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Supporting a student with visual impairment in the ICU

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Presentation with some preliminary findings of a study we conducted after placing a final year physiotherapy students with a visual impairment in the Intensive Care Unit.

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Supporting a student with visual impairment in the ICU

  1. 1. Supporting a student with visual impairment in the ICU Michael Rowe Blake Boggenpoel Shamila Gamiet Julie Phillips Tania Steyl
  2. 2. Background The South African government has ratified the UNRCPD which means that it has a legal obligation to facilitate both education and employment, for PWDs. Students with disabilities continue to form only a small proportion of the total number of higher education enrolments (Eagleton, 2008). The Department of Physiotherapy at the University of the Western Cape (UWC) began accepting and supporting students with visual impairments in 1996, graduating 8 since then, all of whom worked in the health system (Steyl, 2010).
  3. 3. Background (cont.) HPCSA has a new requirement for all students to be placed in the ICU as part of their clinical training In 2015 one of our final year students - who has a VI - asked why he was the only one in the class who did not get an ICU placement.
  4. 4. Aim The aim of the study was to explore the experiences of the student, clinician and clinical coordinator with the placement of a student with a visual impairment in the ICU.
  5. 5. Method Design: Case study with student involvement (Willig, 2008) Setting: GSH ICU and neuro clinical rotations Sample: UWC student, GHS clinician, UWC clinical coordinator Data gathering: Interviews with self-developed guide, conducted by a 3rd party Data analysis: Thematic analysis
  6. 6. Method | Ethics United Kingdom has a long history of educating physiotherapists with visual disability, initially in a segregated setting (Thomas, 1957) but more recently as part of the mainstream undergraduate programme (Atkinson & Hutchinson, 2013) Student support in the ICU setting is essential (Atkinson & Hutchinson, 2013) VI coordinator at UWC, clinician, supervisor and student prepared for the placement with meetings and clinical visits to manage expectations (Steyl, 2010)
  7. 7. Results | Different expectations “I was more focused on the environment, asking the student, what do you think of the space, what do you think you’re going to need...then [the clinician] said to me, we’re not here for that, we’re here to see how [the student] performs. So it was quite a surprise for us when they asked him to read the folder, assess the patient and treat the patient.” “with other placements [the student] is used to assessing and treating the patient and then he does digital recordings of his notes and then he writes it up later. And GSH/ICU was saying that cannot happen in ICU; he cannot write up his notes later, he needs to complete the notes before he leaves the ICU”
  8. 8. Results | Different expectations (2) “we tried to give the least complicated patient to [the student], whereas with the other students we just monitor what was happening with the patient regardless of the complications.” “For every two hours that [the student] was in the ICU he needed to be constantly supervised; he cannot be left independently.” “There’s a big difference when you’re sitting behind your desk and thinking about this as a manager, and actually being in the clinical setting and seeing the student. That was more positive; they were very keen to help and they admired us for doing this.”
  9. 9. Results | Negative perceptions “this person is disabled and this person should not be allowed in ICU; if this was my mother or my grandfather or a family member, I would not want someone who cannot see, treating me or my family member in an ICU” “it does raise the question that you’re in ICU and as a patient am I being disadvantaged by having somebody that isn’t as aware and can’t work independently?” “the feedback that I got from the patients was, wow, this is fantastic, this is a great step that you’re taking, we admire your university for doing this, for supporting the student”
  10. 10. Results | Negative perceptions (2) “Is this in the best interest of the patient – because where’s this going to lead to? Are we now going to say that this person is qualified to [work in] an ICU? I don’t think they are.” “This opens up the idea that now we are saying that with this little bit of training and the hours he spent there, that when he qualifies...he hasn’t worked independently in this area for us to qualify him in that aspect. He should never be allowed to work independently in an ICU after he graduates.”
  11. 11. Results | Preparation “I think it was just overcoming the perception that we can’t have disabled people working in the ICU – I think that was the biggest thing. Once we were over that…” “I think that we also need to prepare the nursing staff; I don’t think they were ready for a visually impaired student.” “The sister there gave [the student] the bedside charts and put readings on for him so that he could take it home and so that when he comes back into the ICU he’s familiar...where’s the temperature, where’s the heart rate, where’s the blood pressure, where are the ventilator settings.”
  12. 12. Results | Challenges “We can enlarge the readings but it’s still difficult due to the contrast in colours; I can see if something is white on black or black on white. But, for example, I had a difficult time to read the invasive blood pressure which was red on black.” “where the patient was situated in the ICU in relationship to where the windows were. The blinds couldn’t adjust and I'm photophobic.” “the monitor was set up quite high and it’s fixed, so it can’t move down, which made it difficult to actually read everything out.”
  13. 13. Conclusion “I would definitely recommend this because it gives you a lot of experience. I remember a student I knew that was in fourth year when I was in my first year. She also had a vision impairment and she didn’t go on an ICU block. I I told her about this ICU trial that we are doing, and she said that would have been nice to have because when you go out on comserve you have to adapt and you can’t just tell people, sorry I can’t do this because I didn’t have any experience. She only started this year introducing herself to the ICU. Luckily there were clinicians who were willing to help her.”
  14. 14. Thank you mrowe@uwc.ac.za mrowe.co.za/blog @michael_rowe

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