Proper Positioning: Beside and Slightly Ahead
The most important aspect of assisting a visually impaired resident with walking is establishing trust and ensuring their safety. The standard and most effective technique for a nursing assistant (NA) involves walking beside and a half-step in front of the resident. This method is known as the "sighted guide" technique.
The resident holds the NA's arm just above the elbow, creating a secure connection. This position allows the NA to act as a clear, communicative guide, with their body movements indicating what the resident can expect. It is crucial to offer your arm and allow the resident to grasp it, rather than grabbing or pulling them along, which can cause anxiety and loss of dignity.
Initiating the Sighted Guide Technique
Before beginning, the NA should always communicate with the resident. Start by identifying yourself and asking, “Would you like to take my arm to walk?”. If they accept, you can offer your arm. Some residents may have a preferred side based on their remaining vision or other physical needs, so it's best to ask. Once the resident has taken your arm, you can begin moving forward slowly and steadily, with the resident staying a comfortable half-step behind you.
Providing Verbal Cues
Effective communication is a vital component of the sighted guide technique. The NA should use clear, concise verbal cues to describe the environment as they walk. This prepares the resident for upcoming changes and builds their confidence. For instance, instead of a sudden turn, the NA might say, "We're approaching a turn to the left," and their body will naturally guide the movement.
Navigating Common Obstacles
Throughout the walk, the NA must be vigilant and proactive in alerting the resident to potential hazards. This is one of the key benefits of walking slightly ahead—the NA can see what's coming and communicate it in advance. Obstacles can range from steps and curbs to doorways and narrow hallways.
When navigating stairs, the NA should pause before the first step and clearly state whether they are going up or down. At the top of the stairs, another pause is necessary to allow the resident to find their footing on the flat landing. For narrow spaces, the NA can move their guiding arm behind their back, signaling to the resident to walk directly behind them in a single file.
Comparison of Assisting Positions
| Technique | NA Position | Resident's Role | Advantages | Disadvantages |
|---|---|---|---|---|
| Sighted Guide | Beside and slightly ahead | Holds NA's arm above the elbow | Promotes confidence, clear communication, and safety. Respects independence. | Requires good coordination and trust between NA and resident. |
| Behind Resident | Following closely behind | Resident leads blindly | Not recommended as a primary technique. May be used in rare, specific circumstances. | Creates insecurity, confusion, and is unsafe for navigating obstacles. |
| In Front, Without Contact | Three feet in front | Resident follows verbal cues only | Avoids physical contact if preferred. | High risk of falls due to delayed reaction time for obstacles. Inefficient for sudden changes in direction. |
| Pushing or Pulling | Grabbing resident's arm or shoulder | Resident is forcibly moved | Should never be used. | Extremely unsafe, disorienting, and disrespectful to the resident. |
Seating a Resident
When assisting a visually impaired resident to a chair, the process should be respectful and reassuring. Do not simply push the resident into the chair. Instead, guide them by placing their hand on the back of the chair. The resident can then use this tactile information to orient themselves and safely sit down on their own. The NA can also provide a description of the chair, noting if it swivels or has armrests, to further inform the resident.
Conclusion
For a nursing assistant helping a visually impaired resident to walk, the correct position is consistently beside and slightly ahead. This standard sighted guide technique ensures the resident’s safety by giving them control and direct communication through the physical connection of holding the NA's arm. It's a practice that not only prevents falls but also respects the resident’s dignity and independence, fostering a relationship built on trust and mutual respect. Always remember to ask for permission, communicate clearly, and adjust to the resident's pace for the most positive and secure experience. [https://www.rnib.org.uk/living-with-sight-loss/supporting-others/guiding-a-blind-or-partially-sighted-person/]
