Aci Nurse Delegated Emergency Care Basic Eye Problems Management Competency Assessment Tool printable pdf download

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This competency assessment tool allows a facilitator to assess nurse confidence and competence in undertaking a basic nursing eye

assessment and commencing basic nursing management of eye problems as guided by the Emergency Care Institute’s Nurse Delegated

Emergency Care “Eye Problems” Nursing Management Guideline.

This assessment tool may be applicable to other basic nursing eye assessment contexts; however, facilitators should note that the tool is

designed within the guidelines and principles of the Nurse Delegated Emergency Care (NDEC) program.

Confidence

Performance Criteria

Competent

NYC

Comments

CENA

ANMC

General Understanding of Basic Eye Problems Management

Describes the types of eye problems that can

present to an Emergency Department

(Traumatic – blunt and penetrating, chemical, foreign body,

lacerations to eye lid or surrounding tissue.

Non traumatic – infection, allergies, degenerative processes)

Summarises eye problems that are considered

suitable for inclusion through NDEC

(Low acuity / low risk – Australasian Triage Scale category 4 or

5 and no Red Flags as per the Nursing Management Guideline.

Examples could include “red eye”, “Welder’s flash”, non-

embedded foreign body)

States further patient care resources for eye

management

(Eye Emergency Manual, ECI, local guidelines or protocols)

Employs principles of infection control and Work

Health and Safety throughout eye problem

management

NDEC Eye Assessment

Sets up correct equipment for eye exam

(Visual acuity / Snellen chart, Pinhole occulder or equivalent,

ophthalmoscope, Fluorescein drops, ophthalmoscope)

Identifies potential aids that a patient may require

during the exam

(Glasses, contact lens, interpreters, alternate visual charts –

pictures instead of letters or figures)

Prepares patient correctly for visual acuity

assessment

(Patient comfortable and correct distance from visual chart

being used. Can identify the correct distance required as per

the chart being used)

Demonstrates visual acuity assessment on both

eyes and explains clinical significance of findings

(Descending order of letters on the visual chart. Uses other

charts if appropriate. Any acute alteration in vision requires

medical review – not an NDEC patient)

Describes or demonstrates procedure for

continued testing if visual acuity is less than 6/6

(Pin hole disk on affected eye to improve vision, other methods

of assessing vision using hand signals then light perception)

Demonstrates correct method for instilling

Fluorescein eye drops (or using blotting paper)

for eye exam

(Pull down lower eyelid to form a ‘pocket’, tilt head slightly back

and get patient to look up, instil drops into pocket formed [or

place blotting paper on eye lid], instruct patient to close eyes

and move eye side to side/ up and down to spread medication)

Adapted from Sydney / Sydney Eye Hospitals Clinical Nursing Services Department (2012) Assessment of Visual Acuity and Assessing and Performing Instillation of Eye Drops / Ointment SSEH

CNSD

Completed by the participant. Confidence is a declaration from the participant that they are confident in the particular performance criteria prior to formal assessment.

NYC = Not Yet Competent. Competence is not adequately demonstrated.

CENA = Criteria mapped to: College of Emergency Nursing Australasia (2007) Practice Standards for the Emergency Nursing Specialist ( )

ANMC = Criteria mapped to: Australian Nursing and Midwifery Council (2006) National Competency Standards for the Registered Nurse ( )

ACI/D13/2736 V1.0