From the Guidelines
A Personal Outcome Notice (PON) for a visually impaired individual with a white cane should prioritize their safety and independence, focusing on preventing falls, injuries, and other complications that could impact their morbidity, mortality, and quality of life.
Signs and Symptoms
Signs and symptoms to monitor include:
- Increased difficulty navigating familiar environments
- Bumping into objects more frequently
- Complaints of eye pain or discomfort
- Headaches
- Expressing feelings of disorientation These signs and symptoms can indicate a decline in the individual's visual function or an increase in their risk of falls and injuries, as noted in the vision rehabilitation preferred practice pattern 1.
Look for and Call the RN On-Call
Look for and call the RN on-call if the individual:
- Experiences minor injuries from falls or collisions
- Shows signs of dehydration or missed medication
- Expresses increased anxiety about mobility These situations require prompt attention from a healthcare professional to prevent further complications and ensure the individual's safety and well-being, as emphasized in the vision rehabilitation preferred practice pattern 2.
Call 911 and Notify the RN
Call 911 and notify the RN if the individual:
- Suffers a significant fall resulting in head injury, severe bleeding, suspected fractures, sudden changes in vision, extreme disorientation, or loss of consciousness These situations are medical emergencies that require immediate attention to prevent serious harm or even death, as highlighted in the literature on eye disease and international travel 3.
Actions to Take
Actions to take include:
- Ensuring pathways remain clear of obstacles
- Maintaining consistent furniture arrangement
- Verbally announcing your presence when entering a room
- Offering assistance only when requested
- Ensuring proper white cane maintenance
- Encouraging regular vision check-ups
- Providing verbal descriptions of surroundings when in unfamiliar environments These actions can help prevent falls, injuries, and other complications, while also promoting the individual's independence and dignity, as recommended in the vision rehabilitation preferred practice pattern 1 and the literature on eye disease and international travel 3.
From the Research
Signs/Symptoms
- Difficulty navigating through spaces with a white cane 4
- Inability to detect obstacles or drop-offs while using a white cane 5, 6
- Limited mobility and independence due to visual impairment 4, 7
- Increased risk of falls or accidents due to undetected obstacles 5, 6
Look for and Call the RN on-call
- If the individual experiences any signs of distress or discomfort while using the white cane
- If the individual reports any difficulties or challenges with mobility or navigation
- If the individual's visual impairment is suspected to be worsening or changing 7, 8
- If the individual has any concerns or questions about their white cane use or mobility 4
Call 911 and Notify the RN if
- The individual experiences a fall or accident while using the white cane
- The individual reports severe pain or discomfort due to an injury or accident
- The individual's visual impairment is suspected to be caused by a medical emergency (e.g. stroke, head injury) 7, 8
- The individual's condition is worsening or changing rapidly 7, 8
Actions to Take
- Provide assistance and support with mobility and navigation as needed 4, 5, 6
- Encourage the individual to use their white cane correctly and safely 4, 5, 6
- Offer to accompany the individual while they are using their white cane, if desired 4
- Refer the individual to a low vision specialist or occupational therapist for further assessment and support, if needed 7, 8