Lecture: Ophthalmic Nursing from Around the World

Join us for a live webinar hosted in collaboration with the American Society of Ophthalmic Registered Nurses in celebration of Nurses Week and International Nurses Day. A panel of international ophthalmic nurses will describe the roles they play in global health, ophthalmic disease prevention, patient education, and the global challenges they may face.

Transcript

[Lori] Hi, everyone! Welcome, thank you so much, everyone, for joining me today. I got a sneak preview of participants and where everyone is from, as of yesterday. And we have participants from 91 countries. That is just amazing! I am truly honored to be here with you today. Thank you for taking the time to log in and be with us. I know many of you personally, a lot of you are here really early in the morning or late at night. My sincere thank you, and a shout out to all of our ophthalmic nursing associations around the world that are joining us, so thank you.

For those of you who may not know me, my name is Lori Pacheco. I am a registered nurse, here in the US. I am certified in ophthalmology. And I come to you wearing two hats. One, I work with Orbis International. Their teaching platform, Cybersight, is the platform that we’re using today for this webinar. And I’m also a board member for the American Society of Ophthalmic Registered Nurses. Together, ASORN and Cybersight could bring you this webinar, which we hope will be both educational and inspiring and maybe bring you tips that you can bring back to your own practice.

I am going to start first by introducing our speakers today. Let me share screen with everyone. We have all ophthalmic nurses joining us today. First, Clauda Darko from Ghana, Nadine Grant-McKenzie is from the United Kingdom, Wilson is from Cameroon, Jaona is also from Cameroon, and Tisia Cumberbatch is from Barbados. Hi, everyone and thank you, welcome, for being with us today sharing your knowledge and your expertise with everyone.

Before we get started, I’m going to do a little bit of housekeeping. Today’s webinar, one nursing contact hour has been requested for this activity. And nursing contact hours are provided by ASORN. Credit contact hours will be denied to any individual who misses more than 10 minutes of the webinar. Make sure you stick around, everyone, okay? All attendees must complete a post evaluation in order to receive credits. Post evaluations will be emailed to US participants within 24 hours. Please give me a little bit of time, everyone, if you don’t mind, patience. Just give me some time to get those post evaluations out to you. If you’re outside the US, a Certificate of Attendance will be available on Cybersight for you.

This is the financial disclosures. As mentioned, I am a volunteer on the board for ASORN and I work full-time for Orbis International. And in regards to our speakers, none of our speakers here today have any financial interest or conflicts to disclose. They are presenting voluntarily and are all very gracious to volunteer their time. Thank you.

These are our objectives today, we’re going to define global nursing. And we’re going to describe the roles ophthalmic nurses play in the prevention of ophthalmic disease.

Our discussion is going to be on global health, we’re going to talk about disease prevention, and patient education as well.

If you have any questions during the webinar, you can use that question and answer, that Q&A box in the bottom of your screen. Just type in your question and we’re going to address all questions at the end. I’ll try to get as many as we can, time permitted, so please feel free to write in any questions. I got a few of them prior to the webinar that we will address as well. So we’ll do our best to get to everyone.

This is a nice segment into our discussion today which is a definition of global nursing from the Global Nursing Caucus. And it talks about a global nurse and what is global nursing? It’s nurses with common global health interests. And that includes everything you see here today. So that’s networking, collaboration, it includes training, and raising the voices of others, raising the voices of other nurses. To help improve patient outcomes, visibility, advocacy, and quality of care, all this across the globe. I always like to say we’re in this together. We help each other. A global nurse works together, we raise our voices together for the quality of care for our patients.

All right, enough of me talking. Claudia, you want to come on screen, my friend? Hi! This is my wonderful friend, Claudia, you can go off mute, Claudia. There you are! Hi, my friend!

[Claudia] Hi, Lori.

[Lori] Claudia and I met in 2019 in Orbis’ program to Ghana. She was one of the nurse trainees on our Flying Eye Hospital. And we got to know each other very well. And we kept in touch since then. Claudia is a very dedicated, very motivated ophthalmic nurse, which I am very proud to know. Claudia, thank you for being with us today.

[Claudia] Thank you, thank you.

[Lori] Claudia, when you and I chatted before, you mentioned to me that ophthalmic nurses in Ghana act as major patient educator in every setting in eye care in Ghana. And that ophthalmic nurses travel all over the country to deprived and rural areas to give education on eye care, and to screen patients, and prepare cataract surgery camps. Community outreach, I think, is very important in eye care. Can you tell us a little bit about those outreach programs and what exactly is a surgery camp?

[Claudia] Okay. Thank you, Lori. The Ghanian ophthalmic nurse plays a very big role in the prevention of blindness and eye care in general. And one of the major ways we do this is through outreach to patients because we have a lot of areas where eye care is not really accessible. And the patients traveling to where the hospital is can be a big burden. And some people even have problems with their eyes but they do not know.

One of the basis, for let me say, outreach, is delivering eye care in a very efficient way. That is using the less available resources in terms of human resource, time, and then the consumables, to deliver care to a wide range of people. We do this by going to the rural areas. I could be the school, it could be the whole community, it could be a market setting. And arranges education on eye conditions, on what eye conditions are, because some of them have these eye conditions and they do not know. And they do not know that pre op assessments of patients, that’s the visual acuity, funduscopy, anterior segment prior to the cataract surgeries. And even booking the surgeries for the surgeons. In areas where there is no ophthalmologist, the ophthalmic nurses do this and then plan with the ophthalmologist on the day the ophthalmologist will visit the place. And during the education, there are so many things that we can see.

But the emphasis is made on expectation management post op. That you want to let this patient know that you try as much as possible to help them see, but in the course of the surgery, there can be complications. There are chances the patient has other underlying conditions that may impair the vision that the patient may be expecting. This is very important because when you do this, whatever happens post op, the patient understands, and then we educate them on what they should do. Like using of medications. Then during the surgery, the ophthalmic nurses responsible for getting of logistic settings of a theater, organizing the whole operation team, circulating and then the scrub nurses assist during the surgeries.

Then post op, still it could be either cataract come, or we bring the patients to a teaching hospital or outreach hospitals or their primary eye care, to their hospital, whichever way it is. We either do it at where the patients live or we bring them over. But at the end of the day, we go to where and we reach out to the patients.

Post op, you want to let the patients know that they need to use their medications effectively, that surgery is not the only, surgery is just a static point. That there is a lot that is expected of them post operatively. And immediate post op, we let them know that when the pad is taken off your eye, you might see very well, or might not see because the cornea might be hazy. These are things that you emphasize during the patient’s education.

Then, asides the cataract, we also have glaucoma patients. People who have been diagnosed with glaucoma and don’t really believe it. We let them know that the management of glaucoma with their medication doesn’t really mean that you are going to get your vision improved, but the management is aimed at letting your vision remain where it is so that you don’t lose much. We also educate during outreach in refractive errors in the use of spectacles. Because in our setting here, when it comes to children especially in our setting, some parents don’t really accept having their kids wearing spectacles, thinking that it can affect them in the future. As ophthalmic nurses, we get into advising our patients and their parents. And telling them that this wouldn’t really have any effect on them.

And then visual rehabilitation for those who have already lost their vision. In our settings, a lot of people who are the key family members, those who take care of the families after having an eye condition and losing their sight, everything ends for the family. This leads to poverty. If the role of ophthalmic nurses and this is something we really do to let them know that blindness or the loss of your sight is not the end of it all. We refer them to rehabilitation centers and for their kids, they can go to the school of the blind and still have education.

[Lori] Thank you, Claudia, that’s awesome. Patient education is so big, and expectations, and giving the right expectations to your patients, and good patient education so they know what to expect. Thank you. I also know you’re interested in advancing your career in ophthalmology and possibly getting certified. Are there any opportunities there in Ghana for the advancements in ophthalmic nursing?

[Claudia] Well, the Ghanian ophthalmic nurses, somebody who has a training in general nursing. Let’s say for three years or two years, depending on if it’s a BSC or Ed diploma. And after that, you work for a minimum of three years as a general nurse as an errand. Then you can go to the ophthalmic school. The ophthalmic school used to be an advanced diploma which lasts for one year, until 2016 when it was advanced to a BSC and it takes two years. After the degree in ophthalmic nursing, where we have some in-hospital training programs with some partners such as HCP and Orbis. And I have been a beneficiary of that as well. And partners like HCP and Orbis also sponsor some ophthalmic nurses to go out of the country for subspeciality programs, lasting maybe six months or three months.

But as we speak, there is no well-structured pathic way for the ophthalmic nurse as regards to education and further career opportunities in Ghana. Ophthalmic nurses have to go for a masters program in probaby public health or general nursing. But we have something in the pipeline. The Ghana College of Nursing is still discussing that in a couple of years they want to enroll ophthalmic nurses in a fellowship program, where we can have subspeciality courses. But this has not started yet, it is still in a discussion. Thank you.

[Lori] Thank you, Claudia, thank you so much for sharing that.

[Claudia] Thank you, Lori.

[Lori] Nadine, you there? You can come on screen.

[Nadine] Hello, Lori.

[Lori] Hi, Nadine, thank you so much for being here!

[Nadine] Thank you for having me.

[Lori] Sure, Nadine comes to us from London. Nadine’s primary function is in infection control. And I’d like to really focus on that because that is a very big and very important aspect of what we do in nursing. Especially opthalmic nursing. Nadine, can you tell us a little bit about being an infection control nurse and any tips that you may have for our audience and how best to provide continuing education in infection control in ophthalmology?

[Nadine] First of all, I am a trained ophthalmic nurse now for, I was counting today and realized it’s 20 years since I’ve done my ophthalmic course.

[Lori] Congratulations!

[Nadine] And I’ve been doing infection control now for seven years. The most important thing for us in infection control, especially my role, is surveillance. It’s basically looking at ophthalmic post operative infection within ophthalmology. As you would know that’s commonly endophthalmitis because that would be something related to procedure, surgical procedure, or intravitreal injection. Something that we actually do. And we need to educate people, i.e. doctors and nurses. Because in the UK, a significant number of the intravitreal injection are done by nurses. And it’s just to educate people, make them aware of the potential risk of someone having a post procedure endophthalmitis and the implication that might have one someone’s sight. That is one of the main things.

How this information is sent out? We do have, within the trust, in the infection control team we send out a regular newsletter. On a monthly basis we’ll send out what we call a bug brief, and it just basically highlights what is currently happening within the organization wherein infection control is concerned.

Now, what I didn’t say is that my organization is only ophthalmology, we do there. Everything around my infection control practice is ophthalmology-related. Or ophthalmic related.

We send out a monthly bug brief and that engages people. What will happen then, these are displayed in the clinical areas. So individual are aware with what is current in infection control and if there’s an outbreak of an ophthalmic, most likely endophthalmitis or graft, or keratitis, anything relating to an infection. It could be national, international, or within our organization. We highlight that so that it can be looked for.

For argument’s sake, at the moment one of the things that is quite topical within the country, I think it might be wider than the UK, is the relationship between COVID vaccine and reactivation of uveitis. A number of patients who have had uveitis dormant for a significant number of years and after they’ve received their COVID vaccine, then they seem to have a flare up. There is no hard and fast evidence, it’s just something that they’re currently looking at.

With that information shared by us, it tends to get disseminated and then other institutions around the UK will start to look out to see if this is something that is common within their cohort of patients as well. That is where we branch out a bit wider.

But to our local team, what we do and I’m not sure everyone do it, but that could help their organization, is have a group of champions. Or what we call them in our trust is infection control link practitioners. Within every area within our trust, because we have 32 sites across London and the southeast. We, as infection control nurses, could not cover all these sites. So one of the things that we do, we have these champions and I do regular webinar, now that COVID is happening, is regular webinar. We used to do a half a day workshop, and they’ll send questions and we’ll just update them on what is happening, what is current. And they’ll disseminate throughout their areas. They’re the ones, also, responsible for doing the audits. We do regular audits, a lot of infection control audits. So you do hand hygiene audit, cleaning audit, decontamination. How often the slit lamps are cleaned? We do spot checks to make sure that items are clean. We observe staff discretely to make sure that they decontaminate equipment between patients. There’s a number of things that we are doing to try and minimize, decrease infection within our ophthalmic setting.

[Lori] I love it, infection control champions. I like that! I’m going to use that, that’s fabulous. A lot of education for your staff, as well, I imagine? Providing continuing education for your staff and infection control. Are there any requirements in London or where you are, by the government to provide a certain amount of infection control training or anything like that?

[Nadine] Right, so currently the guidance is that if you are working clinically, so if you’re a clinical individual, you must do a refresher, infection control awareness course every year. If you’re a non-clinical staff, so if you’re a backroom staff, clerical, then that is every three years you have to do that, yep.

[Lori] Okay, it’s very interesting. Yes, here in the US, you have to show that you need an infection control coordinator for your facility. Someone like yourself, that’s in charge of infection control. And you do need to show that that person has been trained and has a certain number of continuing education on infection control each year. So it sounds very similar.

[Nadine] Yeah, it’s just that they do it online. And what tend to happen is that if you’re not 100% compliant with all of your mandatory training, then you won’t pass your appraisal. And then if you need to get revalidated to practice, that is going to hinder you. So it’s in your best interest to make sure that you are compliant with your mandatory training.

[Lori] Tell me, when a person does, unfortunately, get an infection like endophthalmitis, do you follow that patient? How do you get that information? What’s the process of how you get that information?

[Nadine] Right, so the process is, first thing, the patient have their procedure. Most time they’ll come back to our institution when they start exhibiting signs of endophthalmitis. They’ll come in. We get notified by a few ways. One is once you treat a patient for endophthalmitis, because we do have endophthalmitis protocol for both endogenous and exogenous endophthalmitis. Once they get treated, then an incident report form, they need to complete an incident report form. And then we, the infection control team, is notified via that way.

As you know, no process is 100% foolproof. So there are people who haven’t completed it. Whether what I do on a daily basis, and also the microbiologists, we have an external microbiologist, once they receive a vitreous or aqueous specimen, he’ll email across to us of any findings from that. And also we have a pathologist assisting that we check on a daily basis to see if any specimen is sent to the lab. In case we don’t get notified via the incident report, we check the specimen. And if there is a specimen, we go into another online portal called OpenEye to see why that patient came in and if it is a procedure that the patient did here. And if that procedure, when I say here my world, yes. If the procedure was done within my organization, then what I’ll do, I’ll look back to see what the procedure was, who did the procedure, and the general presentation. Because that patient was treated as an endophthalmitis.

And then we do a root cause analysis. We pick it apart, look at the instrument, what the ventilation was like in theaters at that time, how many staff were in theaters, is there any commonality between this case of endophthalmitis and other cases? If that is the case, where there is, then we use a probability data chart that we put the information in. How many cases were done as opposed as how many endophthalmitis and that will determine if that unit should carry on practicing, or they should stop and get assessed.

We send that notification letter to the surgeon or the nurse who did the procedure, along with… no, we send RCA, root cause analysis, with a notification letter to remind that individual that these are the steps that we need to take. I.e. make sure that you clean the patient or if the patient have blepharitis, you should postpone surgery, make sure you use povidone-iodine on the surface, make it stay for however long. The notification have that. Those are standard, we send it and we request it back within 10 days. Once they send that back, we then again look to see if all the information is there and if we need to share with a wider group of people.

But before we do that, we have an ophthalmologist who is the chairman of the infection control committee, who then we’ll discuss the case with and they determine that yes, it is a true case of endophthalmitis. And a true case of endophthalmitis in our case doesn’t depend on the growth of microorganism it’s just a clinical presentation. Because 40% of endophthalmitis do not actually have a growth.

[Lori] Wow, Nadine, that’s fascinating. Thank you so much for sharing that. What such great work you do, thank you.

[Nadine] Thank you.

[Lori] Wilson, come on in!

[Wilson] Hello, Lori.

[Lori] Hi, Wilson, how are you?

[Wilson] I’m fine, thank you, how are you doing?

[Lori] I am doing great. If I can get my slide to move, so Yvvone is going to have to help me here. Wilson! (laughs) You’ve been doing work that I find absolutely fascinating. You work in the preparation room doing peribulbar and retrobulbar blocks, did I hear you say that to me?

[Wilson] Yes, I was.

[Lori] Tell me about that.

[Wilson] Okay, thank you. I’m Wilson, I’m a certified. I work as the head of the operating theater and I cover several units. And one of the units where I practice is the preparation room. As we all know, for us to maintain the patient calm and quiet during our procedures, we should make sure that blocks are properly administered. In our settings we practice a wide range of techniques, along which we have the peribulbar blocks. We have the retrobulbar blocks, we have the sub-tenons, we have the facial blocks which we do, topical blocks. And all of these depend on the recommendations of the surgeon, as well as the clinical presentation of the eye or the clinical situation of the patient.

In our context, when the patient come into the preparation room, the file is assessed, we have to look at the most recent recommendation from the surgeons. The surgeon may want us to proceed with the retrobulbar block or a peribulbar. This will depend on how long the surgeon thinks he is going to put, to realize his intervention. When we have a difficult condition such as retinal surgeries, which can take relatively a very long time, we would want to consider great for the retrobulbar and not the peribulbar.

And when we have procedures which wouldn’t last so long, such as cataract surgeries, and also taking into consideration the speed of our surgeons, we want to go for the peribulbar. If we have patients with comorbidities such as hypertensive patients, already on blood thinners, so we wouldn’t want to create a lot of trauma to blood vessels by practicing the peribulbar or the retrobulbar block, so we would want to practice the sub-tenons. Because the sub-tenons are less traumatizing. And also, we also face sometimes with some conditions which are not invasive, we would want to consider just the topical. Just a topical applications of the anesthetic agent.

Gratefuly, those are the different techniques we do realize. And in our context, also, the ophthalmic nurses are trained to realize this because in all our settings we will have an anesthetist do that. But in my country, in our context, we do not have so many of them. The ophthalmic nurses are trained to be able to realize this. And also, sometimes, we could incorporate anesthetic nurses, nurse anesthetists also to do that. In my setting, we have a nurse anesthetist who are trained to realize this and we also have ophthalmic nurses who are also on scene for conditions which are a little bit complicated for them to manage. They will call on the ophthalmic nurses to better handle them. Briefly, that is what we do in the preparation room, preparing the patients for surgery. Understanding different techniques which we do implement to make sure our patients are calm and our surgeons are comfortable as well.

[Lori] Thank you, that’s fascinating. There, in the US, at least in Massachusetts, actually doing peribulbar or doing retrobulbar blocks is on our end, is not within our scope. We have either anesthesia or nurse anesthetists. The surgeon will do it as well. That’s fascinating. A lot of people are having a hard time hearing you, Wilson, so I’m going to have you speak up a little bit, if you don’t mind.

On the next part, I wanted to ask you, you said you’re certified in ophthalmology, what’s the process of certification where you are? How did you get certified in ophthalmology?

[Wilson] Okay, in our context, before being certified in ophthalmology, you will have to be a registered nurse first. That is to say, three years of training as a general nurse and thereafter, you will have to practice for at least two years. And there’s a competitive entrance exams which is launched by the Ministry of Public Health and all the general nurses are invited to compete. Now those who make it through the exams will enroll for training which will last for two years. Thereafter, you are an ophthalmic nurse but yet, all our certifications are not really present in our context. But we have the IJCAHPO, which the nurses in my institution have been introduced to. So we do take the IJCAHPO, which is some of the certifications which I have. I’m a certified ophthalmic assistant. That is what we have currently in certification programs. But nationally or locally, other than just being an ophthalmic nurse, we don’t have all the certification programs at present.

[Lori] Okay, thank you so much, Wilson, thank you for sharing all that.

[Wilson] Okay, thank you. You made mention of the fact that in the US we would have the surgeons do the blocks themselves, or the anesthetists. Yes, in context, for example, in a day, we could do at least 30 surgeries, we could go up to maybe 40 sometimes. Sometimes it gets too difficult to have the surgeons do that. We have to step in to make the process faster and easier for them. The ophthalmic nurses are given the necessary tools to know how to go about that. And we also have nurse anesthetists who are also on site to permit us and realize the blocks faster so that the waiting time is reduced and surgeons are not so exhausted. And we also help them and assist them to carry out with their activities in a better way.

[Lori] That’s great, sounds like you’re ophthalmic nurses are such a great asset to your facility. That’s wonderful, thank you.

[Wilson] Thank you, Lori.

[Lori] Jaona, come on screen, my friend!

[Jaona] Yes, hello, Lori!

[Lori] Hello, how are you?

[Jaona] Fine, thank you.

[Lori] Thank you for being here today. Thank you for joining us. I know you’ve mentioned to me that you have been doing a lot of outreach activities in response to COVID. That’s something I think would be great to share. How you’ve been doing these outreach activities and how the ophthalmic nurses have stepped up, becoming involved in response to COVID in Cameroon?

[Jaona] Yeah. Like those people in Ghana, as Claudia said, outreach program is also available here in Cameroon, as in so many African countries. So for us here in Cameroon, we are doing the outreach activities to respond to the need of the patients who is in the rural area. During these COVID-times, we faced the challenges and difficulties to conduct an outreach program. So we put in place such strategies to adapt the structure of the outreach program activities to the COVID response.

What we did here in Cameroon, mostly for patients, we do the site outreach as usual, but we just tell them that they have to register ahead of time, a focal point in the rural community. So we just register 100 patients a day. To handle those 100 patients a day, we scattered them as a sort of 50% per groups. So we handled 50% at the time, according to the government restriction to gathering people, not more than 50 in one area. But before that, one of the team from the hospital go to the field and identify where is the space, which is an open space not in a closed area, to gather these patients?

During the process there is a lot of procedure we have to do. We have to restore the washing, bucket washing, handwashing with soaps available for patients and staff to wash their hands regularly. And then instead of using benches for patients to sit, we have to use a single chair, seat chair. Just to avoid and respect the social distancing of patients during their waiting time.

As the policy of the hospital are so, we have to issue facemasks from the hospital and bring them and share to every patient who attend the outreach camp. Because most of those patients from the rural area, they do not have even an opportunity to provide themself a facemask. So the hospital have to provide them a facemask individually, which is handmade from the hospital and sterilized before bringing to the field. Each patient have to be shared one facemask during the camp.

According to the COVID suggestion as so, the staff have to wear a face shield during the condition process. Mostly as we note, those outreach screening is conducted by the ophthalmic nurses. Then to adapt the suggestion to the COVID suggestion, we evolve to use indirect ophthalmoscopy to do the fundus. We have 10 ophthalmic nurses to do indirect ophthalmoscopy with the two which is available with them. Either they use the 10 dioptry or the 20 dioptry lenses with a torch if indirect ophthalmoscopy is not around. Either they use indirect ophthalmoscopy itself with the 20 dioptry volk lens.

This was put in place to respect and identify the disease of the patients in the field. Most of the things I saw is to put in the place the temperature check in for patients who attend the camps. All of the patients who attend the camps have to be checked for the temperature check in. If they are having high temperature, they’re immediately sent for a general clinical screen to find out if they are not at risk for a COVID situation.

One of the things I saw, which is a new version that we introduced to the field, I saw the use of the portable slit lamp using the smartphone, which is available from India. We imported slit lamps, adapted with a smartphone. At that time, the ophthalmic nurses who screen the patient does not put their heads on a portable slit lamp, but just on adapt the smartphone on that slit lamp, so that they can see all of the abnormality on the eyes of the screen of the smartphone. That is some of the innovation we adapted for the outreach program during the COVID time here in Cameroon.

[Lori] Wow, that’s fascinating. That’s such great work, thank you. I notice that you have your COA certification. Can I ask, do many nurses in Cameroon go and get their COA or COT before becoming a nurse or is that something that you did while you were a nurse? Did you do it before or after?

[Jaona] Normally, as Wilson said before, nurses camps as general nurses in the field. After practicing what we do here in our own hospital, is to enroll our own nurses, which have been as a general nurse, to do the certified ophthalmic assistant program with their IJCAHPO. Up to now, we are just as a starting program to end as a certified ophthalmic assistant. We are looking in a way how to bring them up to certified ophthalmic technician. But the program is not yet set with the IJCAHPO or head office in the US. We are trying to find a way how to put it in place. As Wilson said also, mostly there is only ophthalmic nursing school, which is headed by the government here in Cameroon, like in every other countries in Africa.

This program is for two years. They are running in that area to do ophthalmic nursing. But now it’s also available in South Africa and in London, the school for the master of public health. So most of the ophthalmic nurses applied if they want to get involved in public health to go to the London school or school in the University of Capetown in South Africa.

If they want to have their career as administrator or coordinator of programs, they would be enrolled in those eye care public health program.

[Lori] Great. Thank you so much, thanks for all that information.

[Jaona] Yeah, you are welcome.

[Lori] Last, but certainly not least, is Tisia. Tisia, you on?

[Tisia] Hi, Lori.

[Lori] Hi, Tisia, welcome.

[Tisia] Thank you.

[Lori] Tisa is an ophthalmic nurse in Barbados. But, please note, that Tisia is the first and only certified ophthalmic registered nurse in Barbados. Tisia, I think you are a great inspiration for ophthalmic nurses here and in Barbados. And I’d love you to share your journey of what it was like to get certified and any tips that you can provide our ophthalmic nurses who are considering becoming certified. Something that maybe they can utilize in their own practice and their own lives.

[Tisia] Okay, no problem. If you don’t mind, I will start from where I came into ophthalmology in 2006.

[Lori] Please do.

[Tisia] I didn’t choose ophthalmology but it was chosen for me after I had a medical illness. I was sent to an area that had nursing care, but it was a cleaner environment. After I got there, I had this desire, I wanted to understand what was going on with the eye patients and I started doing my own reading and research. And I would ask some of the doctors if they know anything about nursing certification. I was not pointed in any direction of nursing certification, but I became a COA, a Certified Ophthalmic Assistant, because that was the programs that our surgeons were aware of. I did that particular certification in 2014.

But we have this thing called OSWI which is the Ophthalmological Society of the West Indies. We have a yearly conference in the Caribbean and for the one that was held in Barbados, which was the one that had the first nursing symposium, we had the opportunity to hear about a certified registered nurse in ophthalmology certification. That’s when we were introduced to it. This was 2016. And I had a few years of procrastination.

But in 2018, after Orbis came to Barbados to do a mission here, we had the opportunity to be reintroduced to this CRNO certification. The first week of the Orbis mission, the nurses would have spent time doing certification courses. And we had to do two tests, one before, one after. And each time I scored decent, I scored well. And I was encouraged by the facilitators to don’t let the fire die. Don’t go procrastinating again, pursue the certification. That was in May 2018, and in September I went on to do the certification examination. It’s not available here, locally, but I would have gone to Canada to do the certification.

What I would say to persons who are considering certification? I would say go for it. It’s a boost to your confidence because the preparation is grueling. It’s one where you have to do a whole lot of reading. And the more you read, the more educated you become, the better you are able to advise your patients, as well as when the doctors are speaking you don’t feel lost. You are fully aware of what they are talking about. I shouldn’t say fully aware, you have a better understanding of what they’re saying. Certification to help nurses in boosting their confidence.

[Lori] Wow, Tisia, that’s fantastic. That’s wonderful. Tell me more, yes, please.

[Tisia] One second. I didn’t get a chance to update you, but since we spoke last, one other person in Barbados became certified.

[Lori] Yay!

[Tisia] So we have two certified registered nurses in ophthalmology here in Barbados.

[Lori] That’s wonderful, so if a nurse comes along and says, they don’t think they can do it, they’re not sure what it’s going to take, what would you tell them? What inspiration can you give them?

[Tisia] I won’t be able to, I won’t lie. I would say it’s a lot of work. But it’s not impossible. It would call for you to get the resources. ASORN, if you choose that particular examination to certify with, they have plenty of publications out there to help you. And I use my books, up to this week, we have a new nurse to the unit. I was able to go to the one on office procedures and show her about doing visual acuity the correct way and the rationales for doing it. ASORN has plenty of information out there to help. And then there’s other certification exams out there if you choose not to do the ASORN one. And just go for it, it’s a lot of work but it’s worth it in the end.

[Lori] That’s awesome, thank you. Now everyone has been sharing what they do in their country for work and what their scope of practice looks like. I want to give you the opportunity to share with us as well. What do you do in Barbados as an ophthalmic nurse?

[Tisia] I, as an ophthalmic nurse, I work in the eye clinic. And I do a pre operative assessment clinic. There, I would interview the patient, state their history. Using these ophthalmic assistant certification, I do biometrics, and care readings, and everything, and prep for cataract surgery. I do a lot of education, not just for the patients, but for staff as well. I have the opportunity, even this evening, to be able to do a presentation to culminate Nurses Week, on glaucoma this evening. But I would have done other public lectures as well.

[Lori] Awesome, thank you so much! Thank you, everybody!

[Tisia] You’re welcome.

[Lori] For all the information that you’ve given us. And this is great, this is right on time. And it allows us to answer some questions.

If anyone has any questions for any of our panelists, please feel free to write it in the QA. I do see we have some in here and we can certainly do our best to answer. I did want to answer one question that came prior to today that they had put in the registration. And the question is, what are the tips you can provide to other ophthalmic nurses to help them enjoy their work? And I thought that was something for sure to reach out. And to say, I know for myself, personally, I love what I do. I love being an ophthalmic nurse. But one of the things that contributes to that is constantly learning. And I think something very important that I’ve had the opportunity to do is work in different areas of ophthalmic nursing. If you have the opportunity to do that, surgical nursing is primarily my background, but I worked in clinic for two years. Somebody calls out sick, I work in preoperative recovery room, sterile processing., I’ve had just wonderful opportunities to move around a little bit and I really helps keep it fresh. It keeps me learning. It also gives you a great appreciation for what your peers do and what other nurses do and how they contribute towards patient care. Would anyone like to jump in? Any of our nurses here like to jump in? What would you say to a nurse to help them enjoy their work and help them love what they do?

Anyone want to jump? Nadine or Tisia, you want to share?

[Nadine] For me, what I have done is I’ve been in ophthalmic nursing for a long time. Because I was trained, originally, in Jamaica. And I came to the UK. I did ophthalmic in Jamaica and I’ve been doing ophthalmic here as well. And what tend to happen is that sometime you might get sort of bored doing one thing. There is so many scopes that you can go in ophthalmic. Because since I’ve joined my trust, I have done day surgery, I have done anesthetic, I have done recovery, I’m telling you, the scope is endless. And I don’t know whomever have certain things in their country such as advanced practitioners, intravitreal injection, some people do lumps and bumps. So there’s so many other scopes, so don’t get bogged down and bored with one. You can always go somewhere else in ophthalmology because there’s a lot of areas.

[Lori] Exactly, I agree.

[Tisia] Adding on to what Nadine was saying, yes, the scope is endless. At this point in time, I’m not even sure where I want to go next. Do I go in the direction of a nurse, administrator, or do I do just education? But I also have the interest in the clinical side. I don’t have as much experience as Nadine has and some of the others, but it really is good to hear that there are opportunities out there. Because they’re not available on my island, doesn’t mean that they’re not available. I think that if people get to realize that ophthalmology is not stagnant and it’s fluid, people would be really interested in what we do as ophthalmic nurses.

[Lori] That’s so great, thank you. Claudia, I’ve got a question here for you. Someone asked if you are doing ECCEs where you are? Or if you’re doing phacos in your cataract programs? Are you able to come on, Claudia?

If not we can, there she is.

[Claudia] Hello?

[Lori] Hi, Claudia.

[Claudia] All right, okay. We are doing phacos and SICS along that. But most of our outreach cases are SICS.

[Lori] Okay, so many of you, some in the US may not know what SICS, that is small incision cataract surgery. A little similar to-

[Claudia] We do phacos in the hospital settings, especially the tertiary institutions.

[Lori] Do you do IOP checks as well as part of your pre op? Do the nurses do the eye pressure checks?

[Claudia] Both nurses and doctors do. Even on an outreach basis. Sometimes we take the possible tonometers, the Tono-Pens and packings to do that.

[Lori] Awesome. I do have some questions here on certification. If you don’t have an ophthalmic nursing association in your area to reach out to, I’m going to give you my information towards the end. And I’m happy to help you find a nursing organization and see what I can do to help you advance in your ophthalmic nursing career. Many of the questions that do have, in regards to certification or just advancing your career, I’m happy to help you after the webinar.

Let’s see. Another question that came up was ophthalmic associations. Are there many around the globe? And I do believe, last time I checked, it was 12 ophthalmic nursing associations. But the Philippines, I’ve been speaking with a physician in the Philippines lately. And just in the last year or the year before, they put together their first ophthalmic nursing association. Very excited for them, I believe they make 13. Last time I checked we had 13 ophthalmic nursing associations around the globe. And the question was how many in Africa? And I believe there are five in Africa.

Let’s see here.

I think we may have answered all of our questions. There’s some information here from some of our nurses in the Flying Eye Hospital, as well, on infection control. A lot of questions on ophthalmic nursing and how to get certified. What is the difference between CRNO and RN in terms of their roles and responsibilities in the eye hospital?

Tisia, as a CRNO, did that change your roles and responsibilities?

[Tisia] Not really. Yes, I work in the eye clinic, so it didn’t really change my roles. I got more responsibilities because I’m the one who gets to do a lot of teaching. And persons look up to me because of the certification. But there are others who can function as well with any department without the certification. But like I told you earlier, being certified boosts your confidence and you know that what you’re saying is the correct thing and it’s on paper versus just doing it because somebody told you to do it.

[Lori] Exactly. I got certified because ophthalmology’s all I ever wanted to do. And it’s all I want to do. So it seemed right for me. Most nurses I speak to as well, it’s their way of saying this is what I love to do and I want to do my best in it and I want to learn and do as much as I can. And they went on to get certified. So thank you.

Very educational and great to hear what each and everyone is doing. Many people are reaching out saying thank you for this educational talk. Let’s see.

Do any of the nurses do imaging? OCT, angiography? I believe, I don’t remember if it was Jaona or Wilson that does? Jaona, was it you who did your OCT in biometry or was it Wilson?

[Wilson] Yes, Lori, I do OCTs, biometry, and these scans. And fundus photographies.

[Lori] Okay, you do the fundus photographs. They’re asking about fluorescein angiograms. Any of the panelists, any of you nurses do FA, fluorescein angiograms, do you assist with FAs in clinic?

No? Some of our nurses here in the US do that as well. They work directly with diagnostics and we get a lot of IV nurses that will come in and do fluorescein angiograms.

Infection control training in Nigeria? Does someone have access to any infection control training? Nadine, any suggestions on infection control training? If somebody, not necessarily where you’re from, but in other areas? Any tips of where they can gain access to infection control training?

[Nadine] You can tap into WHO. They will have, if you have access to CDC, because most of the places that do. And your country should have an infection control body so you should be able to get some information there. That should be something that is within every organization because it’s mandatory. It’s just to find out where you can get that information within your trust or your hospital.

[Lori] Thank you. Question if anyone is aware of ophthalmic nurses actually performing cataract surgery? I am not, not in the US, I don’t believe that’s also been our scope of practice. Are any of our nurses aware of ophthalmic nurses actually performing surgery in any of your countries, or anything that you’re aware of.

[Claudia] Yes.

[Lori] Claudia?

[Claudia] Yes, in Ghana. But it used to be before. We used to have ophthalmic nurses go into Gambia for a training on cataract surgery. So I still think we have a couple of them.

[Lori] Wow, really? I wasn’t aware of that. That’s fascinating. The nurses themselves actually perform the procedures?

[Claudia] Yes, they do.

[Lori] Wow, thank you for sharing that.

[Claudia] But I think that training has stopped.

[Jaona] As far as I know, the Gambia still train the cataract surgery for nurses. Of course, I’m in touch with some of them in Gambia. They are still doing the training for nurses for doing cataract surgery. But in Malawi, they have stopped and Namibia and Kenya also. But Kenya also trained some ophthalmic nurses to do cataract surgeries.

[Wilson] Yes, Lori, I wish to add something about that. Ophthalmic nurses are trained as cataract surgeons mostly in areas where you have no ophthalmology, no ophthalmologists. For example, in Cameroon, we have areas where you wouldn’t find an ophthalmologist. So the ophthalmic nurses they go for such trainings. Where there is no ophthalmologist, then they could practice. But it’s something that is already getting outdated. I think now the ophthalmologists have come in and at least we can find an ophthalmologist in every region and it’s getting better. So the ophthalmic nurses are no longer getting to do that so much these days.

[Lori] Wow, thank you. Let’s see her, Gambia nurses also do cataract surgery. I find that absolutely fascinating.

You guys, it’s ten o’clock, we’re right on time. Thank you! Lawrence, we’re going to go to the next slide. I just want to share with everyone my contact information. Some of the questions were about just how to help advance their nursing careers in ophthalmology. And I’m more than happy to help you. And if you have any questions for any of our nurses here, I’m certain that I can help you get in contact with them. Take a pic of my contact, write it down, and please feel free to reach out to me.

I want to thank everyone, from the bottom of my heart, for being here. All these nurses, everyone here, all our participants, as well as all our panel nurses, you guys are all an inspiration to everyone. And I thank you for sharing all your information. I hope the information we provided today can help you in your practice and help you grow as an ophthalmic nurse. Thank you, everyone, take care. Stay safe and be well.

[Wilson] Thank you, Lori.

[Claudia] Thank you.

May 14, 2021

Last Updated: September 12, 2022

6 thoughts on “Lecture: Ophthalmic Nursing from Around the World”

  1. A very enlightening panel and interactions. As an RN and a CRNO oh how I wish this specialty in nursing would be recognized by my administrators in the hospital, region and country where I work.

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  2. Great experience and insights from around the world showcased…I’m showing my nurses today..in Nigeria

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  3. WHO recommends that each ophthalmologist is to be supported by 4 nurses. The better the nurses are trained, better will be outcome of intervention.

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