When helping a resident with the visual impairment walk, the nursing assistant should? employ proper guiding techniques for safety and respect

According to the CDC, over 12 million adults in the U.S. aged 40 and over have a visual impairment. When helping a resident with the visual impairment walk, the nursing assistant should utilize specific sighted-guiding techniques to ensure safety, respect, and effective communication throughout the process.

Quick Summary

A nursing assistant should offer their arm for the resident to hold, walking a half-step ahead while providing clear, descriptive verbal cues about the environment. This technique ensures the resident feels secure and informed, promoting safety and independence without pulling or pushing.

Key Points

• Offer Your Arm: A nursing assistant should offer their arm for the resident to hold, with the resident grasping just above the elbow, ensuring they lead the pace.

• Walk a Half-Step Ahead: Position yourself slightly in front of the resident, allowing your body's motion to naturally signal upcoming changes in direction or stops.

• Provide Descriptive Cues: Clearly describe the environment, including obstacles like steps, curbs, or turns, using specific, non-visual language (e.g., "We are turning left now").

• Verbally Announce Obstacles: Proactively warn the resident of any potential hazards or changes in terrain, such as stairs or a narrow doorway, to prevent falls.

• Respectful and Patient Approach: Always ask permission before assisting, allow the resident to set the pace, and avoid pulling or pushing, which can be disorienting and degrading.

• Ensure Safe Seating: Upon arrival at a chair or bed, guide the resident's hand to the back of the seat, allowing them to confirm position and sit down safely.

Essential Steps for Sighted Guiding

Assisting a resident with visual impairment requires a systematic and respectful approach. The process begins before any movement occurs and continues until the resident is safely seated or has reached their destination. Never assume a resident needs help; always ask first and respect their response. The core principle is to empower the resident while providing a secure and reliable point of contact.

Initiating Contact and Offering Assistance

The interaction starts with a clear and confident approach. Avoid startling the resident by speaking to them before making physical contact. Approach them from the front, state your name, and explain your purpose.

1. Identify yourself verbally: Clearly state your name and role, for example, "Hello, Mr. Jones, this is Sarah, your nursing assistant. I'm here to help you walk to the dining room."
2. Offer assistance and wait for consent: Ask, "Would you like me to assist you?" and respect their answer. Some residents may be more independent and prefer to use a cane or other mobility aid alone. They are the best judge of their needs.
3. Explain the guiding method: Briefly describe how you will assist, such as, "You can hold onto my arm, and I will walk slightly ahead of you to guide the way."

Proper Sighted-Guide Technique

Once the resident has accepted your offer, establish the correct physical connection. The resident should be in control of the pace and movement, not the assistant. This method prevents confusion and maintains the resident's dignity.

• The resident should grasp your arm, just above the elbow, with their fingers on the inside and their thumb on the outside.
• The nursing assistant should keep their guiding arm relaxed and close to their side.
• Walk a half-step ahead of the resident, allowing your body's movement to signal upcoming turns, stops, and obstacles.
• Allow the resident to set the pace. Do not rush or pull them along.

Providing Clear Verbal Cues

Effective communication is paramount when assisting a visually impaired resident. The assistant serves as the resident's eyes, describing the environment clearly and proactively. Verbal cues should be descriptive and use consistent terminology.

• Announce changes in terrain: Clearly state upcoming obstacles such as steps, curbs, or ramps. For instance, "We are approaching three steps down" or "There is a small curb here."
• Describe surroundings: As you walk, provide a running commentary on the environment, including landmarks and changes. For example, "We are passing the nurses' station on our left" or "The floor is now carpeted."
• Use precise, non-visual directions: Avoid vague phrases like "over there." Instead, use clear directions based on the resident's perspective, such as "The door is on your left" or "We will turn right at the end of this hallway".
• Warn of obstacles: Mention any stationary or moving objects in the path, such as furniture, people, or a dropped item, with a calm alert. Example: "Stop, there's a chair directly in front of us."

Navigating Specific Obstacles

Navigating doorways and narrow spaces requires specific techniques to ensure the resident's safety and comfort.

Approaching and Passing Through Doorways

When nearing a door, the nursing assistant must provide a clear, descriptive cue.

1. Describe the door: Tell the resident which way the door opens. For example, "The door opens away from us to the right."
2. Move through: The guide should walk through the door first, with the resident holding the guide's arm. As the guide passes through, the resident can feel for the door frame and handle, following through smoothly.
3. Close the door: The guide holds the door open until the resident has passed through, allowing them to feel the handle and close it behind them if able.

Moving Through Narrow Passages

When approaching a narrow area, such as between a wall and a piece of furniture, the guide should change position.

1. Announce the change: Tell the resident, "We are coming to a narrow space. I need you to step directly behind me."
2. Adjust position: The guide moves their arm to the middle of their own back. The resident can slide their hand from the guide's elbow to their wrist and step in behind the guide, walking single-file until the passage is clear.

Comparison of Guiding Techniques

Feature	Proper Sighted Guiding	Incorrect Guiding
Contact Method	Resident holds NA's arm above the elbow.	NA grabs or steers the resident's arm.
Positioning	NA walks a half-step ahead.	NA walks directly beside, pushes from behind, or pulls from the front.
Pace	Resident sets the pace; NA adjusts accordingly.	NA rushes or dictates the speed, causing stress.
Communication	Descriptive, clear verbal cues; uses resident's perspective.	Vague language like "over there"; pointing or non-verbal cues.
Navigating Obstacles	Provides clear warnings and descriptions of steps, curbs, etc..	Does not communicate changes in terrain, creating fall risks.

What to Do at the Destination

Upon reaching the destination, the task is not complete until the resident is safely situated. For instance, when seating a resident, the assistant should guide the resident's hand to the back of the chair. This allows the resident to orient themselves and sit down safely on their own. The assistant should then describe the immediate surroundings and any items within reach, such as a call light or a cup of water. Always inform the resident when you are leaving the area to avoid the resident talking to an empty room.

Conclusion

When helping a resident with the visual impairment walk, the nursing assistant should prioritize respect, clear communication, and safety. By employing the proper sighted-guiding techniques—allowing the resident to hold their arm, walking a half-step ahead, and providing descriptive verbal cues—nursing assistants foster a sense of security and independence. This empathetic approach not only minimizes the risk of falls and injury but also strengthens the bond of trust between the caregiver and the resident, significantly enhancing the resident's quality of life. Consistent practice of these skills is vital for all caregiving staff. For further guidelines on interacting with visually impaired individuals, refer to resources from reputable organizations like the National Federation of the Blind.

The Role of Empathy and Ongoing Training

Beyond the technical steps, the nursing assistant’s attitude plays a crucial role. A patient, understanding, and respectful demeanor can make all the difference. Remember that visual impairment does not diminish a person's intelligence or their desire for independence. Caregivers should consistently receive training and education on best practices for assisting residents with sensory deficits to ensure the highest standard of care is met. This includes regular refreshers on techniques for guiding, communication, and creating a safe environment.

Moreover, the assistant must always be mindful of their own position and movements. Erratic or hurried movements can disorient the resident. The guide's arm provides a critical source of non-visual information, so any sudden changes in motion can cause anxiety. Ultimately, sighted guiding is a partnership where trust and clear communication are the foundation for safe and dignified mobility.

Frequently Asked Questions

What is the very first step a nursing assistant should take when approaching a visually impaired resident?

The first step is to verbally identify yourself, stating your name and purpose, and then asking the resident if they would like assistance. Never assume they need or want help.

Where should the resident hold the nursing assistant when walking?

The resident should hold the nursing assistant's arm just above the elbow. This position allows them to feel the guide's movements and anticipate changes in direction or elevation.

How should a nursing assistant communicate a narrow space or doorway?

Announce the narrow space verbally. The nursing assistant should then move their guiding arm behind their back, prompting the resident to step in behind them and walk in single file.

Is it acceptable to pull or push a visually impaired resident to guide them?

No, it is never acceptable to pull or push a resident. This is confusing, unsafe, and disrespectful. The resident should initiate movement by holding the assistant's arm and following their lead.

What is the correct way to help a resident sit down?

Guide the resident to the chair and place their hand on the back of the seat. This allows the resident to orient themselves and judge the height and position before sitting down safely on their own.

How should a nursing assistant communicate changes in flooring or steps?

Use clear, descriptive verbal cues. For example, state "steps going down" or "steps going up," or mention when the flooring changes from carpet to tile. Briefly pause to give the resident time to adjust.

What should a nursing assistant do when leaving a visually impaired resident?

Always inform the resident when you are leaving, even if for a short time. This prevents them from continuing to talk to an empty space and ensures they know they are alone.