Blepharitis in patients' eyelids: a discussion for nursing care.

Blepharitis affects the ocular surface and is characterised by symptoms such as inflammation of the eyelashes, redness of the eyelid margins and itchiness. This article aims to create an awareness of this disease among community nurses by explaining its potential consequences to a person's physical and psychosocial wellbeing. Suggestions are made for its care and intervention.

Age-related macular degeneration: care of the patient in the community setting.

The aim of this article is to explain age-related macular degeneration (AMD) and how it impacts on the wellbeing of patients in the community setting. It explores the anatomy and physiology associated with AMD, its symptoms and treatment, and goes on to discuss related nursing care.

Cataracts: the essentials for patient care.

It is estimated that over 2.2 billion people globally have a visual impairment. Cataract is one such form of impairment, which can be surgically corrected. However, disruptions in ophthalmic services due to the pandemic have resulted in long wait times-estimated to take up to 5 years to clear. Considering these issues, there is no doubt that individuals affected by the condition will be negatively impacted. In this article, Penelope Stanford provides information on the anatomy and altered physiology of the crystalline lens, and informs on the essentials of patient care.

Chronic Open Angle Glaucoma: a Biopsychosocial Approach to Patient Care.

It is estimated that 2.2 billion people are affected by impaired vision resulting from eye conditions. Chronic open angle glaucoma (COAG) is one such condition, which primarily affects older adults, and is linked to other factors such as genetic predisposition, high blood pressure, diabetes and smoking. By 2025, it is projected that 44% of the UK's ageing population will have COAG. Vision loss due to this condition is irreversible. In this article, Penelope Stanford discusses the bioscience of COAG, and provides information on access to care and patient interventions.

The causes of falls: views of older people with visual impairment.

BACKGROUND: Sight impairment increases with age and, compared with the general older population, older people with sight impairment are more likely to fall. There is a growing body of evidence on the views and perceptions of older people about falls, but little is published on the views of older people with sight impairment. OBJECTIVE: To explore what older people with sight impairment believe to be the causes of falls. DESIGN: A qualitative design was used, incorporating focus groups and interviews in which participants discussed falls and falls prevention. Framework analysis was employed to identify themes arising from participants' discussions of the causes of falls. SETTING AND PARTICIPANTS: Fifty-four community dwelling men and women with sight impairment, aged 65 and over, were recruited from across Greater Manchester, UK. RESULTS: Five types of factors were identified that were believed to cause falls: (i) health issues and changes in balance caused by ageing; (ii) cognitive and behavioural factors; (iii) the impact of sight impairment on getting around the home; (iv) the impact of sight impairment on negotiating the environment away from home; and (v) unexplained falls. DISCUSSION AND CONCLUSIONS: Older people with sight impairment reported many researched risk factors previously identified by older people without sight impairment but also described many perceived risks unique to people with sight impairment. There are few interventions to prevent falls aimed at older people with sight impairment, and the results of this study allow further tailoring of such interventions based on views of older people with sight impairment.

Changing practice for the non-medical ophthalmic hospital workforce in the UK-a snapshot survey.

BACKGROUND/OBJECTIVES: To obtain a picture of the current status, training and governance for advanced practice and extended roles in the ophthalmic hospital non-medical workforce. METHODS: A 10 question, quantitative survey was designed with multidisciplinary members of the UK Ophthalmology Alliance and sent to the membership to obtain information on expanded non-medical roles. RESULTS: 34 of the 58 UKOA member hospitals responded (58% response rate). All responding units were using registered optometrists, orthoptists and nurses to undertake expanded outpatient roles and 28/34 (82%) had expanded roles for undertaking procedures. Some units had large numbers of staff undertaking these roles. There were noticeable trends for certain professional groups to undertake certain roles. For example, nurses were undertaking most procedures, apart from lasers which were mainly delivered by optometrists. Nurses had the lowest banding and optometrists the highest for apparently similar roles. Training was mostly in-house apprenticeship style although some formal external qualifications were undertaken. CONCLUSIONS: Ophthalmology is developing many innovative roles for the non-medical workforce and, with the launch of the OCCCF training, this is likely to increase. Terminology is confusing and a categorisation suitable for ophthalmology is proposed.

Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts.

An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.

Developing sustainable nursing and allied health professional research capacity.

BACKGROUND: Research provides the evidence on which to base effective, safe clinical services. Engaging healthcare staff in research improves healthcare. However, clinical staff may not want to leave clinical practice to develop their research experience. Gaining postdoctoral research experience is a difficult step to make and opportunities are limited. AIM: To describe an approach to developing sustainable research capacity by supporting nurses and allied health professionals to develop their postdoctoral research skills while remaining in clinical practice. DISCUSSION: An approach to developing nursing, midwifery and allied health professionals (NMAHPs)'s postdoctoral research skills was devised and implemented in an acute NHS hospital in England. This collaborative approach involved negotiating strategic support from senior managers and incorporated an action-learning framework to develop and fund a research project addressing a clinical priority. CONCLUSION: A 'whole organisation' approach is needed to develop postdoctoral nurse and NMAHP researchers that requires a reflexive model with strategic, organisational and individual support encompassing action learning and corporate buy-in from senior managers. IMPLICATIONS FOR PRACTICE: Taking such an approach can enable nurses to remain in practice while developing NMAHP-led research. This shows its usefulness to senior managers and enables nurses to have the knowledge and confidence to support others to develop their research skills.

Glaucoma, dementia, and the "precipice of care": transitions between states of medication adherence.

PURPOSE: "She wouldn't remember. Even when I go through, and she's decided to go to bed, I'll say I'll come and do her drops. If I didn't say that, they wouldn't be done." Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals. METHODS: Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities. RESULTS: Using Pound's synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration. CONCLUSION: Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.

Assessment of injury severity in patients with major trauma.

Major trauma centres provide specialised care for patients who have experienced serious traumatic injury. This article provides information about major trauma centres and outlines the assessment tools used in this setting. Since patients in major trauma centres will be transferred to other settings, including inpatient wards and primary care, this article is relevant for both nurses working in major trauma centres and in these areas. Traumatic injuries require rapid assessment to ensure the patient receives prompt, adequate and appropriate treatment. A range of assessment tools are available to assist nurses in major trauma centres and emergency care to assess the severity of a patient's injury. The most commonly used tools are triage, Catastrophic Haemorrhage Airway to Exposure assessment, pain assessment and the Glasgow Coma Scale. This article summarises the use of these assessment tools in these settings, and discusses the use of the Injury Severity Score (ISS) to determine the severity of patient injuries.

A feasibility study to prevent falls in older people who are sight impaired: the VIP2UK randomised controlled trial.

BACKGROUND: Published evaluations of successful interventions to prevent falls in people with sight impairment (SI) are limited. The aim of this feasibility study is to optimise the design and investigation of home safety (HS) and home exercise (HE) programmes to prevent falls in older people with SI. METHODS: A community-based feasibility study in north-west England comprising a three-arm randomised controlled trial (RCT) allocated participants to (1) a control group receiving usual care and social visits, (2) an experimental group receiving the HS programme and (3) an experimental group receiving the HS + HE programme. Participants were community-dwelling, aged 65 years and older and sight impaired. Primary outcome data on falls were collected continuously over 6 months. Secondary outcomes on physical activity (self-report and instrumented) and adherence were collected at baseline and 3 and 6 months for HE and at 6 months for the HS programme. Costs for the HS and HS + HE groups were calculated from logs of time spent on home visits, telephone calls and travel. The research assistant and statistician were blinded to group allocation. RESULTS: Altogether, 49 people were recruited over a 9-month period (randomised: 16 to control, 16 to HS, 17 to HS + HE). The interventions were implemented over 6 months by an occupational therapist at a cost per person (pounds sterling, 2011) of £249 (HS) and £674 (HS + HE). Eighty-eight percent (43/49) completed the trial and 6-month follow-up. At 6-month follow-up, 100 % reported partially or completely adhering to HS recommendations but evidence for adherence to HE was equivocal. Although self-reported physical activity increased, instrumented monitoring showed a decrease in walking activity. There were no statistically significant differences in falls between the groups; however, the study was not powered to detect a difference. CONCLUSION: It is feasible and acceptable for an occupational therapist to deliver HS and HE falls prevention programmes to people with SI living independently in the community. Future studies could access Local Authority Registers of people with SI to improve recruitment rates. Further research is required to identify how to improve adherence to HE and to measure changes in physical activity before conducting a definitive RCT. TRIAL REGISTRATION: ISRCTN53433311 , registered on 8 May 2014.