# A nurse is caring for a client who has been diagnosed with legal blindness. Which nursing intervention should be the priority to ensure the client's safety in the hospital environment?

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## 문제

A nurse is caring for a client who has been diagnosed with legal blindness. Which nursing intervention should be the priority to ensure the client's safety in the hospital environment?

A 68-year-old client with diabetic retinopathy has been admitted to the medical unit and diagnosed with legal blindness (visual acuity of 20/200 in the better eye with correction). The client appears anxious and states, "I'm afraid I'll fall or get hurt here since I can't see well."

## 보기

1. Orient the client to the room layout and keep furniture in consistent positions **✔ 정답**
2. Assign the client to a room closest to the nurses' station
3. Provide the client with a call bell and instruct to call for all needs
4. Ensure adequate lighting is maintained in the client's room at all times

**정답: 1**

## 해설

Orienting the client to the room layout and maintaining consistent furniture placement is the priority safety intervention for a legally blind client. This allows the client to develop spatial awareness and navigate safely using memory and tactile cues, preventing falls and promoting independence.

## 심화 해설

Understanding Legal Blindness and Safety Priorities

The client's diagnosis of legal blindness, defined as visual acuity of 20/200 or less in the better eye with correction, means they have a significant sensory impairment. The primary concern in the hospital setting is safety, specifically the prevention of falls. The client's own statement, "I'm afraid I'll fall or get hurt here since I can't see well," directly highlights this risk and their anxiety. Research consistently identifies sensory impairment as a critical, progressive risk factor for falls and fractures in older adults [4]. For a newly admitted client with vision loss, the unfamiliar environment is the most immediate and modifiable hazard. Therefore, the priority intervention must directly address the client's ability to navigate their immediate surroundings safely.

Analysis of Interventions

Option 1: Orient the client to the room layout and keep furniture in consistent positions.

This is the correct priority action. A structured orientation creates a cognitive map of the environment, reducing the risk of collision with objects. The qualitative data from individuals with vision loss reveals a profound sense of being "blocked" and a constant fear of falling, which leads to activity limitation [1]. By orienting the client to the fixed layout—the path from bed to bathroom, the location of the call bell, and the position of the bedside table—and committing to never moving furniture, the nurse directly mitigates the primary environmental hazard. This intervention builds on the principle that a predictable environment is a safer environment for someone who cannot rely on visual cues to detect obstacles. The study on fall risk discrepancies in patients with cataracts underscores that an individual's awareness of their own fall risk is a critical variable; a thorough orientation actively bridges the gap between the patient's perceived risk and the actual environmental dangers .

Option 2: Assign the client to a room closest to the nurses' station.

While placing a high-risk client closer to the nurses' station can facilitate more frequent monitoring, it is not the priority intervention. A retrospective analysis of inpatient falls identifies contributing factors and characteristics, but proximity to the nursing station alone does not prevent a fall if the client attempts to get up in an unfamiliar room . The client's safety is not primarily enhanced by the nurses' ability to respond quickly to a fall, but by preventing the fall from occurring in the first place. Environmental familiarity is the foundational safety measure.

Option 3: Provide the client with a call bell and instruct to call for all needs.

This intervention is important for all hospitalized clients, but it is a dependent strategy that relies on the client's willingness and ability to call for help every single time. It does not empower the client to move safely if they choose not to wait or forget to call. The fear of falling expressed by the client is linked to a loss of independence and control [1]. Solely relying on a call bell can increase feelings of helplessness, whereas environmental orientation promotes a degree of safe, independent mobility, which is crucial for psychological well-being and preventing deconditioning.

Option 4: Ensure adequate lighting is maintained in the client's room at all times.

Adequate lighting is a general safety measure, but its effectiveness is limited for a client with legal blindness. Legal blindness does not mean a complete absence of light perception, but the remaining vision is severely compromised. For a client with diabetic retinopathy, glare or uneven lighting can actually distort perception and increase fall risk. More critically, this intervention does not address the core problem: the client's inability to reliably use vision to identify the location of objects. A well-lit obstacle is still an obstacle. The foundation of safety is knowing where things are, not just making them more visible.

Clinical Rationale and Evidence Synthesis

The priority is established by directly linking the client's specific sensory deficit to the most effective, evidence-based fall prevention strategy. The cumulative burden of sensory impairment, such as vision loss, is strongly associated with injurious falls [4]. The immediate post-admission period is a high-risk time because the hospital environment is novel and filled with hazards. A study on inpatient falls confirms that understanding the characteristics and contributing factors of falls is essential for prevention . The most direct contributing factor for a client with legal blindness is an unpredictable physical environment. By providing a systematic orientation and ensuring environmental consistency, the nurse directly modifies this primary risk factor. This approach is supported by the experiences of individuals with vision loss, who describe their environment as a series of barriers that limit activity and increase the fear of falling [1]. Removing the element of surprise from the environment is the single most impactful action a nurse can take to ensure immediate safety, build trust, and reduce the anxiety that stems directly from the fear of colliding with unseen objects [1,2].References (research sources)

- [1]'Everywhere I turn, I'm blocked': a qualitative exploration of experiences of Charles Bonnet syndrome and its impact on physical activity and falls.Research articleFisher K, Sanders C, Jolly JK, Stanford P, Stanmore E. (2026) · DOI: 10.1093/ageing/afag125

- [4]Association of average cumulative sensory impairment with falls and hip fractures in older adults: Evidence from a longitudinal study.Research articleJing X, Hou S, Li Y. (2026) · DOI: 10.1016/j.jnha.2026.100895

## 임상 시나리오

Hospital Safety for Clients with Visual ImpairmentPrioritizing Environmental Orientation to Prevent Falls
For a client with legal blindness, the unfamiliar hospital room is the most immediate safety hazard. The priority intervention is to orient the client to the room layout using a clock-face or descriptive method (e.g., "The bathroom is at 2 o'clock from your bed").

This orientation must be reinforced by maintaining a consistent environment. Furniture, personal items, and the call bell must never be moved without re-orienting the client. A predictable space allows the client to create a cognitive map, reducing the risk of collisions and falls.

CautionDo not rely solely on increased lighting or proximity to the nurses' station. These are adjuncts, not substitutes, for a structured orientation. The client's fear of falling is a valid clinical indicator that the environment must be made navigable immediately upon admission.

## 핵심 개념

- **Legal Blindness** — Visual acuity of 20/200 or less in the better eye with best correction, or a visual field of 20 degrees or less.
- **Diabetic Retinopathy** — A complication of diabetes mellitus caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).
- **Sensory Impairment** — A deficit in the ability to perceive or process sensory stimuli, such as vision or hearing, which is a significant risk factor for falls.

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