12 Components of a Strong Vision Health System of Care: Part 3-Standardized Approach for Rescreening.

Strong school-based vision and eye health systems include 12 key components to be implemented before, during, and after the actual vision screening event. The National Center for Children's Vision and Eye Health (NCCVEH) at Prevent Blindness partnered with the National Association of School Nurses (NASN) to provide guidance for school nurses for each of the 12 key components via a Vision and Eye Health webpage on the NASN website ( https://www.nasn.org/nasn-resources/practice-topics/vision-health ). This online resource is designed to support school nurses accountable for vision screening and maintaining the eye health of preschool- and school-age children. This NCCVEH/NASN webpage addresses key activities that provide overall support for a child's vision and eye health-beginning with parent/caregiver education and ending with an annual evaluation of the school's vision and eye health system. NASN School Nurse is publishing information about each of these 12 components. The May 2019 installment provided details about the 12 Components approach as a whole and Components 1 and 2: Family Education and a Comprehensive Communication/Approval Process. The July 2019 edition described Components 3 and 4: Vision Screening Tools and Procedures and Vision Health for Children With Special Health Care Needs. This article describes Component 5: Standardized Approach for Rescreening.

12 Components of a Strong Vision Health System of Care: Part 2-Vision Screening Tools and Procedures and Vision Health for Children With Special Health Care Needs.

Successful vision screening efforts require the implementation of 12 key components of a strong vision health system of care. The National Center for Children's Vision and Eye Health (NCCVEH) at Prevent Blindness partnered with the National Association of School Nurses (NASN) to provide guidance around these 12 components via a Vision and Eye Health webpage on the NASN website ( https://www.nasn.org/nasn-resources/practice-topics/vision-health ). This online resource is organized according to the 12 Components of a Strong Vison Health System of Care to support school nurses accountable for screening the vision of preschool and K-12 students. This NCCVEH/NASN webpage addresses key activities that support a child's vision health-beginning with parent/caregiver education and ending with an annual evaluation of the school's vision health system. Each of these 12 components will be described in NASN School Nurse. The May 2019 installment provided information about the 12 components approach as a whole and details on Family Education and a Comprehensive Communication/Approval Process. This installment describes Components 3 and 4: Vision Screening Tools and Procedures and Vision Health for Children with Special Health Care Needs.

The effects of a bioresponse system on the joint attention behaviour of adults with visual and severe or profound intellectual disabilities and their affective mutuality with their caregivers.

BACKGROUND: The subtle communicative behaviour of individuals with visual and severe/profound intellectual disabilities hinders the success of their interaction with professional caregivers. The bioresponse system, a tool to raise caregivers' awareness of the client's communicative behaviour, may improve the client's joint attention behaviour and the dyad's affective mutuality. METHOD: Four client-caregiver dyads participated in a randomized multiple baseline study with repeated baseline, intervention and follow-up observations. The bioresponse system's effect was evaluated with measures of joint attention and affective mutuality. RESULTS: Two clients showed a significant difference on one or two joint attention subscales (including one significant decrease), and for all clients, at least one joint attention subscale revealed a positive trend. Positive trends in affective mutuality scores were observed in two dyads. CONCLUSIONS: The results stress the importance of further research to the effects of using the bioresponse system's in daily care for persons with severe/profound intellectual disabilities.

Health and social care practitioners' understanding of the problems of people with dementia-related visual processing impairment.

It has been highlighted that health and social care staff need a greater awareness of the needs and problems of those people with young onset dementia in the UK. Symptoms of Alzheimer's disease are relatively well known (memory loss, disorientation, language difficulties and behavioural problems). However, there is less awareness of dementia-related visual processing impairments in Alzheimer's disease, Dementia with Lewy Bodies or rarer dementia syndromes such as posterior cortical atrophy (PCA), leading to delayed assessment, diagnosis and management. This qualitative study explored health and social care practitioners' opinions of the needs of people with dementia-related visual processing impairment (such as individuals with PCA) and identify any training that these practitioners might need. Social workers, occupational therapists, care home staff, rehabilitation workers (visual impairment), optometrists and admiral nurses participated in focus groups or one-to-one semi-structured interviews. All participants were shown video clips of people with dementia-related visual impairment to facilitate discussion. Sixty-one participants took part in focus groups or interviews between November 2014 and December 2015. Participants' experiences and understanding of dementia were explored and thematic analysis of the data identified two major themes. Theme 1 explores participants' understanding of dementia-related visual impairments. Theme 2 recounts how participants address and support people with dementia-related visual impairment and their families. Participants discussed, reflected and critically analysed the video clips during data collection. Most considered new perspectives of their own clients' difficulties and those participants working with people with rarer dementias consolidated their experiences. However, some participants seemed hesitant to accept the existence of visual processing impairment arising due to dementia, rationalising novel information to existing understanding of memory loss or behavioural problems. This study highlights that health and social care practitioners want more training and better understanding of less well-recognised symptoms of dementia and rarer syndromes (including PCA) to ensure appropriate, evidence-based assessment and intervention.

Process evaluation of a National Primary Eye Care Programme in Rwanda.

BACKGROUND: Visual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda. METHODS: We used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results. RESULTS: Structured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care. CONCLUSIONS: A model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum.

A maternidade de mulheres cegas: possíveis contribuições de enfermagem / The motherhood of blind women: possible nursing contributions / La maternidad de mujeres ciegas: posibles contribuciones de enfermería

Objetivo: identificar o estado da arte do contexto da maternidade de mulheres cegas. Método: revisão integrativa através de busca on-line de artigos indexados em periódicos do sítio Portal de Periódicos CAPES e da Biblioteca Virtual em Saúde, utilizando termos em Português e seus correspondentes em Inglês: mães e deficiência visual; mãe cega. Adotou-se como critérios de inclusão para a seleção: todos os artigos publicados entre 2000 e 2016, em Português e Inglês, disponíveis na íntegra, com enfoque na deficiência visual e maternidade. Resultados: a comunicação e interação mãe/filho são destacadas nos estudos examinados. Conclusão: a realização de estudos sobre mães cegas - seus anseios, suas experiências de vida com relação a elas mesmas e a seu novo papel social - pode fortalecer e aprimorar o cuidado em saúde e indicar para quais aspectos a enfermagem pode efetivamente direcionar o cuidado em saúde.

Objective: to identify the state of the art of the maternity context of blind women. Method: This integrative literature review was conducted by an online search for articles indexed in CAPES Journal Portal and the Virtual Health Library, using the terms in Portuguese and their correspondent in English: mothers and visual impairement; blind mother. The inclusion criteria were: all articles published between 2000 and 2016, in Portuguese and English, with full text available, focusing on visual impairment and maternity. Results: the examined studies highlighted mother/child communication and interaction as the main concern. Conclusion: the studies of blind mothers - their longings, their life experiences regarding themselves and their new social role - can strengthen and improve health care and indicate to which issues the nursing can effectively direct the health care.

Objetivo: identificar el estado del arte del contexto de maternidad de las mujeres ciegas. Método: revisión integradora de literatura llevada a cabo mediante una búsqueda en línea de artículos indexados en el Portal de Peiodicos CAPES y en la Biblioteca Virtual de Salud, utilizando los términos en portugués y su corresponsal en inglés: madres y discapacidad visual; madre ciega Los criterios de inclusión fueron: todos los artículos publicados entre 2000 y 2016, en portugués e inglés, con texto completo disponible, centrado en la discapacidad visual y la maternidad. Resultados: los estudios examinados destacaron la comunicación e interacción madre / hijo como la principal preocupación. Conclusión: los estudios de madres ciegas (sus anhelos, sus experiencias de vida con respecto a sí mismos y su nueva función social) pueden fortalecer y mejorar la atención en salud e indicar a qué temas la enfermería puede dirigir efectivamente la atención en salud.

Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study.

BACKGROUND: The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment. METHODS: As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis. RESULTS: Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed. CONCLUSIONS: Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

An Eye on Vision: Seven Questions About Vision Screening and Eye Health-Part 4.

Current evidence-based and best-practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the past 18 years. To help the busy school nurse with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to seven questions that are often received from the field. Topical areas are (1) instrument-based screening and stereopsis, (2) optotype-based screening if child is referred from instrument-based screening, (3) next steps if a student's glasses are scratched or broken, (4) critical line screening with a threshold eye chart, (5) full threshold screening if student does not pass critical line screening, (6) holding a ruler beneath line of optotypes to identify, and (7) convergence insufficiency screening in the school setting.

Raising awareness of sensory impairment among community nurses: a brief intervention in a remote island setting.

INTRODUCTION: The prevalence of sensory impairment that includes sight and/or hearing impairment is projected to rise worldwide given the strong correlation between sensory impairment, older age and the demographic structure of the global population. Sensory impairment and associated disability is thus a significant global health concern. The prevalence rates for sensory impairment in Scotland are significant: as more people live into older age and as the age distribution in rural areas is markedly different with a higher proportion of older people, the extent of sensory impairment in the rural population will increase proportionally. In rural areas community nurses have a key role in recognising sensory impairment and directing people to sensory services to reduce the debilitating impact of sensory impairment. However, there is limited evidence about the utility of educational interventions to enhance healthcare professionals' knowledge, skills and attitudes about sensory impairment and subsequent impact on referral practices. The aim of this study was to evaluate the impact of a brief educational intervention with community nurses. The educational intervention was a training workshop that included simulation practice, information on assessment and referral pathways. The study was conducted in a remote island community health setting in the Western Isles of Scotland. The study evaluated nurses' perceptions of the training on their knowledge, attitudes and practice. METHODS: Mixed method, longitudinal design was implemented in three phases. Phase 1 was a pre- and post-workshop questionnaire, phase 2 a postal questionnaire 3 months post-workshop and phase 3 a qualitative focus group interview 6 months post-workshop. Kirkpatrick's model of training evaluation provided a framework for data evaluation. RESULTS: A total of 41 community based healthcare professionals who were mostly nurses participated in the study. Participants described increased awareness of the potential for their patients to have a sensory impairment, greater understanding and empathy with patients who experience sensory impairment, more robust patient assessment to identify impairment, and increased likelihood to inform of, and refer to, sensory services. CONCLUSIONS: Community nurses are often well placed to identity disabilities and patients at risk of injury because of sensory impairment. Participation in simulation training can help to develop greater awareness of the impact of that sensory impairment. Knowledge of specialist services will increase the opportunities for referral to services and impact positively on the lives of older people living in rural settings. Provision of accessible education on sensory impairment for health and social care professionals can enhance care delivery to older people.

An Eye on Vision: Five Questions About Vision Screening and Eye Health-Part 3.

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the past 18 years. To help the busy school nurse with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to five questions that are often received from the field. Topical areas are: (1) instrument-based screening for children ages 6 years and older, (2) stereoacuity screening and Random Dot E, (3) binocular distance visual acuity screening, (4) a 2-line difference between the eyes as part of referral criteria, and (5) state vision screening guidelines excluding evidence-based tools.

An Eye on Vision: Five Questions About Vision Screening and Eye Health-Part 2.

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the last 3 years and advances in research during the past 18 years. To help the busy school nurse, with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to five questions that are often received from the field. Topical areas include (1) which numbers to record when using a 10-foot chart, (2) instrument-based screening and visual acuity, (3) screening children who wear glasses, (4) referring children who do not pass color vision deficiency screening, and (5) conducting near visual acuity screening monocularly or binocularly.

An Eye on Vision: Five Questions About Vision Screening and Eye Health.

Current evidence-based and best-practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the past 18 years. In providing answers to the five questions in this article, the National Center for Children's Vision and Eye Health at Prevent Blindness used published, peer-reviewed research; vision screening and eye health national guidelines; and consensus-based best practices from eye care professionals and public health experts. The answers may differ from your state or district vision screening guidelines and mandates. This is the second installment of the "An Eye on Vision" frequently asked questions section that will appear in future editions of NASN School Nurse. To review the first installment, see the March 2018 edition of NASN School Nurse. The authors encourage vision screeners to submit their vision screening and eye health questions to the email address that appears at the end of this article.

An Eye on Vision: 20 Questions About Vision Screening and Eye Health.

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the last 16 years. To help the busy school nurse with little time to keep up with changes in children's vision practices and a growing body of literature, the National Center for Children's Vision and Eye Health at Prevent Blindness is providing answers to 20 questions received most often from the field. Question topics are: (1) arranging the screening environment, (2) occluders to cover the eyes during vision screening, (3) optotype-based screening at distance, (4) optotype-based screening at near, (5) instrument-based screening, (6) muscle imbalance screening, (7) referrals, and (8) vision screening certification.

Preserving vision and promoting visual health in older people.

Reduction in vision is not inevitable but a manageable consequence of getting older. Some physiological and disease processes associated with ageing may reduce vision and, in some cases, this reduction in vision cannot be treated. Much of it can be prevented, however. Prevention of visual loss is one of the keys to the maintenance of independence in older people. This article describes the main visual conditions associated with ageing and considers what can and should be done by the older person and their network of friends, relatives and carers to ensure that vision is maintained by the early detection and treatment of eye problems and that independence is maintained by putting strategies in place to help the person manage any untreatable vision loss.

Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.

OBJECTIVES: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. DESIGN: Qualitative study alongside a cluster randomised controlled trial. SETTING: 17 long-term care homes spread across the Netherlands. PARTICIPANTS: 34 licensed practical nurses supporting 54 dual sensory impaired older adults. INTERVENTION: A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. PRIMARY OUTCOMES: Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. RESULTS: Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. CONCLUSIONS: Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. TRIAL REGISTRATION NUMBER: NCT01217502, Post-results.

Computer Vision Syndrome: A Review of Literature.

Computer vision syndrome is caused by prolonged computer use. Symptoms, treatments, and recommendations are discussed.