Assisting adults with sight loss in hospital

Prior to an appointment

If you know that a person is blind or vision impaired, call and ask them if they would like to receive appointment letters, prescriptions, menus in large print, audio, braille, on disk, or via email. Nearer to the appointment time, telephone the patient to remind them of their appointment. Tell them if they need to bring anything with them and ask them if they know their way to the hospital.

Going for an appointment

1. A patient with sight loss may have difficulty with finding their way around an unfamiliar hospital building. Signs can be small and difficult to see.
2. Large clear signs with good light and large print can help a patient with sight loss to find their way.
3. Anyone in the hospital can offer assistance to a patient with sight loss, the receptionist, the porter, the nurse. Before giving assistance, always ask the patient first if they would like assistance, and if they do, ask what assistance is needed. Do not assume that you know what assistance the patient needs.
4. Introduce yourself and say what your job is, as the patient may not be able to see your face. Speak clearly but do not shout.
5. Giving directions such as “Ward 4 is over there through the red door on the left” is not helpful to a patient with sight loss. If you are giving directions, don't point! Give clear verbal directions or offer to guide or accompany the patient.
6. Find out more about guiding a person with sight loss safely or do's and don'ts when meeting and greeting a person with sight loss.

In the waiting room

• In the reception area or waiting room, offer to assist the patient if they need to complete a form. Standard practice is for a staff member to find a quiet and, if available, private place to read the questions aloud, and write down the answers on behalf of the person. Forms can be completed by showing the patient where to sign. This method can work very well for people with sight loss.

• If you leave a patient with sight loss in a waiting room, try to ensure that it is easy for the patient to reach the door. If possible, seat the patient near to the door. Toys, mats or low coffee tables in a waiting room could be a tripping hazard.

• If the patient is waiting in a queue, ensure that the patient is called by name when it is their turn rather than saying ‘next’. Let the patient know if there is ticket system and digital display. Ensure that the patient knows what their number is and inform staff that a person with sight loss is in the waiting room and may need assistance.

• Where appropriate, when changing shifts inform other staff that the patient might require assistance.

Offering medical care to the patient

If you are a nurse or doctor and you are offering medical care to the patient, speak to the patient directly by addressing them by name so they will know that you are speaking to them. Introduce all of the other staff in the room. Before touching the patient, explain what you are about to do in advance so that the patient is prepared.

Providing medical information to the patient

• Just because the patient can to move around with little difficulty does not mean that they can see enough to ‘read’ or see ‘details’. Similarly, a patient with tunnel vision can sometimes read the newspaper but cannot necessarily see to move around safely.

• Provide any medical information in a format that the patient can read, for example, large print using a thick black felt pen or read information onto a cassette tape. Give clear instructions about medication or further tests and ensure that the patient has understood.

After the patient’s appointment, ensure that they can find their way out by giving clear verbal instructions or offer to guide or accompany them.

Being admitted to hospital – on the ward

Even if a patient has a sighted companion with them on admission to hospital, don’t assume that all of the person’s needs will be catered for. It can be very reassuring to have a member of staff meet them at reception. This staff member should be trained in how to guide a blind person and communicate appropriately with them. NCBI can offer training and advice to hospital staff in how to guide a blind person safely and how best you can offer assistance.

Introduce the patient with sight loss to other patients and staff on the ward. Some patients with sight loss may feel comfortable if the other patients on the ward are told that they have sight loss. Others prefer to keep this information private, so it is very important to be discreet until you have ascertained the individual’s preference.

Familiarise the patient with their immediate surroundings for example, the position of the bed in relation to the entrance to the ward. Describe the room from left to right. It may be necessary to explain the exact position of certain objects, for example, the location of the light switches, call system, bed, bedside locker and what exactly is on top of the locker for example, a jug of water, glass, charts. One of the first places to show the patient is the route to the toilet, public telephone and day room. It may be useful to practice the route a few times. The patient may also need some assistance with unpacking, but make sure to say where their different personal items are stored so that they can find them when you have left the room.

• Always tell the patient about potential hazards or something which must not be touched.

• If you need to move something put it back in the same place so that the patient can find it when you are gone.

• Explain loud noises (e.g. if something falls over), as this may cause the patient unnecessary worry and concern.

• Depending on their circumstances, the patient may be able to use the toilet and bath independently. However, it would help if you tell them the exact position of the toilet – tell them where the flushing handle and toilet roll holder is placed and leave the rest up to them. Check that they know where everything is situated in the toilet cubicle. If it is necessary for the patient to have a bath, and they require assistance, place their hand on the side of the bath and leave them to lower themselves into it. Most adults with sight loss can dress and undress themselves independently.

• If you have to give the patient tablets at any time, place the tablets in their hand rather than just leaving them on the locker for them to find.

• If a patient with sight loss leaves the ward for tests, ensure that other hospital staff are informed that the patient has sight loss and may need assistance.

• At mealtimes, offer to read the menu or ask the patient if they would like a large print or braille menu. When a meal arrives, the easiest thing to do is to place the plate on the table in front of the patient, offer to describe the location of food on the plate as corresponding to the numbers on a clock face. For example, tell the patient that their vegetables are at 3 o'clock and their chips are at 9 o'clock. Put the patient’s hand on the glass of water so that they will have an idea where it is situated. For a patient with low vision, use plates and cups that contrast in colour to the table or tray, for example, a dark plate will stand out against a white tray.

• Many people with sight loss enjoy television, so, when in the day room, don’t be embarrassed to ask them if they would like the television switched on.
  
• Some people with sight loss smoke. When they visit the smoking area, ask if they need help lighting up, and give them an ashtray.

• If you are unsure of something or need to know what the patient requires, just ask them.

Going home

When the patient is going home, ensure that they know

1. The date and time of any future appointments.
2. Information about medication they are to take.
3. Distinguish different medicine bottles by for example, placing a rubber band around one.
4. How to care for wounds or change dressings.

Some people with sight loss may not be able to see their appointment card or instructions. Make this information available in large print or audiotape or whatever format the patient requests.