacing them with healthy corneal tissue. Preoperative care may be short, with little time for teaching because transplantation is performed when the donor cornea becomes available. The patient is usually anxious. Use a calm approach to assess his or her knowledge of the surgery and of care before and after surgery. Examine the eyes for signs of infection, and report any redness, drainage, or edema to the ophthalmologist. Instill prescribed antibiotic eyedrops, and obtain IV access before surgery. Operative procedures are keratoplasties and are usually performed with local anesthesia in an ambulatory surgical setting. The transplant may involve the entire depth of corneal tissue (penetrating keratoplasty) or only certain layers of the corneal tissue (lamellar keratoplasty). The nerves around and behind the eye are numbed so that the patient cannot move or see out of the eye. The center 7 to 8 mm of the diseased cornea is removed ( Fig. 49-3 ) with an instrument that works like a cookie cutter. The same instrument is used to cut the tissue graft from the donor cornea so that the graft will be a perfect fit. The donor corneal graft is sutured into place on the eye. Fig. 49-4 shows the eye after transplantation. The procedure usually takes about an hour, and the patient is discharged to home 1 to 2 hours after the procedure. FIG. 49-3 The steps involved in corneal transplantation (penetrating keratoplasty). FIG. 49-4 The appearance of the eye with sutures in place after corneal transplantation. Postoperative care involves extensive patient teaching. After the procedure, an antibiotic is injected under the conjunctiva and an antibiotic ointment instilled. The eye is covered with a pressure patch and a protective shield until the next day, when the patient returns to the surgeon. Notify the ophthalmologist of changes in vital signs or of drainage on the dressing. Instruct the patient to lie on the nonoperative side to reduce intraocular pressure (IOP). Show the patient or family member how to apply a patch, and obtain a return demonstration. The patch may need to be worn during the day for the first 3 to 5 days. Teach the patient to wear the shield at night for the first month after surgery and whenever he or she is around small children or pets. Instruct him or her not to use an ice pack on the eye. Complications after surgery include bleeding, wound leakage, infection, and graft rejection. Teach the patient how to instill eyedrops, and obtain a return demonstration. Show pictures of what the eye and sutures should look like. Teach him or her to examine the eye (or have a family member do the examination) daily for the presence of infection or graft rejection. The presence of purulent discharge, a continuous leak of clear fluid from around the graft site (not tears), or excessive bleeding should be reported immediately to the surgeon. Other complications include decreased vision, increased reddening of the eye, pain, increased sensitivity to light, and the presence of light flashes or “floaters” in the field of vision. Teach the patient to report any of these manifestations to the surgeon if they develop after the first 48 hours and persist for more than 6 hours. The eye should be protected from any activity that can increase the pressure on, around, or inside the eye. Teach the patient to avoid jogging, running, dancing, and any other activity that promotes rapid or jerky head motions for several weeks after surgery. Other activities that may raise intraocular pressure (IOP) and should be avoided are listed in Table 49-1 . Returning to work depends on the type of work. Patients who have sedentary jobs, such as secretaries, may return to work in 1 week, whereas those who perform heavy lifting or manual labor may need to be off work for 6 to 8 weeks. TABLE 49-1 ACTIVITIES THAT INCREASE INTRAOCULAR PRESSURE • Bending from the waist • Lifting objects weighing more than 10 lbs • Sneezing, coughing • Blowing the nose • Straining to have a bowel movement • Vomiting • Having sexual intercourse • Keeping the head in a dependent position • Wearing tight shirt collars Graft rejection can occur. Inflammation starts in the donor cornea near the graft edge and moves toward the center. Vision is reduced, and the cornea becomes cloudy. Topical corticosteroids and other immunosuppressants are used to stop the rejection process. If rejection continues, the graft becomes opaque and blood vessels branch into the opaque tissue. Eye donation is a common procedure and needed for corneal transplantation. Corneal tissue is obtained from a local eye or tissue bank. An eye bank obtains its supply of corneal tissue from volunteer donors. These donors must be free of infectious disease or cancer at the time of death. If a deceased patient is a potential eye donor, follow these steps: • Raise the head of the bed 30 degrees. • Instill prescribed antibiotic eyedrops, such as Neosporin or tobramycin. • Close the eyes, and apply a small ice pack to the closed eyes. • Contact the family and physician to discuss eye donation.  NCLEX Examination Challenge Health Promotion and Maintenance Which comment made by a client 1 week after a corneal transplant indicates to the nurse a need to review postoperative care? A. “I have been feeding my cat on the counter so that I don’t have to bend over.” B. “I have been using an icepack on my eye to reduce the redness and swelling.” C. “My daughter has been helping me inspect my eye and place the eyedrops.” D. “Instead of reading a book, I now listen to books on tape.” Cataract Pathophysiology The lens is a transparent, refractive elastic structure suspended behind the iris. A cataract is a lens opacity that distorts the image projected onto the retina ( Fig. 49-5 ). With aging, the lens gradually loses water and increases in density ( Touhy & Jett, 2010 ). This increased density occurs as older lens fibers are compressed and new fibers are produced in the outer layers. Lens proteins dry out and form crystals. As the density of the lens increases, it becomes opaque with a painless loss of transparency. Both eyes may have cataracts; however, the rate of progression in each eye is usually different. FIG. 49-5 The visual impairment produced by the presence of a cataract. Etiology and Genetic Risk Cataracts are classified by nature or by onset. They may be present at birth or develop at any time. Cataracts may be age-related or caused by trauma or exposure to toxic agents. They also occur with other diseases and eye disorders ( Table 49-2 ). TABLE 49-2 COMMON CAUSES OF CATARACTS Age-Related Cataracts • Lens water loss and fiber compaction Traumatic Cataracts • Blunt injury to eye or head • Penetrating eye injury • Intraocular foreign bodies • Radiation exposure, therapy Toxic Cataracts • Corticosteroids • Phenothiazine derivatives • Miotic agents

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Health Promotion and Eye Vision Health for Nurses

Authors: mary lou de natale *.

* Corresponding author: Mary Lou De Natale, Professor, Community and Mental Health Nursing, University of San Francisco School of Nursing and Health Professions, San Francisco, California USA

Professor, Community and Mental Health Nursing, University of San Francisco School of Nursing and Health Professions, San Francisco, California USA

Received Date: 03 June, 2022

Accepted Date: 13 June, 2022

Published Date: 17 June, 2022

Citation: De Natale ML (2022) Health Promotion and Eye Vision Health for Nurses. Int J Nurs Health Care Res 5: 1305. DOI: https://doi.org/10.29011/2688-9501.101305

Eye vision is used each day as nurses are providing care in all health care environments. Nurses must be able to provide safe care to their patients in performing assessments, recording data for electronic medication records, dispensing medications, teaching at the individual patients’ bedside or walking in the hallways or into rooms in the daylight, evening, and /or night lighting influencing vision. The purpose of this study was to: (1) assess nurses’ understanding of their own health promotion and vision health, and (2) provide nurses with the education regarding eye care, vision screening and computer practice strategies for vision health. The results of the study support that nurses do recognize that vision and eye health is essential for patient care with vision screenings and eye exams with visual breaks at the computer station to reduce eye strain at work. Empowering nurses to address the preventive care strategies for self-care can promote wellness and lower the risk of health conditions that cause vision problems and support safety in practice.

Eye vision; Health promotion; Nurses; Workplace vision health

Introduction

Vision is an essential part of the life for nurses who are providing care to patients across all clinical environments. The nurse must be able to provide safe care that is directed at: performing assessments, recording data for electronic medication records, dispensing medications, teaching at the individual patients’ bedside or walking in the hallways or into rooms in the daylight, evening, and /or night lighting influencing eye vision. The researcher designed instrument was used to support self-care and further identify the knowledge and concerns that nurses have about their health and vision. The results of the survey support implications for nursing practice, policy development, and education of nurses advocating for vision health in the workplace. For their own health promotion and patient safety, nurses need to be able to maintain their personal eye vision health and support patient care in the technology-based work environment. Nurses are faced with many decisions to be made in using hand-held devices and using computers in the workplace while managing patient care. The demands of the nurses job requires many hours of computer use and increased stress in being able to focus on the computer for specific periods of time while maintaining an ergonomic position and less eye strain.

Although there are many contributions to the literature on the importance of maintaining health and wellness for nurses, there is little evidence that eye vision and health are linked to patient safety. Indeed, improper lighting, glare, work demands computer screen design, and the tasks of looking at various fonts and computer systems can cause eye strain. In nursing and medical literature, there have been no studies aimed at examining the possible role that health promotion and vision has on patient care. With nurses interfacing with technology there should be consistent support in the environment for the nurses to be reminded to practice the 20-20-20 rule: “Every 20 minutes, look up from what you are doing and focus 20 feet in front of you for 20 seconds.” [1].

Additionally, nurses should be encouraged to use their health insurance and vision plans for periodic assessment supporting the important goal for patient safety in nursing practice. Achieving this goal may be a challenge for the nurse working in an environment in which they also need to bring their glasses to work or get another prescription to see the print on the medication vials, or use some type of magnification in the clinical setting because of vision issues and health. It is an individual nurse’s professional responsibility to practice safely and to maintain their personal health and eye vision should be included. There are patients and their families that are expecting the nurse to be able to provide safe and quality care-and the nurse must want this as well for their own health promotion. In observation in both acute care and clinical settings, it became evident to the researcher that nurses could benefit from using their glasses at work; make appointments for vision testing using their health vision plan, and practice good ergonomics in the work environment, while spending hours with input and interpretation on a computer screen. Overall, this study was designed to determine first how a small convenience sample of nurses in one California medical center responded to questions related to health promotion and vision health.  

Nurses completed a survey about their own vision health and appointments for eye exams, their hours or computer usage on an average day in their practice, and their ability to practice safely whether enlarging the screen font size on their computer or making their vision a priority.

These studies report findings that nurses were aware of the importance of vision in their workplace and are not satisfied in how they took responsibility for their own vision health. The environment that a nurse works in requires patient safety that is optimal in an environment in which one wears one’s personal eyeglasses and practices vision ergonomics. Promoting vision health for nurses can support patient safety.

Overview of Vision and Health Promotion

According to Healthy People 2030 , the goal of the National Institutes of Health was to support improving visual health through prevention, early detection, treatment, and rehabilitation as key priorities. [2] Vision is an essential part of everyday life for all individuals of all ages as it affects learning, communicating, working, health, and quality of life. In the United States, an estimated 12 million adults 40 years or older in the United States had visual impairment: 1 million were blind, 3 million had uncorrectable visual impairment, and 8 million had visual impairment owing to uncorrected refractive errors. While an estimated 93 million adults in the United States are at high risk for serious vision loss, only half visited an eye doctor in the past 12 months. [3-7] Additionally, myopia, or nearsightedness, is a common condition in which images of distant objects are focused in the front, instead of on, the retina and occurs in 25% of the population 12-54 years [7].

Nurses working in clinical environments need to be aware of how much time they are spending in front of a computer screen and consider vision health as part of safety in patient care. In clinical environments, the importance of making patient safety as a priority cannot be overstated. [9-10] The education of the health care provider, specifically the nurse, related to the delivery of care related to: daily patient care, computer use for patient records, electronic charting, preparing medications, and working in a technology-based environment and on units with daylight, evening, and night lighting in the personal work environment is important to be considered in overall support of quality patient care and safety. Additionally, aging and individual health issues are also important to be addressed; especially regarding vision in the workplace [5,8].

Review of Visual Health

According to the American Optometric Association (AOA), visual symptoms occur with computer usage, indicating visual problems. In the nursing profession today, charting is done on computers, which has a negative effect on one’s visual system. The AOA states, “visual discomfort and related symptoms occurring in VDT [Video Display Terminals] must be recognized as a health problem” with health prevention guidelines. Furthermore, the AOA points out that there is a high percentage of computer users that have uncorrected vision problems that can be corrected with adjustment of the computer workspace, use of proper lighting, taking vision rest breaks, and maintaining proper posture [11]. 

The National Institutes of Health state that vision affects all aspects of our lives, including: development, learning, communicating, and working, in addition to the quality of life. According to the Center of Disease Control, “visual impairment is 1 of the 10 most frequent causes of disability in the United States.” [2,12] More specifically, myopia occurs in 25% of the United States population with the recommendation for early intervention through regular vision exams. [7] The recommendation of routine eye exams includes an assessment of accommodative abilities, assessment of ocular coordination, determination of refraction for the required viewing distances at the computer work station, design of occupational lenses if required, and counseling regarding the visual environment at the workstation. In summary “many of the eye and vision problems users experience can be resolved by evaluation and improving the visual work environment” [1] (p.418).

Vitale, Sperduto, and Ferris (2009), aimed to compare the prevalence of myopia in the United States in 1971-1972 and 1999- 2004. A total of 9,609 participants aged 12 to 54 years Participated in the study. During 1971-1972 the researchers found that myopia was prevalent in 25% of people aged 12 to 54 years. In 1999- 2004, the researchers found a statistically significant higher prevalence of myopia: 41.6% compared to 25%, respectively. [8] This study proposes that environmental stressors may contribute to the increased prevalence of myopia. Environmental stressors include the increase of society’s dependence on technology, including computers. [8] p.1632.

About 90% of Americans using computers for more than three hours a day experience symptoms of CVS in some way or another. [12-13] Pooja (2006) states that those who suffer from myopia that spends more than eight hours a day on a computer are 82% more likely to develop glaucoma along with computer vision syndrome.[p.2] This information indicates that computer users need some relief during their time at the computer screen. Pooja (2006) suggests utilizing the blink, breathe, and break method that involves “blinking 20 times per minute, breathing often to increase blood flow around the eye muscle, and after 20 minutes of nonstop work in front of the monitor, take a break for 20 seconds. This is also called the 20/20 rule (Dr. Jeffrey Anshel, shared, the blink, breathe, and break rule). [14] p.2. Other suggestions are marked to decrease symptoms associated with computer vision syndrome. The American Optometric Association (AOA) notes that the symptoms of CVS occur due to the visual demands of the task exceeding the visual abilities of the individual to comfortably perform with uncorrected vision problems can increase the severity of Computer Vision Syndrome (CVS) or digital eye strain symptoms. [15].

Research Design and Methods

The purpose of this qualitative research study was to support self-care and further identify the knowledge and concerns that nurses have about their health and vision. Questionnaires were hand-delivered to each unit and their surveys were completed by the nurses on the unit and put in a sealed envelope in a designated box on the unit with no identifying name and/or unit when completed. The researcher personally picked up the surveys every other day during the month of the study. All nurses that completed the survey were anonymous and supported information on demographics, health and vision self-care, and nursing practice on the unit. There were no face-to-face interviews and just the completed survey was returned by the participating nurse.

This convenience sample was conducted at a medical center in a large metropolitan area in California. The participants, aged 25-70, were working on the various hospital units, offices, or clinics, which were part of the medical center nursing staff.

Recruitment of Participants

The units were all identified by the Nurse Educator at the Medical Center with the names of the nurse managers of the various units of the hospital were obtained for letters organized for each of the units. Informational meetings were scheduled with the Nurse Educator, Research Nurse, and Nursing Administration for five months prior to the study. The Nurse Educator informed all of the Nurse Managers by email and during the leadership team meetings prior to the study beginning. All materials were available for review prior to the study. Each unit manager was asked to participate and supported a designated place on the unit for the surveys. The researcher did not attend any staff meeting though all of the nurses were informed of the research study prior to the study. During this time, there was an informational meeting scheduled with two of the Chief Nursing Officers regarding the study. As thanks for their time and information, participants were given a Vision and Health Handout and the opportunity to be entered into a drawing for one of three dinners that were donated by a local restaurant. The research protocol was submitted, reviewed, and approved by the Institutional Board of the University of San Francisco and also the designated Institutional Board at the Medical Center.

Sample Size

A convenience sample of 111 nurses (17 males and 94 females) volunteered to participate in the study. The average age of the participants ranged from 45-50 years. The participants were representative of the racial and ethnic backgrounds. The nurses were predominantly bachelor prepared with 59.4% and 10.1% with a Masters or higher in educational expertise/ practice.

Instrumentation

Based on the information in the literature, the researcher developed the collection tool: Vision 20/20 Assessment Survey with a demographic section. The survey originally assessed both vision and hearing but it was recommended in the final review to concentrate on vision only for this survey. The survey contained 6 questions opened on demographics, 20 questions related to vision health and prevention, and 3 questions on nursing practice and safety and medication errors in practice. A panel of six experts in nursing education, 2 physicians, 3 hospital nursing administrators, and 3 nursing faculty reviewed the survey questions and demographic information for validity; the instrument was subsequently revised based on their recommendations.

The data was analyzed by the researcher and identified themes in practice and coding the responses. The themes were related to self-care and health promotion and the application to health promotion, computer usage in the work environment, and potential safety issues for clinical work.

Each of the 111 nurses generated value and was supported in their nursing specialty, age, and vision plan (Table 1). There were 4 that did not respond to the initial question on the survey. Nurses in the study emphasized that because they were working full-time they were able to have the benefits of a medical health and vision plan and did seek care varying from 1-2 years or 3-5 years with an ophthalmologist or optometrist. A comment from one of the nurses noted: “I work per diem and not choosing a health plan at this time --I will consider in the future the medical and vision plan.” Other nurses commented that they would review their current plan and seek an appointment as needed. Additionally, several nurses identified the following: “I have not been able to get the time to do this-it is always the last priority. “I know that I do have a vision plan and really should use it more.” I have not had any problems lately but this reminds me to follow-up next year.” The nurses were going to support further follow-up with their doctor but no time was given within the next month to six months. Health changes and having medical follow-up for hypertension, diabetes, weight changes, cancer screenings, and pregnancy which are individual and vision screening can be encouraged with the increased computer usage.

Are you working in an environment in which the computer or use of the electronic record is a part of your job?

Personal Health and Vision

Each of the nurses responded on how satisfied they were with their health on a scale of 1-10. Those nurses rating their health an 8 out of 10 were 30 nurses (28%), 9 out 10 were 33 nurses (31%), and 10 nurses were 17 (16%) for a total of 75% supporting healthy practices for physical exams, annual check-up, or follow-up for chronic health concern (diabetes, hypertension or cancer). These nurses commented that the importance of an eye vision exam was as follows: 47 nurses (43%) went yearly for an eye exam while 36 nurses (33%) went for vision checks and new glasses every 1-2 years; 18 nurses (17%) went every 3-5 years; and the remaining 10 mentioned no follow-up due to lack of insurance or any changes needing follow-up. Additionally, there were 68 nurses (61%) and 25 nurses (22%) that identified they did need eye glasses, 6 nurses (5%) wearing contacts, and 13 (12%) having contacts and glasses. Fifty-two nurses (68%) were wearing their glasses to work all the time and 25 nurses (32%) only occasionally.

Workplace Environment -Technology and Nurse in Practice

Nurses are working in an environment that is technology based with safety in patient care and practice of premium importance. Additionally the acute care setting is using computerized systems for medication dispensing with safety in administration key in practice for the nurse. In this research study over 97% of the nurses responding are using the computer in patient care. Additionally, these same nurses are acknowledging that they spend from 1-8 hours in front of a computer screen to support patient care, charting, and follow-up with lab results/tests for patient care. The time in front of the computer screen was for 39 nurses (37%) to be 3-4 hours; 21 nurses (20%) to be 5-6 hours, and 21 nurses (20%) spending between 7-8 hours. The nurses on the units noted that 68 nurses (61%) wear their prescriptive glasses to work and 25 nurses (22%) did not need prescription glasses for reading and for work in the acute care setting. Of the nurses that had glasses 52 nurses (68%) would wear them all the time; 25 nurses (32%) occasionally wear them at work. Although, most nurses (79%) that responded wore glasses for reading and computer work and 21% of the nurses wore their glasses occasionally for reading and computer work.

One nurse stated that she had left her glasses at home and was able to borrow another nurse’s reading glasses at work. Others left another pair of reading glasses in their locker /or on the unit. With the considerable amount of time for nurses in their job to be on the computer, there were 4 nurses that commented that they would be checking with their doctor to prescribe special computer lenses for the screens/ hand -held devices. Thirty-six nurses acknowledged that they were nearsighted (myopia) and twenty-five were farsighted (hyperopia) with twenty-five nurses acknowledging being both near/ farsighted. Forty nurses (37%) mentioned that they had trouble seeing the screen because it was too small and others 68 (63%) had no trouble seeing the screen. For those that had trouble seeing the computer two nurses changed the computer screen all the time and 31 nurses only occasionally.

Nursing Practice and Medication Administration on Unit

The overall standard for nursing practice supports safety in practice and at this time there has been no mention of nurses wearing their glasses consistently and or doing their Eye exercises for vision health or advocacy amongst each other for health promotion and vision testing. Eighty nurses (75%) mentioned that they take extra care in preparing medications while 13 nurses (12%) take some care in preparing medications. These same nurses noted that they had observed nurses on their units taking special care in preparing medications on the unit (s). Each of these same nurses was given an opportunity to respond as well to their own errors in medication administration and there were 97% that acknowledged an error in medication administration due to a confusing order. The noted past error in administration of medications was commented on in the survey with acknowledgement that having the electronic record on the units were helpful in reading the medications including dosage and administration.

Following the study, a summary was sent to each of the floors in the hospital and reviewed. Additionally, the nurses were informed on their units with posted results on the communication board in each area with an emphasis on health promotion related to the following: medical follow-up with their personal doctor or practitioner as possible for their vision assessment and plan as a baseline, seeking opportunities for vision safety and following the 20/ 20 / 20 rule while on the unit, and wearing their eyeglasses for patient safety. There was a scheduled meeting following the study with the leadership team (Nursing Leadership Council and Chief Nursing Officer) on this research and support for health promotion.

Additionally this research was supported at a nursing and technology conference with a focus on the nurse’s time spent on the computer while working, vision health, and workplace ergonomics. Overall, these results support that nurses should advocate for their own health promotion, bi-yearly vision screening, vision eye breaks, and workplace vision ergonomics on the hospital units. If there is a change in one’s medical history more vision screening may be encouraged with your doctor. In this study, the fact that they were not seeking vision screening annually, and providing care with the use of technology and computer screens on the units for more than 4-6 hours (Table 2).

This researcher supports that the nurses need to be positively supported in eye and vision health and practicing self-care with discussions with their primary doctor or practitioner. These results further support implications for eye vision assessment in nursing, policy development in the profession, and self-care education on vision health in the workplace. Providing nurses with the knowledge that their own vision health is a personal responsibility for self-care that will influence patient care and vision health in a community of health care providers using technology on all levels of care.

Implications for Nurses

With the increasing number of nurses and individuals in health care providing care and validating health care records, it is important for nurses to support the standards of practice for eye vision health. In this study, it was noted that the standard eye care was an individual nurse’s responsibility with 87% having the vision plan and yet only 53% not using the vision plan. As nurses are aging in their practice this also becomes a responsibility for increased frequency in vision testing and also monitoring one’s personal health with a physical exam and lab work as medical health plan supports. It is the case that if the nurse cannot see the value on an instrument, the dosage number on a prescription, or a label on medication, a piece of equipment or instructions, patient safety is at risk. Based on this data and the nature of the practice setting, it is key that the next study needs to focus on (1) nurses’ vision and (2) possibility to impact safety. 

Implications for Nursing Practice and Policy for Nurses Health

At the conclusion of the research project, the nursing leadership was given a summary of the results and recommendations. The results of the research noted that the nurses with advocacy to support health promotion, yearly vision screening if changes are noted in medical health, and support for workplace vision ergonomics on the hospital units. Nurses identified that they are not seeking vision screening annually, accommodations in their use of technology and computer screens on the units for more than 8-12 hours. Table 3 though, there are many benefits to using computers in the workplace, nurses need to incorporate ergonomic factors into work settings to promote safe workplace environments [15].

Conclusion with Professional Considerations

The increasing number of health professionals working with computers in clinical settings and for this study it has relevance to apply to others in the medical profession. Most importantly, standard eye care remains an individual responsibility. Nurses and other professions in the workforce are empowered to find time for their own self-care and health promotion as working professionals across the life span. With encouragement, nurses can be proactive about their preventive eye and vision benefits and communicate with health providers. Additionally, as part of the nurses professional competencies or continuing education units (CEU’s)—adding vision screenings. In summary, for this research study, 97% of the nurses used the Electronic Health Record (EHR) as a part of their job, 81% of their time was centered on patient care, charting, and the unit responsibilities. There were 87% of the nurses that identified having a vision plan, yet only 53% used the vision plan for scheduled eye exams. Individual attitudes about eyesight and vision screenings can influence preventive eye care and communication with primary health care providers. [16] A nurse’s health and wellness can begin with a routine eye exam or scheduled vision screening with the “checklist” to include: adjusting for proper use of computer workspace, enlarging the font size, using proper lighting, reminder to follow the 20-20-20 rule and blink, maintaining proper posture and wearing personal eyeglasses for patient care.

Acknowledgments

This is to acknowledge the support of Dr. Michelle Galos for her initial review of the literature as a senior BSN nursing student at USF, Dr. Judith Karshmer, former Dean and Professor at USF, who helped edit the initial writing and inspired me to do this research, and my son Tom De Natale, who helped to support, organize, and assist with the data analysis. Special thanks to the nurses who participated in this research and further supported an awareness of their vision care and health promotion.

Finally, an appreciation of the USF Beta Gamma Chapter of Sigma Theta Tau International for a research award for this project.

Conflicts of Interest Disclosure

The author declares no conflicts of interest.

Table 1:  (Computer Use in Nursing for Patient Care).

Table 2:  Hours of Computer Use for Patient and Charting.

Table 3:  Nurses Vision.  

• Anshel JR (2007) Visual ergonomics in the workplace. AAOHN Journal: official Journal of the American Association of Occupational Health Nurses, 55: 414-422. doi:10.1177/216507990705501004.
• Center for Disease Control and Prevention (June 9, 2020). Accessed on June 2, 2022.
• The Eye Diseases Prevalence Research Group * (2004) Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 122:477-485. doi:10.1001/archopht.122.4.477.
• Congdon N, O’Colmain B, Klaver CCW, Klein R, Muñoz B, et al. (2004) Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 122 (4): 477-485. doi:10.1001/ archopht.122.4.477.
• Saydah SH, Gerzoff RB, Saaddine JB, Zhang X, Cotch MF (2020) Eye care among US adults at high risk for vision loss in the United States in 2002 and 2017. JAMA Ophthalmol 138(5): 479-489. doi:10.1001/ jamaophthalmol.2020.0273.
• National Eye Institute (2020). Published March 12, 2020. Accessed on June 2, 2022.
• Center for Disease Control and Prevention (June 9, 2020). Accessed on June 2, 2022
• Vitale S, Sperduto RD, Ferris FL (2009) Increased prevalence of myopia in the United States between 1971-1972 and 1999 Arch Ophthalmol 127(12): 1632-1639. doi:10.1001/ archophthalmol.2009.303.
• Beyea SC (2008) Placing patient safety first. AORN Journal. 87(4): 829-831. https://doi.org/10.1016/j.aorn.2008.03.010.
• Vaismoradi M, Tella S, Logan PA, Khakurel J, Vizcaya-Moreno F (2020) Nurses’ adherence to patient safety principles: A systematic review. Int J Environ Res Public Health 17 (6): 2028. https://doi.org/10.3390/ ijerph17062028.
• American Optometric Association (2022) Computer Vision Syndrome (CVS). Retrieved May 30, 2022.
• Center for Center for Disease Control and Prevention (June 9, 2020). Accessed on June 2, 2022.
• Randolph SA (2017) Computer vision syndrome. Workplace Health Saf 65: 328.
• Pooja G (2006) Blink, breathe, and break. The Journal of Young 20: 1-3.
• Nielsen K, Trinkoff A (2003) Applying ergonomics to nurse computer workstations: review and recommendations. Comput Inform Nurs 21: 150-157. doi: 10.1097/00024665-200305000-00012.
• Alexander RL, Miller NA, Cotch MF, Janiszewski R (2008) Factors that influence the receipt of eye care. Am J Health Behav 32: 547-556.

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Module 1: Making Vision a Health Priority

This module includes information about vision changes that can occur with age, the importance of comprehensive dilated eye exams, and things people can do to keep their eyes healthy.

Download Making Vision a Health Priority PowerPoint presentation PPT  (9.56 MB) Download Making Vision a Health Priority PowerPoint presentation PDF  (650 KB) A slide presentation that introduces vision changes and eye conditions that occur in people as they age.

Download Speaker’s guide PDF  (1.3 MB) The speaker’s text and notes on how to present information contained in the PowerPoint presentation.

Download Promotional event announcement Word (450 KB) Download Promotional event announcement PDF  (244 KB) An announcement to promote an educational event that can be customized with your organization’s name and the location, date, and time of the event.

Download Everyone’s vision can change with age PDF  (635 KB) A 3 page explanation of how vision changes with age.

Download Age-related eye diseases at-a-glance PDF  (135 KB) An overview of the most common age-related eye diseases, including a description of the risk factors and symptoms.

Download Parts of the eye PDF  (260 KB) An illustration that shows the parts of the eye.

Download Dilated eye exam PDF  (1.25 MB) A description of what’s involved in a comprehensive dilated eye exam.

Download Financial assistance for eye care PDF  (189 KB) A list of organizations that can help cover the cost of eye exams, glasses, or contact lenses.

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Last updated: July 16, 2019

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• Health and Practice Topics

Vision and Eye Health

The National Center for Children’s Vision and Eye Health at Prevent Blindness has partnered with the NASN to provide national guidance for school nurses and others involved in front-line vision screening. The goal is to standardize approaches to vision health, facilitate follow-up eye care for students who do not pass vision screening, provide family/caregiver friendly educational information, and consult with leading pediatric eye care providers to promote best practices.

The content on this page is organized according to the 12 Components of a Strong Vision Health System of Care .

Vision impairments in children are common and uncorrected vision problems can impair child development, lead to behavior problems in the classroom, interfere with early literacy and learning, and lead to permanent vision loss. i,ii,iii,iv,v Early detection, treatment, and ongoing care is critical. vi,vii,viii,ix,x Additionally, visual functioning is a strong predictor of academic performance in school-age children, xi,xii and vision disorders of childhood may continue to affect health and well-being throughout the adult years. xiii

With the focus on prevention, the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health Report Recommendations (2010), directs registered nurses to provide care within the full scope of their license. A comprehensive vision health program is a school nurse intervention that makes a significant measurable difference in a student’s overall health and learning.

12 Components of a Strong Vision Health System of Care

1. family education.

All parents/caregivers should receive culturally competent educational materials with appropriate reading levels. The materials explain why scheduling and attending an eye examination when a student does not pass his/her vision screening is important for good vision now and in the future, and the increased risk for vision problems in defined high-risk populations.

A Glossary of Eye and Vision Terms: English   A Glossary of Eye and Vision Terms: Spanish

Parent/Caregiver Resources: Small Steps for Big Vision : An Eye Health Information Tool Kit

Fact Sheets:

Vision Screening Is Key to Healthy Development! English Vision Screening is Key to Healthy Development! Spanish

Focus on Eye Health and Culturally Diverse Populations

Signs of Possible Vision Problems in Children: English Signs of Possible Vision Problems in Children: Spanish

The Affordable Care Act and Your Child’s Eyes: English The Affordable Care Act and Your Child's Eyes: Spanish

Star Pupils Eye Health and Safety Curriculum (grades K-2, 3-5, and 6-8)

Developing Eyes Video (A parent discusses the importance of vision screening.)

2. Comprehensive Communication/Approval Process

Facilitate parents’/caretakers’ completing and signing a HIPAA/FERPA-compliant release permitting exchange of vision screening and eye examination information among appropriate healthcare providers to support reciprocal access to and follow-up from eye care. This release will help school nurses ensure vision treatment plans are implemented at school and to talk to eye care providers when treatment plans are unclear.

Referral for an Eye Examination letter with release of information: English Referral for an Eye Examination letter with release of information: Spanish

3. Vision Screening Tools and Procedures

Screen student’s vision with age-appropriate, evidence-based tools and procedures, including optotypes (symbols, letters, or numbers) and/or instruments.

Considerations for Children's Vision Screening Programs During the Covid-19 Pandemic

Presentation: Why Do We Screen Vision in Young Children?

Common Early Childhood Vision Disorders: English   Common Early Childhood Vision Disorders: Spanish

Ages at Which Vision Screening Should Occur

Characteristics of Tests of Recognition of Visual Acuity for Screening the Vision of Children Ages 3-5 years (36 to <72 months)

Challenges with Commonly Used Tests of Visual Acuity (Eye Charts) for Optotype-Based Screening

Tips for Appropriate Eye Chart Design

Evidence-based Vision Screening Tools and Procedures: English   Evidence-based Vision Screening Tools and Procedures: Spanish

Referral Criteria for Optotype-Based Screening

Prevent Blindness Position Statement on School-Aged Vision Screening and Eye Health Programs

18 Vision Development Milestones From Birth to Baby’s First Birthday: English 18 Vision Development Milestones From Birth to Baby’s First Birthday: Spanish [Spanish]

4. Vision Health for Children with Special Health Care Needs (CSHCN)

Implementing policies and procedures for referral and support for visual health of children with special health care needs.

Children Who Should Bypass Vision Screening for an Eye Examination

Children with ADHD at Higher Risk for Vision Disorders

5. Standardized Approach for Re-Screening

Establish standards for the vision health program that directs the re-screening or referral of difficult-to-screen (untestable or unable) children.

Flowchart for Children Who Receive a Vision Screening

Referral for an Eye Examination: English (letter with release of information) Referral for an Eye Examination: Spanish (letter with release of information)

6. Comprehensive Vision Screening Results

Provide parents/caregivers with vision screening results in easy-to-understand language, which respects cultural and literacy needs and provides clearly defined next steps and timelines. Results should be communicated in writing and verbally; parents/caregivers may lack time to review all backpack documents.

Mattey, B., Zein, W.M., O’Malley, D., & Naron, C. (2013). Preventing vision loss among students through eye safety and early detection . NASN School Nurse, 28 (5), 233-236. doi:10.1177/1942602X13497062

7. Systemized Approach to Follow-Up

Implement/facilitate a follow-up system with parents/caregivers following a failed vision screening, which includes creating a system to monitor whether eye examinations occurred and identifying barriers to follow-up eye care and ways to overcome those barriers, such as lack of transportation or assistance with paying the cost of an eye examination.

Marsh-Tootle, W.L., Russ, S.A., & Repka, M.X. (2015). Vision and eye health in children 36 to <72 months: Proposed data definitions. Optometry and Vision Science, 92 (1), 17-23. doi: 1040- 5488/15/9201- 0017/0 17Y23. Retrieved from https://www.researchgate.net/publication/270663059_Vision_and_Eye_Health_in_Children_36_to_72_Months

Hartmann, E.E., Block, S.S., & Wallace, D.K. (2015). Vision and eye health in children 36 to 72 months: Proposed data system. Optometry and Vision Science, 92 (1), 24-30. doi: 1040-5488/15/9201-0024/0. Retrieved from https://www.healthit.gov/sites/default/files/comments_upload/vision_and_eye_health_in_children_36_to_72.98810.pdf

See Jane See! Parental Advice for Healthy Vision in Kids ( NOTE: prevalence is 1 in 17 -- resource states 1 in 20 )

8. Resources for Eye Care

Link parents/caregivers with resources for eye care and seek out eye care providers who specialize in the care and treatment of young children.

VSP Vision TM VSP® Eyes of Hope® (formerly Sight for Students) Gift Certificate Program

Learn more about VSP® Eyes of Hope ®.

Enroll in VSP® Eyes of Hope® to receive gift certificates . (NASN member login required.)

Financial Assistance Information: English Financial Assistance Information: Spanish

How to Schedule an Eye Examination: English How to Schedule an Eye Examination: Spanish

9. Collect Eye Examination Results

Collect eye examination results to help ensure treatment plans are implemented at school and share treatment plans with teachers who may need to make classrooms accommodations.

Template for Collecting Eye Examination Results: English 2nd page Template for Collecting Eye Examination Results: Spanish  2nd page

10. Effective Communication with the Medical Home

Keep the medical home informed by sending a copy of eye examination results to the child’s primary care provider.

Vision Screening is Key to Healthy Development: English Vision Screening is Key to Healthy Development: Spanish Vision Screening is Key to Healthy Development: Chinese

11. Adherence to Treatment

Have a process in place to facilitate the eye care treatment plan prescribed for a student. For example, if a student with patching for amblyopia is required to patch at school, you need to know when and duration. Share this information with the student's teacher(s).

The Eyes That Thrive program to support vision treatment adherence in the classroom.

Information to share with parents/caregivers about their role as part of the eye care health team:

Eye Patch Choices

12. Annual Vision Health Program Evaluation

Evaluating the vision health program annually includes comparing screening and eye examination results to determine whether over-referrals are excessive and screening tools and/or procedures should be reviewed.

Annual Vision Health Program Evaluation Checklist

Background Information References

i Collins, M. E., Mudie, L. I., Inns, A. J., & Repka, M. X. (2017). Pediatric ophthalmology and childhood reading difficulties: Overview of reading development and assessments for the pediatric ophthalmologist. J ournal of AAPOS, 21(6), 443-436. Abstract available at https://www.ncbi.nlm.nih.gov/pubmed/?term=Overview+of+reading+development+and+assessments+for+the+pediatric+ophthalmologist

ii National Academies of Sciences, Engineering, and Medicine (2016). Making eye health a population health imperative: Vision for tomorrow . Washington, DC: The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK385157/

iii Peterseim, M. M., Papa, C. E., Parades, C., Davidson, J., Sturges, A., Oslin, C., Merritt, I., & Morrison, M. (2015). Combining automated vision screening with on-site examinations in 23 schools: ReFocus on Children Program 2012 to 2013. Journal of Pediatric Ophthalmology & Strabismus, 52 (1), 20-24. https://doi.org/10.3928/01913913-20141124-01

iv National Center for Children's Vision and Eye Health at Prevent Blindness. (2020). Children’s vision and eye health: A snapshot of current national issues (2nd ed.). Chicago, IL: National Center for Children’s Vision and Eye Health at Prevent Blindness. https://preventblindness.org/wp-content/uploads/2020/07/Snapshot-Report-2020condensedF.pdf

v VIP-HIP Study Group, Kulp, M. T., Ciner, E., Maguire, M., Moore, B., Pentimonti, J., . . . Ying, G. (2016). Uncorrected hyperopia and preschool early literacy: Results of the Vision in Preschoolers – Hyperopia In Preschoolers (VIP-HIP) Study. Ophthalmology, 123 (4), 681-689. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808323/

vi Wen G, McKean-Cowdin R, Varma R, et al. (2011) General Health-Related Quality of Life in Preschool Children with Strabismus or Amblyopia. Ophthalmology , 2011;118(3):574-580. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017225/

vii Roche-Levecq A, Brody BL, Thomas RG, Brown SI. (2008) Ametropia, Preschoolers’ Cognitive Abilities, and Effects of Spectacle Correction. Archives of Ophthalmology , 2008;126(2):252-258. https://doi.org/10.1001/archophthalmol.2007.36

viii Atkinson J, Anker S, Nardini M, et al. (2002) Infant Vision Screening Predicts Failures on Motor and Cognitive Tests up to School Age. Strabismus , 2002;10(3);187-198. https://doi.org/10.1076/stra.10.3.187.8125

ix Ibironke JO, Friedman DS, Repka MX, et al. Child Development and Refractive Errors in Preschool Children. (2011) Optometry and Vision Science , 2011;88(2):181-187.

x Jonas, D. E., Amick, H. R., Wallace, I. F., Feltner, C., Vander Schaaf, E. B., Brown, C. L., & Baker, C. (2017). Vision screening in children ages 6 months to 5 years: Evidence report and systematic review for US Preventive Services Task Force . Evidence Synthesis No. 153. AHRQ Publication No. 17-05228-EF-1. Rockville, MD: Agency for Healthcare Research and Quality. https://jamanetwork.com/journals/jama/article-abstract/2652656

xi Maples WC. Visual Factors That Significantly Impact Academic Performance. Optometry , 2003;74(1):35-49. https://pubmed.ncbi.nlm.nih.gov/12539891/

xii Basch CE. Vision and the Achievement Gap among Urban Minority Youth. Journal of School Health , 2011;81(10);599-605. https://doi.org/10.1111/j.1746-1561.2011.00633.x

xiii Davidon S, Quinn GE. The Impact of Pediatric Vision Disorders in Adulthood. Pediatrics , 2011;127(2):334-339. https://doi.org/10.1542/peds.2010-1911

Additional References

Special thanks and appreciation to P. Kay Nottingham Chaplin, EdD, Kira Baldonado, MPH , and Prevent Blindness through the National Center for Children’s Vision and Eye Health .

Technical Assistance available from the National Center for Children’s Vision and Eye Health at Prevent Blindness; 225 West Wacker Drive; Suite 400 Chicago, IL 60606; 1-800-331-2020; [email protected]

Page last updated February 2022.

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• v.33(110); 2020

The many roles of an ophthalmic nurse in a tertiary eye institution

Timothy adeyemo.

1 Ophthalmic Nurse and Ocular Ultrasonographer: Vitreoretinal Department, National Eye Centre, Kaduna, Nigeria.

Aminatu AbdulRahman

2 Ophthalmologist: National Eye Centre, Kaduna, Nigeria.

Fatima Kyari

3 Associate Professor: International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK. Consultant Ophthalmologist: College of Health Sciences, University of Abuja, Nigeria.

Ophthalmic nurses have to juggle different tasks each day in order to meet the expectations and needs of their patients and colleagues - especially when working in a busy teaching hospital.

A clinical lecture and demonstration with other colleagues in the vitreoretinal clinic. NIGERIA

Who is the ophthalmic nurse?

Ophthalmic nurses play an important role in global eye health delivery, including eye health promotion; disease prevention, diagnosis and treatment; and low vision and rehabilitation services. In countries where there is a shortage of ophthalmologists, ophthalmic nurses often diagnose and treat patients, referring them where necessary and possible. In this article, we consider the roles of ophthalmic nurses in busy tertiary settings, where they are important members of the eye care team.

Measuring a patient's visual acuity using the tumbling E chart. NIGERIA

A new era in ophthalmic nursing

Modern ophthalmic nursing is dynamic and constantly evolving to meet the growing demands of patients and the ophthalmic profession. In a tertiary setting, the ophthalmic nurse is often faced with expectations to see more patients, more quickly, embrace new technology and treatments, and use their specialist ophthalmic skills to maintain and enhance the eye health and wellbeing of patients. These additional responsibilities have enabled ophthalmic nurses to broaden their skills and expand their practice in various settings where they are expected to play multiple key roles within the various domains of ophthalmic care.

Multiple roles

Undertaking multiple roles is influenced by one's skill and experience, and often requires critical thinking skills. Generally, nursing is considered a high-risk, high pressure profession, given the fast-paced working environment and constant need to handle emergencies, especially for those working in low-resource settings where there are high patient-to-nurse ratios. In a tertiary eye hospital, an ophthalmic nurse's role often involves both clinical and administrative duties, carried out in a way that is patient-centered and efficient.

Due to time pressures in a typical eye hospital, and the desire to be accessible to patients, 1 the ophthalmic nurse with multiple roles is also often under pressure to perform two or more tasks simultaneously. However, such multitasking can increase mistakes and impair one's ability to retain information in working memory. 2 Therefore, it's important that ophthalmic nurses are permitted and supported to manage their own time and priorities so they can concentrate on, and complete, one task at a time.

In conclusion, we hope this article will contribute to colleagues' and managers' understanding of the complexities of ophthalmic nursing, and that it will help them to recognise the daily achievements of ophthalmic nurses.

Ophthalmic nurses should consider how they can switch between their various roles more efficiently, without becoming distressed or causing harm to patients. For example, they can work on mastering individual tasks and carefully anticipating what may be needed of them next. Ophthalmic nurses can also consider ways of minimising or managing interruptions, especially when performing tasks with a high risk of patient harm if something goes wrong, e.g., when dispensing medication.

• Community Eye Health. 2020; 33(110): 46–47.

From the field

Timothy Adeyemo is an ophthalmic nurse with multiple roles in the vitreoretinal clinic at National Eye Centre, Kaduna.

Ophthalmic nurse Timothy Adeyemo performs OCT angiography on a patient in the vitreoretinal clinic. NIGERIA

My responsibilities include:

• Routine examination. Measuring visual acuity (VA), intraocular pressure (IOP), and vital signs
• Special clinical investigations. Carrying out ocular ultrasonography, fundus photography, biometry, ocular coherence tomography (OCT) and OCT A, and fluorescein/indocyanine green angiography
• Patient counselling. Counselling and health education
• Training student nurses. Organising periodic training or lectures for student nurses and other allied ophthalmic assistants
• Other. Providing emergency resuscitation, administration of prescribed medication, assisting the ophthalmologist as necessary, and other administrative duties.

“I always ensure our patients understand their condition and the management plan.”

At the vitreoretinal clinic, we attend to an average of 55 patients daily, excluding patients referred for diagnostic investigations. Clinic starts at 7:00am. As patients arrive, the medical health records officer confirms their appointment status. Once at the clinic, we check patients' vital signs, measure their visual acuity and intraocular pressure, and work out their body-mass index (BMI). We document the results in their respective files on the electronic medical record system (EMR) and place patients in a queue so the ophthalmologist can attend to them. The patients are often seen on a first-come, first-served basis, unless they need to be seen urgently, e.g., if the doctor requests that priority be given to older patients or children. The nurses and the community health officers (who work as ophthalmic assistants) work together to ensure a seamless workflow.

Ocular ultrasonography (B-Scan). NIGERIA

After the consultation with the ophthalmologist, the patients who require more detailed explanation or counselling are directed to me. Despite the fast pace of work and workload, I always ensure our patients understand the nature of their medical condition and the outlined management plan. I use eye models, illustrated charts, and articles from the Community Eye Health Journal to help them understand their condition and management plan. Most of the patients require slow and gentle explanation to ensure they understand. Often, these discussions are continued beyond clinic hours.

At several intervals during the day, I attend to patients referred for different investigations and scans. My ability to switch between roles within a short period of time, while paying attention to every detail, reduces patient waiting time and makes me a valuable member of the team. This is appreciated by the ophthalmologists, who are able to attend to many patients within a short time frame.

My various duties are often interrupted by patients requesting further explanation or clarification of their diagnosis and treatment options. While I consider these interruptions necessary for positive patient outcomes and satisfaction, occasionally they prevent me from completing my tasks within designated timelines, unless I skip my lunch breaks.

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• Professional Development
• Developing Your Presentation Skills...

Developing Your Presentation Skills as a Nurse

What are presentation skills.

Table of Contents

Presentation skills are a crucial aspect of professional development for nurses. As a nurse, you may find yourself in situations where you need to present information to colleagues, patients, or other healthcare professionals. Whether you are giving a formal presentation at a conference or simply sharing updates during a team meeting, strong presentation skills can help you effectively communicate your message.

Presentation skills refer to the ability to deliver information in a clear, organized, and engaging manner. It involves not only the content of your presentation but also your delivery style, body language, and use of visual aids. Effective presentation skills enable you to convey complex ideas, influence others, and engage your audience.

Types of Presentations

There are various types of presentations that nurses may be required to deliver. Some common types include:

• Informative presentations: These presentations focus on providing factual information or updates. Nurses may deliver informative presentations to share research findings, discuss new treatment options, or provide education on specific health topics.
• Training presentations: Nurses often play a role in training new staff members or educating patients and their families. Training presentations aim to teach specific skills or knowledge to the audience.
• Persuasive presentations: In certain situations, nurses may need to persuade others to adopt a particular course of action or support a specific initiative. Persuasive presentations require strong communication and influencing skills.
• Collaborative presentations: Nurses frequently work as part of interdisciplinary teams. Collaborative presentations involve sharing information and insights with colleagues from different healthcare disciplines.

Benefits of Effective Presentations

Developing strong presentation skills offers several benefits for nurses:

• Enhanced communication: Effective presentations allow nurses to clearly communicate their ideas, research findings, and recommendations. This helps in fostering collaboration and improving patient outcomes.
• Professional development: Presenting in front of an audience helps nurses develop confidence, public speaking skills, and the ability to engage with different stakeholders.
• Influence and advocacy: Effective presentations can help nurses advocate for their patients, influence healthcare policies, and drive positive change within their organizations or communities.
• Career advancement: Strong presentation skills are highly valued in the healthcare industry. Nurses who can effectively present information are often seen as leaders and may have more opportunities for career advancement.

Presentation skills are vital for nurses to effectively communicate information, educate others, and influence positive change. Developing these skills can enhance your professional development, improve patient care, and open doors for career advancement. As a nurse, investing time in honing your presentation skills will undoubtedly benefit you throughout your career.

How to Develop Your Presentation Skills as a Nurse

As a nurse, effective communication and presentation skills are crucial in conveying important information to patients, colleagues, and other healthcare professionals. Whether you are giving a presentation at a conference, educating patients, or sharing research findings, honing your presentation skills is essential for success in your nursing career. In this article, we will explore seven key strategies to develop your presentation skills as a nurse.

1. Research Your Topic Thoroughly

Before creating your presentation, it is vital to conduct thorough research on your topic. This ensures that you have a deep understanding of the subject matter and can provide accurate and up-to-date information. Utilize reputable sources such as scholarly journals, authoritative websites, and evidence-based practice guidelines to gather relevant data and statistics.

2. Create a Compelling Introduction

The introduction sets the tone for your presentation and captures the audience’s attention. Craft a compelling opening that highlights the importance of the topic and engages your listeners from the start. You can use an attention-grabbing anecdote, an intriguing question, or a thought-provoking statement to pique their interest.

3. Establish a Clear Structure and Flow

Organizing your presentation in a logical and structured manner enhances understanding and retention of information. Start by outlining the main points you want to convey and arrange them in a coherent sequence. Use clear headings and subheadings to guide your audience through the presentation smoothly.

4. Use Visual Aids Effectively

Visual aids such as slides, charts, graphs, and images can enhance your presentation and make complex information more accessible. However, it is essential to use them judiciously and ensure they support your key points rather than overshadowing them. Keep visuals simple, uncluttered, and visually appealing to maintain audience engagement.

5. Include Engaging Content and Examples

To captivate your audience, incorporate engaging content and relevant examples throughout your presentation. Personal anecdotes, case studies, and real-life scenarios can help make your information relatable and memorable. Including practical examples also helps to demonstrate the application of the concepts you are presenting.

6. Practice Beforehand and Rehearse Out Loud

Practice makes perfect when it comes to presentations. Take the time to rehearse your presentation multiple times, preferably in front of a mirror or with a trusted colleague. Pay attention to your body language, tone of voice, and pace of speech. Practicing out loud helps you identify areas that need improvement and boosts your confidence on the day of the presentation.

7. Remain Calm During the Presentation

Nerves are natural before any presentation, but remaining calm is key to delivering an effective and confident presentation. Take deep breaths, maintain good posture, and speak at a comfortable pace. If you feel anxious, remind yourself that you are knowledgeable about your topic and have prepared diligently.

Remember, developing your presentation skills as a nurse takes time and practice. By following these strategies – thorough research, compelling introduction, clear structure, effective use of visual aids, engaging content, ample practice, and maintaining composure – you can enhance your ability to communicate effectively and deliver impactful presentations in your nursing career.

Sources: – American Nurses Association: https://www.nursingworld.org/ – National League for Nursing: https://www.nln.org/ – Johns Hopkins School of Nursing: https://nursing.jhu.edu/

Disclaimer: This article is for informational purposes only. It is not intended to be professional advice or replace the guidance of healthcare professionals.

Tips for Delivering an Engaging Nursing Presentation

As a nurse, delivering presentations is an important skill that can enhance your professional development and contribute to the advancement of your career. Whether you are presenting research findings, educating colleagues, or speaking at a conference, it is crucial to engage your audience effectively. Here are some valuable tips to help you deliver an engaging nursing presentation:

Be Prepared and Confident in Your Material

• Familiarize yourself with the content of your presentation and gather all the necessary information. This will help you feel more confident and prepared.
• Create an outline or a script to organize your thoughts and ensure a smooth flow of information during your presentation.
• Practice your presentation multiple times to become comfortable with the material and identify areas that may require further clarification or improvement.
• Use visual aids such as slides, charts, or videos to enhance your presentation and make complex information more accessible to your audience.
• Ensure that your presentation is well-structured, concise, and easy to follow. Avoid overwhelming your audience with too much information or technical jargon.

Speak Clearly and Make Eye Contact with the Audience

• Speak clearly and at an appropriate pace. Enunciate your words to ensure that every member of the audience can understand you.
• Make eye contact with individuals in the audience to establish a connection and keep them engaged throughout your presentation.
• Use body language to convey confidence and enthusiasm. Stand tall, use hand gestures purposefully, and move around the stage if possible.
• Avoid reading directly from notes or slides. Instead, use them as prompts to maintain a natural flow and engage with your audience more effectively.

Vary Your Tone and Pitch to Keep the Audience Engaged

• Use vocal variety to keep your audience interested and attentive. Vary your tone and pitch to emphasize important points, add excitement, or convey emotion.
• Avoid speaking in a monotonous or robotic manner, as it can quickly lose the attention of your audience.
• Use pauses strategically to allow your audience to absorb information and emphasize key ideas.
• Inject enthusiasm and passion into your delivery. Show your genuine interest in the topic to inspire and engage your audience.

Respond to Questions Thoughtfully and Appropriately

• Encourage questions from the audience throughout or at the end of your presentation. This promotes active engagement and allows for clarification.
• Listen attentively to each question and make sure you understand it before providing an answer. If necessary, ask for clarification to ensure a thoughtful response.
• Keep your responses concise and relevant. Avoid going off-topic or providing excessive details that may distract or confuse your audience.
• If you don’t know the answer to a question, admit it honestly. Offer to follow up with the person later or direct them to additional resources for further information.

Remember, delivering an engaging nursing presentation requires adequate preparation, confident delivery, effective communication, and the ability to connect with your audience. By following these tips, you can enhance your presentation skills and leave a lasting impression on your audience.

For further resources on improving your presentation skills, you may find valuable information on websites such as:

• Presentation Zen
• Toastmasters International
• Duarte Presentation Skills Training

Take the opportunity to develop and refine your nursing presentation skills, as they can significantly contribute to your professional growth and success in the field.

Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) Programs  in

Common courses for lpn/lvn programs include:.

• Fundamentals of Nursing
• Anatomy and Physiology
• Medical-Surgical Nursing
• Pharmacology
• Maternal and Child Health Nursing
• Mental Health Nursing

Associate Degree in Nursing (ADN) Program in

Common courses for adn programs include:.

• Foundations of Nursing Practice
• Adult Health Nursing
• Pediatric Nursing
• Obstetric and Gynecological Nursing
• Psychiatric and Mental Health Nursing
• Nursing Leadership and Management

Bachelor of Science in Nursing (BSN) Programs in

Common courses for bsn programs include:.

• Health Assessment and Promotion
• Nursing Research and Evidence-Based Practice
• Community Health Nursing
• Nursing Informatics
• Pathophysiology
• Healthcare Policy and Advocacy

Accelerated BSN (ABSN) Programs in

Common courses for absn programs include:.

• Transition to Professional Nursing
• Advanced Health Assessment
• Complex Nursing Care
• Population Health Nursing
• Nursing Leadership and Quality Improvement

RN-to-BSN Programs in

Common courses for rn-to-bsn programs include:.

• Nursing Theory and Research
• Health Promotion and Disease Prevention
• Public Health Nursing
• Nursing Ethics and Legal Issues
• Organizational and Systems Leadership

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