Nursing and Visual Difficulties
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Preparing for a Clinical Placement
If a student is visually impaired, it may affect their mobility whilst on clinical placement, this can be in terms of getting to and from the placement as well as within the environment of the placement itself.
Visually impaired students will general either need to be within walking distance of a clinical placement or be able to access it easily by public transport. If the student is not familiar with the route, it would be advisable to travel it prior to the start of the placement. Although it is the student's responsibility to carry this out, it may be useful for the Clinical Education Co-ordinator and/or the Clinical Educator to be aware of this issue and, on initial contact with the student, to suggest this strategy of prior route familiarisation.
Living Away from Home/College
Some clinical placements are remote and entail the student living out. If this is the case there will need to be close liaison between the Clinical Education Co-ordinator and the placement provider to ensure that the accommodation is appropriate with regard to access. It may be useful for the student to speak to the Accommodation Officer and to visit the living space prior to the beginning of the placement to facilitate orientation and mobility.
If the student is a guide dog user, issues such as room size and facilities for the dog to take comfort breaks will need to be considered. Guide Dogs for the Blind Association (GDBA) may be able to provide some mobility training locally and could also be contacted for advice if necessary.
Timing of Placements
Some partially sighted people can see quite well when light levels are good, but may experience night blindness in low levels of light or at night. If the route to a placement is complicated or involves a long walk, it may be difficult for the student to negotiate the environment during the months of the year when it gets dark early or when working night shifts. Clinical Education Co-ordinators should be aware that this may be an issue and be sympathetic in the allocation of placements. If it is unavoidable that the student has to be placed in a particular clinical setting that involves a difficult journey, this should be discussed with the individual student in advance.
Depending on the student's particular requirements, s/he may need some specialist equipment to enable full participation in the placement. Many students have their own portable equipment that they may be able to take onto placement e.g. lap top computers, Braille note-takers, portable close circuit televisions (CCTV). If this is not the case, students may need to have some equipment provided.
It is helpful for Clinical Educators to be sympathetic to students using a Dictaphone or tape recorder during assessments in order to temporarily record their findings. The student should briefly explain to their patients why s/he is using the equipment.
Access to Information
Clinical placement providers should ensure that any information that students receive prior to or during the placement is available in their preferred format i.e. text, enlarged text, on tape/mini-disk, in Braille or an electronic copy. Appropriate presentation of written information for students with partial sight includes the following principles:
- Produce all information digitally.
- Keep layout simple and clear.
- Keep text to a minimum.
- Use a clear sans serif font e.g. Arial.
- Use good contrast in documents.
- Use matt paper.
- Use headings and pointers to aid navigation round documents.
Completing Patient Records and Other Documentation
It is often assumed that visually impaired people, as a direct consequence of their impaired vision, will necessarily be unable to sign patient records and will, therefore, be in breach of their legal obligations. This is not the case. Many partially sighted people can write legibly and, indeed, can read their own handwriting as well as that of their colleagues; others can write legibly although they are unable to read what they have written or any other handwritten script. Blind people, whose sight has been lost as a result of accident or degenerative condition, retain the ability to write; those whose blindness is congenital are able to produce a mark which, for legal purposes, is recognised as their signature.
It is axiomatic that some visually impaired people will require assistance to complete standard patient record forms and other relevant documentation such as Learning Contracts. It may, therefore, be appropriate to produce a tactile template of each form so that a visually impaired practitioner can learn its layout, complete and sign it independently. Alternatively, an electronic version of each form will afford access to all clinicians, including a user of access technology: the details will be accessible, either in enlarged text on screen or speech output.
Most visually impaired students will require reasonable adjustments in order both to access information and to produce their own written records. This may involve a personal reader, low vision aids (e.g. a magnifier), CCTV, a computer with access technology, Braille note-taker or a combination of these. It is important to explore possibilities with individual students prior to the start of a placement.
Information taken from: CSP Guidance: Support Disabled Physiotherapy Students on Clinical Placement The Chartered Society of Physiotherapy.