During 2018, I was supervising an occupational therapist on a vision rehabilitation placement in the community. One of her tasks was to try to introduce the Eyes Right Toolkit concept into a rest home environment. This seemed like a good idea because we know that vision impairment leads to social isolation, difficulty walking, a higher risk of falls and fractures, particularly hip fractures and – most importantly – a greater likelihood of early entry into nursing or care homes. It may also compound other challenges such as limited mobility or cognitive decline (WHO (2019) World Report On Vision).

We started out with great enthusiasm. One of the nurses was very keen to learn how to use it and he could see great potential for how it would be integrated into their early assessments. Unfortunately, as the project proceeded, the student ended up doing lots of vision screening and reporting back to the nurses. The nurses seemed to be reluctant to integrate it into their everyday practice. It was hard to understand why this was the case, but it may have been something to do with management (which is always an immutable mystery to me).

One of the hazards of the Eyes Right Toolkit is that it is great for doing a rapid vision screening – but it is more complex to create a message of empowerment for population health purposes. The great thing about education is how often you get another chance to try again with a project (just wait for another year).

I have another couple of students who are going to attempt the same project in a rest home. However, this time we are trying another strategy. We are going to focus our efforts around the activity coordinator, rather than the nurses. The theory is that the activity coordinator will be happy to learn about the visual impairment of the residents, because this has obvious implications for how they engage in activity. They may also have more independence from the manager. For some reason, good ideas have to fly under the radar of management – until they are safely trialed.

The students have now started their project, so I should be able to report back in a month or six weeks about how it has gone.