Ophthalmic Nurses Research Articles

Trends and implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020.

BackgroundDevelopment of human resources for eye health (HReH) is a major global eye health strategy to reduce the prevalence of avoidable visual impairment by the year 2020. Building on our previous analysis of current progress towards key HReH indicators and cataract surgery rates (CSRs), we predicted future indicator achievement among 16 countries of sub-Saharan Africa by 2020.MethodsSurgical and HReH data were collected from national eye care programme coordinators on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined them with publicly available population data to calculate practitioner-to-population ratios and CSRs. Data on workforce entry and exit (2008 to 2010) was used to project practitioner population and CSR growth between 2011 and 2020 in relation to projected growth in the general population. Associations between indicator progress and the presence of a non-physician cataract surgeon cadre were also explored using Wilcoxon rank sum tests and Spearman rank correlations.ResultsIn our 16-country sample, practitioner per million population ratios are predicted to increase slightly for surgeons (ophthalmologists/cataract surgeons, from 3.1 in 2011 to 3.4 in 2020) and ophthalmic nurses/clinical officers (5.8 to 6.8) but remain low for refractionists (including optometrists, at 3.6 in 2011 and 2020). Among countries that have not already achieved target indicators, however, practitioner growth will be insufficient for any additional countries to reach the surgeon and refractionist targets by year 2020. Without further strategy change and investment, even after 2020, surgeon growth is only expected to sufficiently outpace general population growth to reach the target in one country. For nurses, two additional countries will achieve the target while one will fall below it. In 2011, high surgeon practitioner ratios were associated with high CSR, regardless of the type of surgeon employed. The cataract surgeon workforce is growing proportionately faster than the ophthalmologist.ConclusionsThe HReH workforce is not growing fast enough to achieve global eye health targets in most of the sub-Saharan countries we surveyed by 2020. Countries seeking to make rapid progress to improve CSR could prioritise investment in training new cataract surgeons over ophthalmologists and improving surgical output efficiency.

Nurse-led intravitreal injection clinics: defining the ophthalmic nurse's scope of practice and educational needs

This article critically explores ophthalmic nurses’ scope of practice and educational needs when undertaking the intravitreal injection. This topic has been more widely discussed since The Royal College of Ophthalmologists recommended that injections of anti-vascular endothelial growth factor (anti-VEGF) medicines can be administered by non-medical health professionals ( Kirkby, 2013 ). The increasing pressure on eye departments to deliver intravitreal therapy in a timely manner for thousands of new and existing patients led to the consideration of the development of nurse-led intravitreal injection clinics ( Kirkby, 2013 ). An in-depth critical review of the literature demonstrates excellent outcomes and patient satisfaction from nurse-led treatments. When undertaking this advanced role, it is therefore important that nurses are given the opportunity to adhere to the Nursing and Midwifery Council's code (2008) and the Royal College of Nursing's ophthalmic nurse competencies (2012) to clearly define their scope of practice and educational needs. This article will offer ophthalmic nurses and stakeholders a discussion on the ophthalmic nurse's scope of practice, and how investing in nurse training will result in highly skilled ophthalmic nurses who are equipped to deliver a well-rounded service that results in benefits to patient care and cost-effective service delivery.

Uncorrected refractive error and associated factors among primary school children in Debre Markos District, Northwest Ethiopia.

BackgroundUncorrected Refractive Error is one of the leading cause amblyopia that exposes children to poor school performance. It refrain them from productive working lives resulting in severe economic and social loses in their latter adulthood lives. The objective of the study was to assess the prevalence of uncorrected refractive error and its associated factors among school children in Debre Markos District.MethodA cross section study design was employed. Four hundred thirty two students were randomly selected using a multistage stratified sampling technique. The data were collected by trained ophthalmic nurses through interview, structured questionnaires and physical examinations. Snellens visual acuity measurement chart was used to identify the visual acuity of students. Students with visual acuity less than 6/12 had undergone further examination using auto refractor and cross-checked using spherical and cylindrical lenses. The data were entered into epi data statistical software version 3.1 and analyzed by SPSS version 20. The statistical significance was set at ≤ 0.05. Descriptive, bivariate and multivariate analyses were done using odds ratios with 95% confidence interval.ResultOut of 432 students selected for the study, 420 (97.2%) were in the age group 7–15 years. The mean age was 12 ± 2.1SD. Overall prevalence of refractive error was 43 (10.2%). Myopia was found among the most dominant 5.47% followed by astigmatism 1.9% and hyperopia 1.4% in both sexes. Female sex (AOR: 3.96, 95% CI: 1.55-10.09), higher grade level (AOR: 4.82, 95% CI: 1.98-11.47) and using computers regularly (AOR: 4.53, 95% CI: 1.58-12.96) were significantly associated with refractive error.ConclusionThe burden of uncorrected refractive errors is high among primary schools children. Myopia was common in both sexes. The potential risk factors were sex, regular use of computers and higher grade level of students. Hence, school health programs should work on health information dissemination and eye health care services provision.

A day in the life of… An Ophthalmic Nursing Officer

International Journal of Ophthalmic PracticeVol. 5, No. 3 Day in the LifeA day in the life of… An Ophthalmic Nursing OfficerEileen NA BuxtonEileen NA BuxtonSearch for more papers by this authorEileen NA BuxtonPublished Online:13 Jun 2014https://doi.org/10.12968/ijop.2014.5.3.116AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 June 2014Volume 5Issue 3ISSN (print): 2044-5504ISSN (online): 2052-2851 Metrics History Published online 13 June 2014 Published in print 2 June 2014 Information© MA Healthcare LimitedPDF download

Impact of an Electronic Health Record Operating Room Management System in Ophthalmology on Documentation Time, Surgical Volume, and Staffing

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Transformational change: nurses substituting for ophthalmologists for intravitreal injections - a quality-improvement report.

BackgroundThe dramatic increase in need for anti-vascular endothelial growth factor (anti-VEGF) intravitreal therapy in the treatment of retinal disease and the absence of an equivalent increase in ophthalmologists to undertake such intravitreal injections created a patient-safety risk. Timing of intravitreal therapy (IVT) is critical to prevent vision loss and local clinics lacked capacity to treat patients appropriately. We aimed to improve capacity for IVT by nurse injections.Materials and methodsA multidisciplinary prospective service-improvement process was undertaken at two adjacent general hospitals in the northwest of England. IVT injections by nurses were a principal component of solution development. After we had obtained appropriate institutional approval, experienced ophthalmic nurses were trained, supervised, and assessed to undertake IVT. Ophthalmologists directly supervised the first 200 injections, and a retina specialist was always on site.ResultsNurses undertook 3,355 intravitreal injections between June 2012 and November 2013, with minor adverse events (0.3% subconjunctival hemorrhage and corneal abrasion). There were no patient complaints at either hospital.ConclusionExperienced ophthalmic nurses quickly learned how to perform such injections safely. IVT by nurses was well accepted by patients and staff. Hospital A trained three nurses sequentially for improved flexibility in scheduling. Novel use of appropriately trained non-medical staff can improve efficiency and access in an overburdened service with time-sensitive disease. Retinal assessment was undertaken by ophthalmologists only. Improved access to IVT is important, as treatment with anti-VEGF therapy reduces blindness at population levels.

Short-term results from a slit-lamp Training-of-Trainers workshop in Greater Accra, Ghana

A slit-lamp Training-of-Trainers (ToT) workshop was held for ten ophthalmic nurses in Ghana who subsequently trained 23 of their colleagues within a three-week period. This article outlines the methods, results and reflections from the training sessions held following the ToT course.

Singapore National Eye Centre: an ophthalmic nursing journey

The growing demand for eye care services and a lack of training opportunities for ophthalmic healthcare professionals have prompted the launch of new educational programmes in Singapore. This article outlines the development of ophthalmic nursing in Singapore and provides an introduction to the Singapore National Eye Centre (SNEC). The new Ophthalmic Academic Clinical Programme at the SNEC focuses on developing a comprehensive framework of research and training capabilities to ensure effectiveness in promoting clinical competence and performance. It is hoped that the pilot project to form a Dedicated Education Unit will act as an innovative model of transforming clinical nursing education into an environment of support. This will enable nurses to continue to provide high-quality care to ophthalmic patients. SNEC aims to provide continuing education, in partnership with other educational institutions, for nurses across the continuum of care as they navigate the rapidly changing ophthalmic nursing environment. This education and training has introduced a diversity of career paths, which provide nurses and allied healthcare professionals with innovative opportunities to advance their opthalmic nursing practice.

Reflections on a slit-lamp teacher-training workshop for ophthalmic nurses in Korle Bu, Ghana

Korle Bu Eye Unit based in Accra, Ghana is linked with Moorfields Eye Hospital in a VISION 2020 partnership. Its primary aim is to support and strengthen ophthalmic services within the eye unit at Korle Bu. This article outlines a recent initiative whereby ten ophthalmic Korle Bu nurses undertook a three-day training course with a final day of assessment to become trainers of slit lamp skills.

The UK Sight Loss and Vision Priority Setting Partnership (SLV‐PSP): Vision research questions prioritised by patients and health care professionals

AbstractPurpose The SLV‐PSP process aims to identify research priorities that can be used to inform decisions of funding bodies and enhance the case for additional research funding.Methods People were asked to submit questions about prevention, diagnosis and treatment of sight loss and eye conditions that are most important to them. The survey was available online, by phone, post and alternative formats (Braille and audio). The partner organisations were Fight for Sight, the College of Optometrists, NIHR Biomedical Research Centre for Ophthalmology, The Royal College of Ophthalmologists and Vision 2020. Over 30 charitable and professional organisations promoted the survey.Results 2,200 people responded generating 4,461 questions. 65% of respondents had sight loss or an eye condition. 17% were healthcare professionals (ophthalmologists, optometrists, orthoptists, ophthalmic nurses, opticians, social care/ rehabilitation). The questions were allocated to 12 eye disease categories before subsequent prioritisation of the top 10 at 12 workshops (questions at http://fightforsight.org.uk/sightlosspsp). The categories were ARMD, cataract, corneal and external, glaucoma, inherited retinal, neuro‐ophthalmology, ocular cancer, ocular inflammatory, refractive error and ocular motility and vitreoretinal/ocular trauma.Conclusion Analysis of demographic data for respondents indicates that the sample is generally representative of the UK population. The number and diversity of conditions represented in responses is distributed across the major conditions and fits projected population incidence.

The psychosocial needs of patients undergoing ocular-odonto-kerato-prosthesis (OOKP) surgery: a nurse perspective

This article explains osteo-odonto-kerato-prosthesis (OOKP) surgery from a nursing perspective, offering a detailed view of the surgical process to aid understanding of these complex patients’ needs, enabling nurses to meet the RCN Ophthalmic Competencies (2005), where nurses are expected to anticipate the effects of clinical diagnosis on the individuals and family/supporters and adjust care to enhance wellbeing. Ocular surface disease and absolute tear deficiency can lead to corneal blindness and severe discomfort ( Geerling et al, 2002 ). It is suggested that OOKP surgery is the keratoprosthesis (artificial cornea) of choice for end-stage corneal blindness ( Liu et al, 2005 ), involving the use of a patient's own tooth root to support an optical cylinder ( Fukuda et al, 2008 ), which is then implanted onto the patient's eye. An in-depth critical review of the literature was performed to offer the reader an explanation of the history of OOKP surgery, and to explore the needs of OOKP patients from a nursing perspective. This literature review indicated that patients undergoing OOKP surgery would benefit from increased psychosocial support from ophthalmic nurses, which can be provided by increasing own knowledge and understanding of the issues relating to this procedure and utilising resources, such as the Changing Faces charity, to facilitate better rehabilitation.

International Ophthalmic Nurses Association event takes a global view

International Journal of Ophthalmic PracticeVol. 4, No. 4 PerspectiveInternational Ophthalmic Nurses Association event takes a global viewHelen GibbonsHelen GibbonsSearch for more papers by this authorHelen GibbonsPublished Online:28 Sep 2013https://doi.org/10.12968/ijop.2013.4.4.169AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 1 August 2013Volume 4Issue 4ISSN (print): 2044-5504ISSN (online): 2052-2851 Metrics History Published online 28 September 2013 Published in print 1 August 2013 Information© MA Healthcare LimitedPDF download

Study on ophthalmic nurses' training demands of professional career development

Objective To discuss the training demands of ophthalmic nurses of different levels,in order to develop nursing training to promote professional career development.Methods A total of 119 nurses from Shenzhen Eye Hospital were investigated with self-designed questionnaire on training demands in March 2011.Results Study showed that the most needed learning knowledge were new knowledge and skills (4.07 ±2.72),eye specialist technical operations (3.94 ±0.24),first aid knowledge and skills (3.93 ±0.25),the knowledge of eye diseases (3.92 ± 0.27) and nursing safety and risk warning (3.91 ± 0.28).Conclusions Hospitals should develop targeted training for nurses of different levels,and organize continuous learning of nurse groups to enhance training effectiveness,which is conducive to career and professional development,and thereby improve nurses' career satisfaction and patients' satisfaction. Key words: Ophthalmic nurse; Training demands; Professional career

Determining the availability and accessibility of online learning tools for ophthalmic nurses in developing and emerging economy regions of the world

As online education and resources continue to grow at a rapid rate for nurses in developed nations, the knowledge gap between developed and developing nation nurses continues to grow. Computer technology, while accessible and easy to use within developed countries, is new and unchartered territory for many others around the world, and issues such as bandwidth access, cost, local language content, translation and computer literacy, and computer skills remain key elements that need to be addressed before nurses in developing regions of the world can effectively benefit from such technology, otherwise they will be subject to an ever increasing digital divide. This paper will discuss the issues facing many developing nation ophthalmic nurses as they seek current evidence-based practice, evidence-based tools and training, connection with the wider nursing community, and an enhanced ability to apply new knowledge to their own practice advancement and patient care. This paper was compiled during a strategic research development phase for ORBIS Internationals' Cyber-Sight ( www.cyber-sight.org ) online learning tool for nurses. To date, Cyber-Sight has predominantly provided telemedicine and education support to international ophthalmologists around the world. The goal to develop a similar nursing page required initial research to determine the accessibility and availability of this internet resource, as it appeared far more difficult due to the language and affordable-access variances between doctors and nurses. Additionally, this task was considered uncharted waters in ophthalmic online nurse training within developing, emerging economy and war-torn areas of the world. Therefore, as part of a preliminary strategy, ORBIS decided that analysis of the online ophthalmic nursing community was necessary prior to commencing development of their on-line nurse training tools on Cyber-Sight. This paper presents the accumulation of investigations undertaken in order to develop a potential ophthalmic nursing programme for online nurse trainee groups in developing and emerging economy nations.

Resources for ophthalmic nurses in the developing world

Knowledge acquisition is much more difficult for nurses in the developing world due to the constraints of funding, resourcing and language. This paper describes an initiative to assist ophthalmic nurses to access comprehensive, relevant and current information in order to help them to update and develop their practice for the ultimate benefit of their patient populations. A network of ophthalmic nurses coordinated by ORBIS, an international ophthalmic charity, have developed a number of accessible resources which are available in both cyber and paper formats. The work is ongoing and colleagues are encouraged to contribute to its development.

Managing glaucoma in Lagos State, Nigeria - availability of Human resources and equipment

There is a paucity of data onthe human resourcesand ophthalmic equipmentavailable for the diagnosis and management of glaucoma in Nigeria. This study is aimed at describing the ophthalmic human resources, as well as available and functioning equipment used in diagnosing and managing glaucoma in Lagos State, Nigeria. This was a prospective multicentre cross sectional study.Data on human resources and equipmentavailable were collected from all government tertiaryand secondary health institutions in the state. One large-practice private eye hospital in the state was included for comparative purposes. The average number of ophthalmologists per hospital was 1.3 and 4.5 in the secondary and tertiary centres respectively, with overall ophthalmologists to population ratio of 1:400,000, and ophthalmic nurses to population ratio of 1:150,000. There were only 2 full time low vision therapists and 3 equipment technicians. Only the private hospital had a dedicated patient counsellor and an eye unit manager. 64% of ophthalmic equipment in the government sector were functioning compared with 100% in the private centre. Overall, equipment to population ratios were; slit lamp=1:517,000, 78/90D lens=1:1,487,000, tonometer=1:660,000, visual field analyser=1:2,380,000, and pachymeter=1:5,950,000. Current population ratios for ophthalmologists and ophthalmic nurses in the state meets vision 2020 recommendations, but there are shortages of other key human resources such as equipment technicians, low vision therapists and patient counsellors. In addition, equipment required for the management of glaucoma wereinadequate, not available or not functioning. Findings from this study suggest that there is an urgent need for increased government funding to glaucoma services in Lagos State.

Developing the specifications of an Open Angle Glaucoma screening intervention in the United Kingdom: a Delphi approach

BackgroundGlaucoma is a leading cause of blindness. Early detection is advocated but there is insufficient evidence from randomized controlled trials (RCTs) to inform health policy on population screening. Primarily, there is no agreed screening intervention. For a screening programme, agreement is required on the screening tests to be used, either individually or in combination, the person to deliver the test and the location where testing should take place. This study aimed to use ophthalmologists (who were experienced glaucoma subspecialists), optometrists, ophthalmic nurses and patients to develop a reduced set of potential screening tests and testing arrangements that could then be explored in depth in a further study of their feasibility for evaluation in a glaucoma screening RCT.MethodsA two-round Delphi survey involving 38 participants was conducted. Materials were developed from a prior evidence synthesis. For round one, after some initial priming questions in four domains, specialists were asked to nominate three screening interventions, the intervention being a combination of the four domains; target population, (age and higher risk groups), site, screening test and test operator (provider). More than 250 screening interventions were identified. For round two, responses were condensed into 72 interventions and each was rated by participants on a 0-10 scale in terms of feasibility.ResultsUsing a cut-off of a median rating of feasibility of ≥5.5 as evidence of agreement of intervention feasibility, six interventions were identified from round 2. These were initiating screening at age 50, with a combination of two or three screening tests (varying combinations of tonometry/measures of visual function/optic nerve damage) organized in a community setting with an ophthalmic trained technical assistant delivering the tests. An alternative intervention was a ‘glaucoma risk score’ ascertained by questionnaire. The advisory panel recommended that further exploration of the feasibility of screening higher risk populations and detailed specification of the screening tests was required.ConclusionsWith systematic use of expert opinions, a shortlist of potential screening interventions was identified. Views of users, service providers and cost-effectiveness modeling are now required to identify a feasible intervention to evaluate in a future glaucoma screening trial.

A Handbook of Ophthalmic Nursing Standards and ProceduresA Handbook of Ophthalmic Nursing Standards and Procedures

Lynn Ring and Miriam Okoro have done an excellent job in filling a gap in the market for an ophthalmic standard procedures handbook. A wide range of ophthalmic procedures is covered.

Investigation of current demands for professional continuing medical education in ophthalmic nurses

To investigate the current demands for professional continuing medical education (CME) in ophthalmic nurses and their influential factors, and to provide evidence for properly setting the curriculum of professional CME for nurses. Qualitative and quantitative analysis was performed on 60 nurses in an ophthalmic hospital by questionnaire survey and group interview. Of the nurses surveyed, 49 (81.7%) thought the training time of professional CME needs to be adjusted, 40 (66.7%) referred to the training pattern, and 53 (88.3%) the training contents. The demanded courses of training mainly included professional nursing knowledge, professional nursing skills, and ophthalmic knowledge. Most nurses considered the influential factors for training were unreasonable training time and lack of applicability of some courses. To improve the quality of professional CME for ophthalmic nurses, the training curriculum should be designed in consideration of ophthalmic characteristics, different work experiences of nurses, and different nursing positions, the training time should be arranged properly, and various training patterns should be adopted flexibly.

Study of work stress among ophthalmic nurses in a tertiary eye center

目的 了解眼科护士的工作压力现况及其来源,并提出应对措施.方法 采用横断面调查法对某眼科医院60名在职护理人员进行问卷调查.结果 54人(90.0％)觉得工作压力大；42人(70.0％)在工作和生活的时间分配方面感到不合理；25人(41.7％)为护理过多患者忙得焦头烂额；30人(50.0％)对薪资不满意.工作中的困惑主要体现于协调难度大、护患关系、医护关系及与上级的关系不好处理；工作压力对护士影响作用包括情绪不好、降低工作效率、失眠、影响家庭生活；目前护士缓解压力的应对方式是向家人或朋友倾诉、自己默默承受.结论 针对眼科医院护理职业的工作压力来源,采取应对措施减轻工作压力负荷,促进护理人员身心健康,从而提高护理质量。