Where should the NA be when helping a visually impaired resident walk?

According to the CDC, over 12 million people aged 40 and older in the United States have some form of visual impairment, a condition that increases the risk of falls and injury, especially during ambulation. Learning exactly where should the NA be when helping a visually impaired resident walk is crucial for ensuring their safety, comfort, and confidence during mobility exercises. This guide provides comprehensive, authoritative information on proper technique and best practices for nursing assistants and other caregivers.

Quick Summary

The Nursing Assistant (NA) should position themselves beside and slightly in front of the visually impaired resident to provide proper guidance and instill confidence during ambulation, never behind. This optimal position allows the NA to act as a clear guide, communicate upcoming obstacles effectively, and help the resident feel secure and supported throughout the walk.

Key Points

• Optimal Position: The NA should stand beside and slightly ahead of the visually impaired resident to act as a guide and maintain clear communication.

• Physical Connection: The resident should hold the NA's arm just above the elbow, allowing them to feel the NA's movements and anticipate shifts in direction.

• Clear Communication: Use descriptive verbal cues to inform the resident of their surroundings, including upcoming obstacles like steps, ramps, or changes in flooring.

• Navigating Tight Spaces: In narrow passages, the NA should move their guiding arm behind their back, prompting the resident to step directly behind them to pass safely.

• Preventing Falls: Always be aware of environmental hazards and warn the resident before they encounter potential risks, such as uneven surfaces or slippery floors.

• Fostering Independence: Engage the resident by asking for their comfort level and encouraging their participation, which builds confidence and respects their dignity.

Optimal Positioning: A Foundation for Safety and Trust

Proper positioning is the bedrock of safe and effective assistance for a visually impaired resident. By positioning yourself correctly as an NA, you not only physically guide the resident but also establish a foundation of trust and confidence that is essential for their emotional well-being. The correct approach is to be beside and slightly ahead of the resident, allowing them to take your arm for support. This is often called the "guided walking" or "human guide" technique.

Why Beside and Slightly Ahead is the Best Position

• Enhanced Communication: Being in this position places you within easy conversational range of the resident. You can provide clear, verbal cues about your surroundings, such as "steps ahead" or "let's turn right now," without needing to raise your voice.
• Anticipation of Obstacles: As the resident's guide, you have a clear view of the path ahead, allowing you to identify potential hazards like uneven flooring, furniture, or a doorway before the resident encounters them.
• Promoting Resident Confidence: By leading, you allow the resident to follow your movements, which builds a sense of security and trust. This helps them feel more in control and less anxious during the walk.
• Maintaining Dignity: This method respects the resident's independence by enabling them to participate actively in their mobility, rather than being pushed or pulled from behind.

The Importance of Physical Contact

The physical connection is a key component of this technique. Typically, the resident will lightly hold onto the NA's arm just above the elbow. This allows them to feel the NA's movements and anticipate shifts in direction, stops, or changes in pace. The NA should not hold the resident's arm, but rather allow the resident to initiate and maintain the grasp. This gives the resident a greater sense of control.

A Step-by-Step Guide to Assisting a Visually Impaired Resident

Executing the guiding technique requires a thoughtful, step-by-step approach to ensure the resident's comfort and safety. From initiating the walk to navigating different environments, each step plays a vital role.

1. Introduce and Offer Assistance: Always begin by identifying yourself and asking the resident if they would like help. Use a clear, calm voice. "Hello, this is [Your Name], the NA. May I assist you with your walk today?".
2. Offer Your Arm: If the resident accepts, offer your arm by lightly touching the back of their hand with yours. The resident will then hold your arm just above the elbow. Avoid grabbing them suddenly, as this can be startling.
3. Position Yourself: Stand beside the resident, with your shoulder slightly ahead of theirs. Your arm should be close to your body to provide a steady and predictable hold.
4. Begin Walking and Verbalize: Walk at a steady, normal pace for the resident. Narrate your surroundings clearly and concisely, using landmarks and directions. "We are approaching a closed-door. I'll open it now," or "There are two steps down here".
5. Navigating Narrow Passages: When you approach a tight space, such as a narrow doorway or a crowded hallway, adjust your technique. Move your guiding arm toward the center of your back, signaling to the resident that they should move directly behind you. Once through, return to the standard side-by-side position.
6. Approaching Stairs: Verbally indicate that you are approaching stairs, and specify whether you are going up or down. Pause at the top or bottom, and signal with your body movements. As you step onto the first step, the resident will feel your motion and follow suit, trailing their foot to find the edge.

Common Hazards and How to Avoid Them

Nursing assistants must be constantly vigilant of the environment to prevent falls, the leading cause of fatal and non-fatal injuries in older adults. By being proactive, you can prevent many common accidents.

Hazard	Potential Risk	NA Best Practice
Uneven Surfaces	Tripping or losing balance, especially on carpeted areas or with small height differences.	Provide clear verbal cues before encountering changes. Lift feet fully and walk deliberately.
Obstacles in the Path	Colliding with furniture, equipment, or other people.	Scan the area ahead and steer the resident around obstacles with gentle arm pressure and verbal guidance.
Slippery Floors	Slipping and falling, particularly on recently mopped floors or spilled liquids.	Warn the resident verbally and slow the pace. Guide them along a clean, dry path.
Poor Lighting	Inability to perceive shadows or changes in depth, increasing trip hazards.	Verbally communicate changes in lighting and adjust pace accordingly. Use handrails when available.
Thresholds and Doorways	Tripping over elevated thresholds or misjudging a door frame.	Verbalize the upcoming transition and use the narrow passage technique when moving through doorways.

Fostering Independence and Confidence

Beyond the physical mechanics, the role of an NA is to foster a sense of independence and dignity. By empowering residents, you contribute significantly to their mental and emotional health, which supports their physical well-being.

Encourage Verbal Communication

Encourage the resident to communicate their needs and preferences during the walk. Ask them questions like, "Is this pace comfortable for you?" or "Do you need to stop for a moment?" This puts the resident in a position of control and makes the experience feel more collaborative.

Provide Descriptive Language

Enhance the resident's understanding of their environment by using vivid, descriptive language. Instead of just saying "turn left," say, "We are going to turn left at the end of the hallway to go toward the dining room." This not only guides them but also keeps them oriented to their surroundings.

The Role of Respect and Patience

Above all, remember that each resident is an individual with unique needs and levels of ability. Patience is paramount. Rushing a visually impaired resident can increase their anxiety and the risk of an accident.

Treat each interaction with respect, asking for permission before touching them, and valuing their input. A simple, respectful approach can make a profound difference in a resident's day-to-day experience. For more foundational knowledge on senior care best practices, visit the National Institutes of Health [https://www.nih.gov/health-information/nih-senior-health].

Conclusion

For a nursing assistant, understanding where should the NA be when helping a visually impaired resident walk is more than a technical skill—it is a cornerstone of compassionate and professional care. By positioning yourself beside and slightly ahead, you create a safe, supportive, and respectful environment that maximizes the resident's mobility and independence. Combining this with clear communication, hazard awareness, and a patient, dignified approach ensures that every walk is a positive and secure experience for the visually impaired resident.

Frequently Asked Questions

Why is it important to stand slightly in front of the resident?

Standing slightly in front is important because it allows the NA to guide the resident effectively by allowing them to follow the NA's body movements. It also enables the NA to spot and verbally warn the resident about potential obstacles in their path before they encounter them.

What is the best way to let the resident know about a doorway or obstacle?

The best way is to use clear and concise verbal cues. For a doorway, you might say, "We are approaching a doorway, and we will step through it now." For an obstacle, you can say, "There is a chair on your left" while using gentle guiding pressure with your arm.

Should the NA hold the resident's arm tightly?

No, the NA should not hold the resident's arm tightly. The resident should initiate the hold on the NA's arm just above the elbow. This promotes a sense of security and control for the resident, rather than making them feel controlled or pulled along.

How should an NA handle a narrow passage, like a crowded hallway?

When approaching a narrow space, the NA should bring their guiding arm toward the center of their back. This signals to the resident that they should move directly behind the NA, allowing them both to pass through the passage safely and efficiently.

What if the resident seems anxious or hesitant during the walk?

If the resident seems anxious, the NA should stop and check in with them. Ask questions like, "Are you comfortable?" or "Would you like to rest?" A slow, steady pace and consistent, reassuring communication can help calm their anxieties.

Can an NA help a visually impaired resident walk without physical contact?

While verbal cues are always used, physical contact is generally recommended for visually impaired residents to provide reassurance and clearer guidance. A resident holding the NA's arm can better anticipate movements, which increases their safety and confidence.

Is it ever okay to stand behind the resident?

No, it is generally not okay to stand behind a visually impaired resident when helping them walk. This can be disorienting and cause the resident to feel insecure, as they cannot see where they are going or what is happening around them. The beside and slightly ahead position is always the preferred method.