Guidelines for medical professionals



Treating the Patient As An Individual



When you encounter blind, deaf blind or visually impaired patients, you will be encountering people with a broad range of visual impairments. Some may have assistance needs; others will not. It is important to regard each visually impaired patient as an individual deserving of the same dignity and respect as any other person you serve during your workday.



Roughly three-quarters of the population who are “blind” are not totally blind, i.e., they have some residual vision. Some may use a white long or support cane, others may use a dog, and still others may not use Braille or a mobility aid at all. Thus, staff should be observant and, when in doubt, ask if the patient has difficult seeing. Demographic data indicate that a significant number of individuals with vision loss are elderly and frequently experience multiple disabling conditions and often are in denial regarding their visual deficits. This population is growing rapidly. There are also a growing number of children with vision loss who also have additional disabilities.



Many visually impaired patients actually have what is known as “low vision.” Some can see primarily in the periphery of their visual field, as if the center of their vision were blocked. Others can see only in the central portion of their visual field, as if looking through a tunnel. Still others have some vision in all sectors of their visual field but what they see is distorted or blurred in some way. Many who are visually impaired function best under specific lighting conditions. Most often, direct lighting that does not produce glare or shadows makes it easier for such persons to perform tasks.



Please keep in mind that it is not always the patient who requires auxiliary aids or services. For example, a parent who is blind may be required to grant consent for his or her child’s surgery. The contents of the consent form must be communicated effectively to that blind parent. In most cases, this can be accomplished by reading the consent form to the patient or by providing the form in Braille, on audiocassette, disk, CD or via email on request. The Earle Baum Center can assist you in the preparation of these materials.



In diagnosing, remember that the eyes of many people with visual impairment may not react normally to light or movement. For example, the pupils of people with cataracts or whose cataracts have been removed may remain dilated at all times. Patients with nystagmus can have “roaming eyes” that may or may not indicate emergent neurological problems. If in doubt, ask an ophthalmologist to provide additional information.



The following scenarios and tips provide guidelines to support you in providing care that is not only thoughtful and beneficial but is ADA-compliant. Additional opportunities for improving access to facilities and services are also suggested in the conclusion.



General Guidelines



Relax, slow down, and let consideration be your guide. The kind of confusion that is created by thoughtless behavior such as that described above can be alleviated by a simple shift in awareness and sensitivity. In most cases, the patient is familiar with living with diminished sight and with helping others to assist their needs.



Don’t make assumptions. The blind and visually impaired have visual acuity or functional deficits associated with their vision loss that may vary widely. For example, the same person may have perfectly adequate travel vision during the day but may find mobility to be more difficult at night under low lighting conditions. Someone who shows no outward signs of visual impairment may need assistance in reading her bill. Respond to your patient’s needs on an individual basis.



When in doubt about what to do, just ask. A simple “What can I do to assist you?” will provide the opportunity for the patient to tell you what, if anything, you can do.

In cases where it appears the patient has limited experience dealing with vision loss and self-direction is difficult, explore options with the patient for providing accommodations while allowing the individual to maintain personal control and dignity.



Using words such as blind, visually impaired, seeing, looking, and watching television is acceptable in conversation. Using descriptive language, including references to color, patterns, and the like is also OK.



When referring to patients with disabilities, refer to the person first, then the disability, for instance, “The patient in 439 who is blind.” Rather than “The blind man in 439.”



Speak to the patient in normal conversational tones. It is not necessary to raise your voice.



Guidelines for Greeting/Orienting



Address the person by name, if you know it.



Identify yourself by name and function and the reason you are there.



Stay in one place, if possible, when you speak. It is hard for a blind person to try to face a speaker who is constantly moving around.



Verbalize and demonstrate procedures before they are performed and identify injections or medication, the dosage, and what it is for before administering, e.g., “Mr. Bennett, I’m Pete Walters, an EKG technician. Have you ever had this procedure before? No? Well, I’ll first be placing an EKG lead on your chest. Would you like to see what the instrument looks like?”



Identify unusual odors and noises and alert the patient to what the procedure you are about to perform might feel like.


If the person is with a companion, avoid using that person as a go-between. Address your questions and comments directly to the patient. For example, rather than asking, “Does he want the TV on?” direct the question to the patient.



Read fully, upon request, and provide assistance, if necessary, in completing consent forms, financial responsibility forms, bills, menus, and other documents if they can’t be supplied in accessible media. If you are asked to read aloud to a patient, be sensitive about privacy—find a private room or area before proceeding.




Guiding The Blind and Visually Impaired



When guiding, identify changes in terrain, such as stairs, narrow spaces, or escalators by hesitating briefly as you approach them and explaining what you are about to do.

Be specific in your directions and use right or left as they apply to the person being guided. Say, “There is a door on your right.” Rather than “There’s a door up ahead.”

When seating a patient ask him if you may show him the back of the chair. If the response is yes, simply place the patient’s hand on the chair back.


Access to Information

It is most important to first ask how your patient prefers to receive information from you. It is also useful to ask the patient how you can recognize that your message has been understood.



When confirming or reminding a visually impaired patient of an appointment it may be most effective to communicate by phone rather than sending a printed appointment communication by mail.



Because of the wide range of visual impairments it is important to have all of the following options to most adequately deliver information:



Large print (materials given to visually impaired patients should be in a minimum of 18 pt. bold, Arial or other sans serif typeface; avoid italics.)



Computer disk or CDs



Audio tapes



Braille



Brailtrak tactile communicator (an inexpensive device that contains Braille and raised character alphabet and numerals.)



Reading aloud (be sensitive to ensure that private information is not overheard.)



Writing on the palm (in the case of some deaf blind patients.)



Orientation and Mobility



Do not leave doors ajar.



Tell the visually impaired or blind patient if you move any furniture or equipment.



When moving a person into a hospital room, let him examine the furnishings in the room. An adequate orientation for a patient at the beginning can foster independence throughout the stay. This can be done by allowing him to trail the wall to learn the order of the doorway to the hall, the doorway to the bathroom, the windows, chairs, closet, etc.



Orient the person to the controls of the bed, paging system, TV and radio. Give other directions that are important, such as, “When you are facing the sink, the toilet is on your left. When you are seated on the toilet, the paper is on your right.”



When dealing with specific orientation to objects like chairs, the sink, and other fixtures, remember the patient sees with his hands. Don’t assume you know what the patient needs simply by observing behaviors.



Do not touch or remove mobility canes unless requested to do so. Do not interfere with guide dogs. If the person is accustomed to using a cane, he or she can be encouraged to use it in her room if she wishes. If it is necessary to remove a cane, tell the person you are removing it and where it can be retrieved.



If you leave a person alone in an unfamiliar area be sure he or she is near something to touch to maintain contact with the physical environment. 

Earle Baum Center: Serving People with Sight Loss (2004). Guidelines for medical professionals.       http://www.earlebaum.org/guidelines-for-medical-professionals/index.shtml