opthalmic student mentor pack 2011

Westminster Eye Centre

Learning Pack

[Type the document title]

For Student Nurses

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Designed by ophthalmology Staff Nurse T Culkin

2

Contents

Introduction ........................................................................................................................................3

Department Information ..................................................................................................................4

“Eye Clinic Orthoptic Service” ......................................................................................................6

Eye Centre Contact Details & Shifts Patterns ........................................................................ 10

Common abbreviations in the ophthalmology department................................................ 11

NHS Career Framework Information ......................................................................................... 12

Ophthalmic Unit Philosophy ....................................................................................................... 13

Remember the Seven Rules of Motivation can aid your development ........................... 14

The Role of Your Mentor .............................................................................................................. 15

The Role of the Student................................................................................................................ 17

VAK Learning Styles Self-Assessment Questionnaire ........................................................ 18

Continuous monitoring using the BENNER assessment model....................................... 23

Anatomy and Physiology of the Eye......................................................................................... 25

Visual Acuity ................................................................................................................................... 26

Performing Visual Acuity in Practice........................................................................................ 29

Practice Learning Opportunities................................................................................................ 30

Common Eye Conditions and Basic Learning Information ................................................ 36

Common Eye Drops ...................................................................................................................... 38

Personal Learning Reflection ..................................................................................................... 39

Feedback Sheet .............................................................................................................................. 40


3

Introduction

Dear .................................................Welcome to the Westminster Eye Centre

The unit has produced this “Learning Welcome Pack” to aid your personal development

during your stay with us. It explains some of the work carried out in this department, and will

provide you with some basic information on ophthalmic abbreviations, common drugs used,

eye conditions and learning opportunities in practice.

After receiving this welcome pack, you will be introduced to your personal mentor who will

guide you during your stay with us. Although we have a number of experienced ophthalmic

nurses who are more than happy to act as a mentor during your placement, you will work

alongside your personal mentor/ assessor during your stay with us, in order to accomplish

your learning needs.

There is also a “Student Notice Board” and some “Information Box Files” situated behind

the “Westminster Eye Centre Reception Desk” to aid your personal development during

your stay. If you require any further information or assistance, please do not hesitate to ask.

I hope you enjoy your placement with us and that you find it a valuable and interesting

experience.

Yours sincerely,

Lead Ophthalmic Nurse

You are responsible to complete all elements of learning within this learning pack

during your stay “you can also retain a copy for your portfolio on your departure”


4

Department Information

The Westminster Eye Centre

This purpose-built dedicated Ophthalmic Day Centre is both comfortable and meets the

highest standards of cleanliness and infection control. It is light spacious and modern, in-

cluding a Local Anaesthetic day area with comfortable armchairs and a General Anaesthet-

ic recovery area. The centre also holds pre-assessment, post-operative, glaucoma and

macular clinics. The optometry service is also situated within this department.

Our patients are referred to the centre by their opticians or general

practitioner.

Waiting times for operations in the Westminster Eye Centre at the

moment are:

Cataract Surgery

Routine -Three Months

Glaucoma Surgery

Routine –Three Months

Lid Surgery

Routine –Five Months

Adult Squint Surgery

Five Months

Children Squint Surgery

One/Two Months

Emergencies Eye Surgery

Next Available Theatre List


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The Eye Outpatient Department

This department holds a variety of clinics for patients of all ages. Their GP, Optician, other

Consultants and the Accident and Emergency Department can refer them. We also hold

clinics at Deeside Community Hospital and Ellesmere Port Hospital for easy patient access.

Clinic Purpose

Rapid Access Clinics

For new GP referrals

General Eye Clinics

To follow up patients

Children’s Eye Clinics

To new/review patients

Laser Clinics

For treatment of glaucoma, and retinal

disorders

Fundal Fluoroscein Angiography (FFA’s)

Investigation and analysis of certain reti-nal problems, e.g. Wet Macular Degenera-

tion

Minor Operations Theatre

For minor operations such as the

removal of cysts on eye lids & Botox injections

Macular Clinics

For Macular problems e.g. Wet AMD and Intravitreal & Avastin Injections

Casualties and Emergencies

These are seen the day of referral or next

available clinic according to the patients needs

Glaucoma Clinics

Consultant-led specialist clinic and daily

specialist nurse-led clinics to follow-up glaucoma patents

Post-Operative Clinics

Dr-led clinics are for patients following eye surgery.

Nurse Pre-Assessment Clinics

To prepare patients for their surgery e.g.

cataract & lid surgery

Visual Fields Testing Room

Two visual field technicians undertake

visual field tests using the latest equip-ment to detect and monitor visual field loss on glaucoma & stroke patients.


6

“Eye Clinic Orthoptic Service”

Orthoptics is concerned with the detection and treatment of vision problems and problems

with the two eyes working together e.g. squint and lazy eyes in children and double vision in

adults.

Children with eye problems need to be identified and treated as early as possible to get the

best results and treatment may mean many eye appointments over a period of several

years. The Orthoptic service provided in this area helps young children with this problem.

Some children, however, can attend for treatment at community clinics, to provide easy ac-

cess to a local service.

Adults with double vision can have prisms fitted to their glasses to aid single vision in this

department, thus allowing them to continue with their usual activities, while awaiting recov-

ery from eye surgery. The department also provides quick active treatments for patients

with thyroid eye disease (TED) which often prevents the need for (TED) surgery.

The department is committed to continual professional development and this enables us to

provide a quality, patient centred service.


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Optometry Service

The optometry department provides a wide range of optical services to patients under the

care of the Eye Unit. These include adult and paediatric refractions, contact lenses in clini-

cally necessary cases and low vision assessments.

In addition, the optometrist provides support for the pre- and post- operative clinics in the

Westminster Eye Centre and the glaucoma clinic in the Outpatient Department.

Patient Focus Group information

The unit benefits from the support and help of the Patient Focus Group. The group consists

of members of the public, patients’ carers and staff from the unit.

“The Focus Group is an ongoing group of interested and interesting people, who meet with

Ophthalmic Staff every two months or so. The members are mostly ex-patients who have

had eye surgery in some form or another and now wish to follow this up by giving a little of

their time. The members meet and discuss with other patients and staff any problems or

otherwise and to put forward any ideas they have, thus giving something back to this out-

standing department.”

J.G. (member of the Focus Group) May 06

“We are always looking for new members and everyone is welcome to attend the meeting.

Perhaps potential members could sit on a meeting before committing themselves”

R.M. (member of the Focus Group)


8

Vision Support Information

Vision Support Is a Regional Charity recognised as the leading provider of local support

and services to people of all ages living with vision impairment in Cheshire and North

Wales.

Established in 1876, our mission is to promote the continuing independence of individuals

living with sight loss and to raise awareness of the needs of people with a vision impairment

living within our local communities.

They have more than 150 staff and volunteers working to achieve this aim, and to deliver a

range of services and opportunities.

The service includes:

Three Resource Centres and Two Mobile Information Units across Cheshire and

North Wales

Hospital Support project at HM Stanley

Rehabilitation Assistance

Support with independent living skills

Supplier of daily living and low vision aids

Home visitors

Welfare and Benefit Advice

IT Training

Volunteering opportunities

Social clubs and activities

www.visionsupport.org.uk.

http://www.visionsupport.org.uk/


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Eye Clinic Liaison Officer (ECLO)

Please be aware that many visually impaired patients are anxious and they may have ques-

tions that they may not ask medical staff as authority figures sometimes intimidate them.

If you come across any patient, who you feel may need to talk to someone about his or her

eye condition or how they are managing at home please refer to the ECLO.

The majority of patients who are, or who are being registered, as sight impaired or severely

sight impaired will be having difficulties at home and would probably benefit from input from

the ECLO.

ECLO referral forms are already available in the clinic and ward area or referrals can be

made by writing the patient’s contact details on a piece of paper- as long as the information

gets to the ECLO contact will be made with the patient.

It is better for a patient to be referred and contacted by phone when they do not need it than

someone who does need support to be left to struggle alone.

Please leave referrals on ECLO desk, in the ECLO tray in the retinal office or hand them to

the ECLO.

If in doubt, ask for advice and refer the patient...


10

Eye Centre Contact Details & Shifts Patterns

Requests for off duty are made by filling in the “request book”. Students off duty is flexible

but they should work with their mentor for at least three shifts every week.

Sickness and Absence

Students should contact this Department and the University. Mentors will then complete a

green form and return a copy to the University with the dates of absence on it.

Bank Holidays and Study Days

Students are not automatically entitled to bank holidays. This should be discussed with the

University, if your placement hours fall around bank holiday periods.

Student Study days are shown on the Allocations Report which is automatically sent

from the University to Ward Managers. If you should have any queries about your study

hours please ask.

Ward Tel: 01244 366438 Open Monday – Friday 7am-8pm Saturday 8.30am-1.30pm

Clinic Tel: 01244 363016 Open Monday – Friday 9am- 5.30pm

Shifts you may work during your placement:

7-3 8-4

8.30-4.30 9-5

10-6 12-8


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Common abbreviations in the ophthalmology department

V.A. = Visual acuity

DNA = Did not attend

FTA = Failed to attend

OPA = Outpatient appointment

NAD = Nothing abnormal detected

L.A. = Local Anaesthetic

G.A = General Anaesthetic

PHACO = Phacemulsification

ECCE = Extra capsular cataract extraction

I.O.L = Intra ocular lens

TRAB = Trabeculectomy

D.C.R = Dacrocystorhinstomy

A.R.M.D = Age related macular degeneration

F.F.A = Fundal fluoroscein angiography

A.C. = Anterior chamber

P.C. = Posterior chamber

Sub-conj = Sub-Conjunctival

I.O.P = Intra ocular pressure

PVD = Posterior vitreous detachment

BCC = Basal cell carcinoma

Bio’s = Biometry

Stat = Immediately

OD = Once daily

MANE = In the morning

BD = Twice a day

TDS = Three times a day

QDS = Four times a day

NOCTE = At night,

Caps = capsules

PR = Rectally

Elix = Elixir

NEB = Nebulised

PRN = When necessary

PV = Vaginally

PO = Orally

INH = Inhaled


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NHS Career Framework Information

The diagram below outlines the Career Framework Levels of responsibility, with nine be-

ing the most senior within the trust. The appropriate clinical level title (in brackets) and a

brief description below illustrate members of seniority you may wish to seek knowledge

from.

S

K I L

L S

&

C O

M P E

T E

N C I

E S

L E

A R N

I N

G &

D

E V E

L O

P M E

N T

Level 9 (More senior staff)

Staff with ultimate responsibility for decision-making and full on-call accountability

9

Level 8 (Consultant Practitioners)

Staff working at a very high level of clinical expertise and/or have re-sponsibility for planning services.

8

Level 7 (Advanced Practitioners)

Experienced clinical practitioners have a high level and theoretical

knowledge. Will make high-level clinical decisions and manage own workload.

7

Level 6 (Senior Practitioners)

A high degree of autonomy and responsibility than band level 5 staff, in a clinical environment,

6

Level 5 (Practitioner) Registered practitioners

Consolidating pre-registration experience and getting ready for higher

level of functioning.

5

Level 4 (Assistant practitioner )

Some work involving protocol based care under the supervision of a registered practitioner.

4

Level 3 (Senior Healthcare Support Workers) NVQ Level 3

Higher level of responsibility than healthcare support worker, Non-clinical roles can include ward clerking .

3

Level 2 (Healthcare Support Worker) NVQ Level 2

Works under the direction and supervision of healthcare professionals

and supports the multidisciplinary team in the delivery of high quality care non-clinical examples are housekeepers and receptionists.

2

Level 1 (Support Worker)

Non-clinical staff in roles that require very little formal education such

as catering assistant or domestic assistant

1

(SGHD, 2009)


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Ophthalmic Unit Philosophy

Our philosophy is to provide an environment which respects patient dignity,

privacy and confidentiality whilst promoting individual choice by creating a

partnership between patient, health care team and relevant others.

Each patient will be provided with a named Health Care Professional for each

visit who will be responsible for psychological, physiological, cultural and

social wellbeing and will provide information to make informed decisions

regarding their care.

The Ophthalmic Team strives to empathise with our patients and carers to

provide a safe and secure environment; this will include health promotion

facilities, providing the client/carer with information and skills in order to

maintain an optimum level of independence.

Members of the Ophthalmic Team are accountable for their own professional

development, to ensure they have the appropriate specialist skills to provide

evidence based practice to meet our patient needs. Members of the team are

also accountable to their different governing bodies.

The Ophthalmic team encourages user views of the service provided. This

information helps us to continually evaluate, enhance and improve our

practice.


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Remember the Seven Rules of Motivation can aid your development

The Role of Your Mentor

While all staff have indivdual expertise to give, mentorship should mean that the student will

receive high quality support, by forming a partnership with an experienced facilitator. As a trust,

we must also strive for some uniformity of input to facilitate a structured learning process.

To have been “identified” as a “Mentor” for student nurses within this hospital the following

qualities will be inherent within that nurse’s practice:

Clinical credibility

ENB 998, NM2157/NM3157, NM6064

Facilitating and supportive skills

Management skills

Commitment

Since Mentoring is a major responsibility, Wards and Departments within this Trust will identify

the learning opportunities, they have available for students as well as induction programmes for

new staff. Your mentor is responsible for negotiating and providing you with the experience of

these learning opportunities available in this department during your time with us.

Each student should also have his/ her own learning objectives. Each major aspect of care ap-

plicable to your learning needs must be discussed between you and your mentor at the

beginning of your partnership.

It is important that you as a student understands that the care given to patients in this

department is to be of the standard of care given by a trained nurse. Therefore,

supervision and guidance from your mentor and others within this deprtment is an ex-

tremely important “so always seek guidance and support”.


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Mentorship Functions

To ensure the mentor facilitates progression they will undertake the following functions:

Role model - demonstrating skills and qualities to be emulated

Advisor – support and advise

Sponsor – influence the student into the culture of the area and organisation

Networker – to facilitate experiences

Counsellor – acting as a listener to facilitate self awareness

Teacher – demonstrate a willingness to share knowledge and reflect experience.

It may also be noted that this document does not discuss assessment; this is a deliberate act,

as we believe that to be an assessor is not a prerequisite to mentorship.


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The Role of the Student

Experiential learning is only of value if based upon good practice. Time should be available to

discuss the care given for observation and assessment of your achievements and improve-

ments. To this end, the mentor needs time management skills to ensure that this takes place.

It is inappropriate for students to be initially admitting and devising care plans alone. Further-

more, supernumerary status does not always mean observation, you must remember nursing is

a practical art and that theoretical knowledge needs to be experienced in practical application.

You will meet with your mentor weekly, so that feedback is given. If any problems arise within

your inter-personal relationship, make sure you highlight this to the ward manager, so we can

be deal with the problem sooner rather than later.

Allocation checklists for first day (please date and sign)

Check List

Tick if Achieved

Signatures/Date

Student welcome pack given

Orientation to the department, Blood

Room, kitchen, HSDU, Theatre, Pharmacy & Canteen

Fire Points & Exits shown to student

How to use the Emergency Call Bells

and Telephone System

Off Duty & Request Book Shown to student

How to Perform Daily Checks Explained


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Please complete the following questionnaire during your first meeting to

discover your learning style...

VAK Learning Styles Self-Assessment Questionnaire

Circle or tick the answer that most represents how you generally behave.

(It is best to complete the questionnaire before reading the accompanying explanation).

1. When I operate new equipment I generally:

a) Read the instructions first

b) Listen to an explanation from someone who has used it before

c) Go ahead and have a go, I can figure it out as I use it

2. When I need directions for travelling I usually:

a) Look at a map

b) Ask for spoken directions

c) Follow my nose and maybe use a compass

3. When I cook a new dish, I like to:

a) Follow a written recipe

b) Call a friend for an explanation

c) Follow my instincts, testing as I cook

4. If I am teaching someone something new, I tend to:

a) Write instructions down for them

b) Give them a verbal explanation

c) Demonstrate first and then let them have a go

5. I tend to say:

a) Watch how I do it

b) Listen to me explain

c) You have a go

6. During my free time I most enjoy:

a) Going to museums and galleries

b) Listening to music and talking to my friends

c) Playing sport or doing DIY

7. When I go shopping for clothes, I tend to:

a) Imagine what they would look like on

b) Discuss them with the shop staff

c) Try them on and test them out

8. When I am choosing a holiday I usu-ally:

a) Read lots of brochures

b) Listen to recommendations from friends

c) Imagine what it would be like to be there


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9. If I was buying a new car, I would:

a) Read reviews in newspapers and magazines

b) Discuss what I need with my friends

c) Test-drive lots of different types

10. When I am learning a new skill, I am

most comfortable:

a) Watching what the teacher is do-

ing

b) Talking through with the teacher

exactly what I’m supposed to do

c) Giving it a try myself and work it out as I go

11. If I am choosing food off a menu, I tend to:

a) Imagine what the food will look

like

b) Talk through the options in my

head or with my partner

c) Imagine what the food will taste

like

12. When I listen to a band, I can’t help:

a) Watching the band members and other people in the audience

b) Listening to the lyrics and the beats

c) Moving in time with the music

13. When I concentrate, I most often:

a) Focus on the words or the pic-tures in front of me

b) Discuss the problem and the possible solutions in my head

c) Move around a lot, fiddle with pens and pencils and touch things

14. I choose household furnishings be-cause I like:

a) Their colours and how they look

b) The descriptions the sales-

people give me

c) Their textures and what it feels like to touch them

15. My first memory is of:

a) Looking at something

b) Being spoken to

c) Doing something

16. When I am anxious, I:

a) Visualise the worst-case scenar-ios

b) Talk over in my head what wor-

ries me most

c) Can’t sit still, fiddle and move

around constantly

17. I feel especially connected to other people because of:

a) How they look

b) What they say to me

c) How they make me feel


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18. When I have to revise for an exam, I generally:

a) Write lots of revision notes and

diagrams

b) Talk over my notes, alone or with

other people

c) Imagine making the movement

or creating the formula

19. If I am explaining to someone I tend to:

a) Show them what I mean

b) Explain to them in different ways until they understand

c) Encourage them to try and talk them through my idea as they do it

20. I really love:

a) Watching films, photography,

looking at art or people watching

b) Listening to music, the radio or

talking to friends

c) Taking part in sporting activities,

eating fine foods and wines or dancing

21. Most of my free time is spent:

a) Watching television

b) Talking to friends

c) Doing physical activity or making things

22. When I first contact a new person, I usually:

a) Arrange a face-to-face meeting

b) Talk to them on the telephone

c) Try to get together whilst doing something else, such as an activity or a meal

23. I first notice how people:

a) Look and dress

b) Sound and speak

c) Stand and move

24. If I am angry, I tend to:

a) Keep replaying in my mind what

it is that has upset me

b) Raise my voice and tell people

how I feel

c) Stamp about, slam doors and physically demonstrate my anger

25. I find it easiest to remember:

a) Faces

b) Names

c) Things I have done

26. I think that you can tell if someone

is lying if:

a) They avoid looking at you

b) Their voices changes

c) They give me funny vibes


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27. When I meet an old friend:

a) I say, “It’s great to see you!”

b) I say, “It’s great to hear from

you!”

c) I give them a hug or a hand-shake

28. I remember things best by:

a) Writing notes or keeping printed details

b) Saying them aloud or repeating words and key points in my head

c) Doing and practising the activity

or imagining it being done

29. If I have to complain about faulty goods, I am most comfortable:

a) Writing a letter

b) Complaining over the phone

c) Taking the item back to the store

or posting it to head office

30. I tend to say:

a) I see what you mean

b) I hear what you are saying

c) I know how you feel

Now add up how many A’s, B’s and C’s you selected.

A’s = B’s = C’s =

If you chose mostly A’s you have a VISUAL learning style.

If you chose mostly B’s you have an AUDITORY learning style.

If you chose mostly C’s you have a KINAESTHETIC learning style.

Some people find that their learning style may be a blend of two or three styles, in this case

read about the styles that apply to you in the explanation overleaf.


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VAK Learning Styles Explanation

The VAK learning styles model suggests that most people can be divided into one of three

preferred styles of learning. These three styles are as follows, (and there is no right or

wrong learning style):

� Someone with a Visual learning style has a preference for seen or observed things,

including pictures, diagrams, demonstrations, displays, handouts, films, flip-chart,

etc. These people will use phrases such as ‘show me’, ‘let’s have a look at that’ and

will be best able to perform a new task after reading the instructions or watching

someone else do it first. These are the people who will work from lists and written di-

rections and instructions.

� Someone with an Auditory learning style has a preference for the transfer of infor-

mation through listening: to the spoken word, of self or others, of sounds and noises.

These people will use phrases such as ‘tell me’, ‘let’s talk it over’ and will be best

able to perform a new task after listening to instructions from an expert. These are

the people who are happy being given spoken instructions over the telephone, and

can remember all the words to songs that they hear!

� Someone with a Kinaesthetic learning style has a preference for physical experience

- touching, feeling, holding, doing, practical hands-on experiences. These people will

use phrases such as ‘let me try’, ‘how do you feel?’ and will be best able to perform a

new task by going ahead and trying it out, learning as they go. These are the people

who like to experiment, hands-on, and never look at the instructions first!

People commonly have a main preferred learning style, but this will be part of a blend of all

three. Some people have a very strong preference; other people have a more even mixture

of two or less commonly, three styles.

When you know your preferred learning style(s) you understand the type of learning that

best suits you. This enables you to choose the types of learning that work best for you.

There is no right or wrong learning style. The point is that there are types of learning that

are right for your own preferred learning style.

Please note that this is not a scientifically validated testing instrument – it is a free assess-

ment tool designed to give a broad indication of preferred learning style(s).

More information about learning styles, personality, and personal development is at

www.businessballs.com.


23

This is how we monitor staff and student progression in this department, (please note

that we do not expect you to become completely competent during your placement it

can take years to get to this stage)...

Continuous monitoring using the BENNER assessment model

Continuous monitoring will be based on your assessment and completion of your spe-

cific learning contracts. The ongoing assessment activity takes place throughout the

duration of your placement. Your skilled nursing interventions will be assessed on

completion of the learning contracts (shown overleaf), and your overall progress and

experience will be monitored using the BENNER Assessment Model and the compe-

tencies achieved overleaf.

Stage 1: Novice

Beginners have had no experience of the situation in which they are expected to per-

form. You will receive training and knowledge during your induction and detailed in-

structions to guide your performance.

Stage 2: Advanced beginner

Advanced beginners are those who can demonstrate marginally acceptable perfor-

mance. You will be able to identify the situations but are unable to sort out which ele-

ments are most important.

Stage 3: Competent

The competent person will have increased understanding and ability to perform without

constant supervision. When competent you will continue to raise your awareness of the

situations, are able to ask questions about what task you are undertaking and act ac-

cordingly.

Stage 4: Proficient

The proficient performer can recognise when plans need to be modified and have the

experience and knowledge to be proficient.

Stage 5: Expert

The expert is highly skilled with enormous background and experience uses analytical

problem solving.

Your mentor will facilitate the training you require in this clinical area.


24

Start reflecting “now” by completing the KSF below on communicating with staff and patients in the ophthalmology department;

grade yourself from 0-5 at the Beginning, Middle & Final stages of your placement.

Developing your communications skills using the Knowledge and Skills Framework (KSF) and the BENNER

assessment model in the ophthalmology department

Individual

Example

Date

initial self Assessment

Date

Midway self Assessment

Date

Final self Assessment

A)

Can communicate with a limited range of people on day-to-day matters in a

form that is appropriate to them and the situation. Example of who you will com-municate with; patients, co workers,

managers and the public.

B) Reduces barriers to effective com-

munication

C) Present a positive image of self and

service

During induction, develop an under-standing of your team members and

effectively communicate through listen-ing and verbal communication

Develop and maintain and understand-ing of techniques to improve communi-cation. For example

Pictures, communication aids.

When greeting patients, their families and colleagues ensure you are wel-

coming. Respect their dignity and ori-entate them to the care environment as appropriate.

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5

0 1 2 3 4 5


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Anatomy and Physiology of the Eye

WWW.thomaseyecenter.com

http://www.thomaseyecenter.com/

http://uk.wrs.yahoo.com/_ylt=A0WTf2zgS2FNLF0AvEZWBQx./SIG=126634hsv/EXP=1298250848/**http:/www.thomaseyecenter.com/images/eye_diag.jpg


26

Visual Acuity

Please read the assessment of vision below

Vision is assessed, by formally testing the acuity of both distant and near vision,

visual fields, (that is, how far you can see all around at the side of your eyes, while

looking straight ahead), checking the health of the eye and looking at the retina.

Binocular vision is vision using both eyes and monocular vision is vision using one

eye. Distant and near vision are tested by using a Snellen Test Charts. Each eye is

tested individually.

Most reports in practice will provide monocular acuities i.e. vision in each eye inde-

pendently and so the VA of the one eye should be used.

It may be helpful to give you some examples:

Left eye Right eye Binocular vision

6/6 6/6 6/6

6/12 6/6 6/6

6/12 No vision 6/12

The rule therefore is if this information is available when monocular vision is rec-

orded; take the better of the two eyes to give what is in effect binocular vision. If in-

formation is not available then we need to obtain VAO and an optometrist report is

likely to be the best source.


27

For distant vision:

The person sits or stands at 6 metres, and reads down the vision chart from the

largest letter at the top, to the smallest letter at the bottom. The chart is a large card

or a lighted box, which displays the letters.

If a person can only see the top letter, their vision is described as 6/60; that means

that, while at a distance of 6 metres they can only see what a person could normal-

ly see at a distance of 60 metres.

However, if they can see the letters on the second bottom line, their vision will be

described as 6/6 (they can see with equal clarity at 6 metres what another person

with unimpaired vision standing at 6 metres will see). Alternatively, the smallest let-

ters on the bottom line, their vision will be described as 6/5, which means that they

can see at 6 metres, what a person with unimpaired vision, standing at 5 metres

can see. 6/5 vision would be better than average.

The vision test card, and light box should be well illuminated.

The visual acuity is tested firstly without, and then with the use of corrective spec-

tacles, or contact lenses.

If the person cannot see the letters on the chart, the person is moved to 3 or 4

metres from the card, and tested. If this is not possible, counting fingers, and hand

movements (at 30cm), or light perception are recorded.


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For Near vision:

Near vision is tested by using a test card and each eye is tested individually. The

card has number of printed paragraphs with print of varying sizes. Each paragraph

is described in terms of “points” measuring the body of the print – where a “point” is

1/72 of an inch. In a common test, N48 is the largest type, and N5 is the smallest,

which an unimpaired eye can see, held at a comfortable reading distance, (usually

14 inches), from the eyes.(patient can also use reading glasses if worn).

This type is N12.

http://dwp.gov.uk/publications/.../visual-acuity-vision.shtml.

http://dwp.gov.uk/publications/.../visual-acuity-vision.shtml


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Performing Visual Acuity in Practice

SNELLEN TEST TYPE

This consists of rows of letter graduated in size and arranged in horizontal rows.

The chart should be well illuminated

Normal vision means this patient should read 6/6.

The top number indicates how many metres from the chart your patient is

Each row is numbered 60, 36, 24, 18, 9, 6, 5, 4 accordingly.

Method

Stand or sit patient 6 meters away from chart (1meter is approximately 1

large stride).

Both eyes open and use an occluder to cover one eye and read chart from

the top. The last line read correctly is noted and recorded as a fraction in the

patient’s notes i.e. 6/60, 6/6, etc.

When the patient wrongly reads letters from the chart subtract from one line

or add to another, i.e. 6/9 – 3, 6/18 + 2 etc.

When the patient cannot read at 6 metres 6/60, take a loose chart from the

wall and move towards the patient one metre at a time until the top line can

be read, i.e. 5/60, 4/60, 3/60, 2/60. 1/60. DO NOT MOVE THE PATIENT.

When the patient is unable to see 1/60 ask him/her to count fingers (C.F.)

if the patient is unable to do this, test for perception of light (P.L.) or as the

case may be No perception of light (N.P.L)

Please always check to see what the patients vision was at their last visit (unless

new patient) to avoid embarrassment. If the patient’s sight is greatly reduced from

their last visit always inform a senior member of staff sister or doctor, because the

patient may need to be seen urgently...


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Practice Learning Opportunities

Please complete the following information during your placement

Learning Opportunities

in practice

Please reflect below on where, when and how you achieved the

following learning opportunities during your time practice

Date/signed

Anatomy and physiology

of the eye

Testing visual acuity

How to In-still eye drops


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Common eye drops used

Common eye conditions

Discharge planning

Pre & post operative

assessment

Moving and handling


32

Record keeping

Patient care pathways

Safe use of equipment

Observing eye operations

Escorting patients to and

from theatre

Team work


33

Fundamental and Key Caring Skills Available (1ST Year OSCE)

Learning Opportunities in

practice

Please reflect below on where, when and how you achieved the following learning opportunities during your time with us in practice

Date/signed

Manual blood pressure taking

Observation monitoring using (EWS)

Fluid balance monitoring

&

nutrition

Adult physical

measurements


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Administration of

medicines

& oxygen administration

Promoting

patients continence

Collecting & measuring

specimens

Blood glucose

monitoring

Catheter care


35

Assisting patients to the

toilet

Aseptic technique

urinalysis

Assessment of skin

integrity & prevention of pressure sores

Patient hygiene & oral

care needs


36

Common Eye Conditions and Basic Learning Information

Common Eye

Conditions

Please tell us a little about the following eye conditions in the boxes

provided below

Date/signed

Astigmatism

Amblyopia

Squint

Chalazion

Retinal Detachment

http://www.eyehelp.co.uk/DetachedRetina.html


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Diabetic Retinopathy

Iritis

Macular Degeneration

Cataracts

Glaucoma

Blepharitis

http://www.eyehelp.co.uk/CommonEyeConditionsCategory.html

http://www.eyehelp.co.uk/DiabeticRetinopathy.html

http://www.eyehelp.co.uk/TreatingCataracts.html

http://www.eyehelp.co.uk/TreatingGlaucoma.html

http://www.eyehelp.co.uk/blepharitis.html


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Common Eye Drops

Eye drop

Use

Find out what we use the following drops for and put your comments in the boxes below

Oxybuprocaine hydrochloride 0.4% Tetracaine 1%

Local Anaesthetics

Lidocaine hydrochloride 4% & Fluoroscein sodium 0.25% Fluoroscein sodium 1% & 2%

Combined local anaesthetics and stains

Atropine sulphate 1% Cyclopentolate 1% & 0.5

Mydriatics and cycloplegics

Phenylephrine 10% & 2.5% Tropicamide 1% & 0.5 %

Mydriatics

Chloramphenicol 0.5% Antibacterials

Dexamethasone sodium phosphate 0.1% Prednisolone sodium phosphate 0.5%

Steroids

Pilocarpine nitrate 2% Saline 0.9 % Artificial Tears 0.35% + 0.44 % Diclofenac

0thers

Personal Learning Reflection

A small piece of written work preferably reflective is expected from you the student, on

this page. It can be a good/or bad experience you have come across during your time with

us.


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Feedback Sheet

“Please note, all elements of this learning pack must be complet-

ed by yourself before handing it back to your mentor, at the end of

this placement.”

Student Evaluation

Agree

Disagree

Not applicable

Did you find the information in this learning pack useful?

Did you discuss your learning needs with your mentor (If not

why)?

Did you find the information in this learning pack aided your de-

velopment in practice?

Did you receive feedback from

your mentor during initial inter-mediate and final interview?

Do you think this learning pack is a good tool to use for other stu-dents visiting our department?

If any changes needed to be made to this pack, what would

you like to see and why?

Thank you for your support hope to see you again


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opthalmic student mentor pack 2011

Documents

learning welcome pack

elements of learning

learning needs

eye outpatient department

ophthalmic abbreviations

basic information

personal development

emergency department