Powdrill, Samuel Glenn; (1993) The evaluation of nurses trained in specific ophthalmic skills in Sierra Leone. Masters thesis (M.Phil), UCL (University College London).

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Abstract

In most of rural West Africa one can expect to find less than one ophthalmologist for every million people. The prevalence of blindness due to cataract, chronic glaucoma, onchocerciasis, trachoma and corneal diseases is high varying between 1 and 5 %. With the present limited manpower and resources an adequate eye care service based on ophthalmologists alone is not possible in the foreseeable future. This study looks at the results of training nurses in specific ophthalmic skills and functions, normally performed by ophthalmologists, with the objective being to use nurses to provide eye care services and help prevent unnecessary blindness in rural areas of Sierra Leone. Ten State Enrolled Nurses being trained over a period of 18 months, as ophthalmic nurses, are compared with an expatriate eye trained doctor for their ability to accurately screen, diagnose, treat or refer 388 selected patients coming to the outpatient clinic at Lunsar Eye Hospital in Sierra Leone. Of these patients 231 were blind in at least one eye from various eye diseases. The study compares each student's clinical skill in assessing visual acuity, measuring intraocular pressure, diagnosing cataract, and assessing the cup to optic disc ratio by ophthalmoscopy. Computer analysis of the data includes weighted kappa statistics of inter-observer variation, sensitivity, specificity, and the range of individual performance. Clinical judgments are assessed by each students' ability to correctly treat or refer patients with a variety of eye diseases, and to differentiate between treatable and non-treatable blindness compared with the eye doctor's assessment of the patient. The percentage of either correct, inconvenient, or unsafe judgments made by each student, is calculated for different clinical situations. The class as a whole correctly managed 81% of all eyes which they examined, 13% caused inconvenience to the patient, and in 6% the management was unsafe. This means that 94% of all eyes seen by the students were managed safely. The conclusion reached is that in Sierra Leone the training of ophthalmic nurses in accurate diagnostic and management skills is feasible, within acceptable limits, and should be encouraged so as to develop widespread eye care services and a referral system for eye patients within the country.

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