NAME and DESIGNATION_________________________
AREA OF WORK_________________________________
COMPETENCY STATEMENT
Demonstrates the knowledge and clinical skills necessary to assess and manage patients who require glaucoma monitoring, in collaboration with departmental ophthalmologists.
STANDARD
Nursing Council NZ Competency: 1.1, 1.4, 1.5, 2.1- 2.9.
Local NDHB Policy/Guidelines:

Glaucoma Assessment Guidelines. (Intranet → Clinical Knowledge Centre (CKC)
Keyword: Glaucoma
PERFORMANCE OUTCOMES

Applies an in-depth knowledge of anatomy and physiology of the eye to the diagnosis, treatment and management of glaucoma.

Discusses and defines the pathology of glaucoma.

Identifies previous ophthalmic history (including glaucoma) and treatment prior to current appointment.

Critically examines visual assessment including visual acuity and intraocular pressures.

Undertakes gold standard intraocular pressure measurement using Goldman applanation tonometry.

Undertakes physiological and psychosocial assessment of the patient using a holistic approach including assessment of quality of life.

Demonstrates good ocular examination techniques including slit lamp examination as described in Glaucoma Assessment Guidelines.

Demonstrates knowledge and understanding of diagnostic tests (HVFA, OCT/HRT,
Pachymetry, Gonioscopy and Stereo pair photography) used for monitoring and or identifying patients with glaucoma.

Identifies presentations or complications requiring referral to the ophthalmologist.

Demonstrates knowledge in regards to pharmacological treatments, mechanisms of drug action, contraindications, adverse effects and drug interactions and concordance with therapeutic regimes.

Has identified any patient concerns and/or answered any patient questions regarding their glaucoma or any other health issues they may have.

Provides accurate and thorough patient education and instructions regarding the patient’s pharmacological treatment including provision of appropriate written material and arranges appropriate follow-up appointments.

Demonstrates correct documentation procedure.
NORTHLAND DISTRICT HEALTH BOARD
TITLE: Glaucoma Assessment and Management – Nursing & Midwifery Workplace Competency.
FIRST ISSUED: MAY 2011 CURRENT ISSUE : July 2014
WRITTEN BY: CNS F. Bamforth
REVISION DATE:
REVIEWED BY:
July 2016
Dr D. Dalziel
AUTHORISED BY: N&M Workplace Competency Assurance Framework Governance Group
Page 1 of 4

LEARNING RESOURCES

Ophthalmologists and Ophthalmic Clinical Nurse Specialists

European Glaucoma Society (2008). Terminology and Guidelines for Glaucoma (3 rd ed.)
Savona, Italy: Dogma.

Glaucoma NZ - Professional Education Programme (online @ http://www.glaucoma.org.nz/ )

Kanski, J.J. and Bowling, B. (2011). Clinical Ophthalmology: A Systematic Approach (7 th
Edition). W.B. Saunders Co

Shaw, M., Lee, S. and Stollery, R. (2010). Ophthalmic Nursin g (4 th Ed.). Chichester, West
Sussex, U.K: Wiley- Blackwell

Slight, C., Marsden, J. and Raynel, S. (2009). The impact of a glaucoma nurse specialist role on glaucoma waiting lists. Nursing Praxis in New Zealand, 25 (1), 25-40.

South East Asia Glaucoma Interest Group (2008). Asia Pacific glaucoma guidelines (2 nd ed.) Sydney, Australia; Scientific Communications. Available from: http://www.seagig.org/toc/APGG2_fullversionNMview.pdf
COMPETENCE
CRITERIA
PERFORMANCE CRITERIA Competence assessment (to be completed by self and supervisor).
Demonstrates knowledge of local policy and practices related to the nurse’s role in glaucoma assessment.
Demonstrates understanding of glaucoma – aetiology epidemiology, and pathology and has undertaken a recognised
Glaucoma programme/course.

Describes local and overseas glaucoma assessment nursing roles. Practices within scope of practice outlined in the glaucoma assessment guidelines.


Provides evidence of participation in a recognised Glaucoma professional programme.
Demonstrates knowledge of glaucoma through discussion groups with colleagues and ophthalmologists and undertaking teaching sessions
NORTHLAND DISTRICT HEALTH BOARD
TITLE: Glaucoma Assessment and Management – Nursing & Midwifery Workplace Competency.
FIRST ISSUED: MAY 2011 CURRENT ISSUE : July 2014
WRITTEN BY: CNS F. Bamforth
REVISION DATE:
REVIEWED BY:
July 2016
Dr D. Dalziel
AUTHORISED BY: N&M Workplace Competency Assurance Framework Governance Group
Page 2 of 4

Demonstrates the knowledge and skills required to undertake an accurate glaucoma assessment using the slit lamp and a 90 dioptre lens.
Demonstrates knowledge of a typical presentation of a patient presenting with different types of glaucoma or is a glaucoma suspect or has ocular hypertension.
Demonstrates ability to recognise a glaucomatous cupped disc and differentiate from a healthy normal disc.
Demonstrates knowledge of diagnostic equipment used to monitor glaucoma.

Positions the patient correctly behind the slit lamp.

Demonstrates correct techniques using the slit lamp when examining the patient.

Chooses appropriate size and brightness of the light and will empathize with the patient who has difficulties during the examination.

Demonstrates ability to use and obtain a good view preferably using a 60, 78 or
90 dioptre lens.

Demonstrates the ability to measure the optic nerve head by obtaining a sharp image of the disc then adjusting the height of the light beam on the lamp so that it corresponds to the height of the optic disc.

Accurately measures intraocular pressure using Goldmann applanation tonometer.
Discusses the following with assessor:
1. Patient eye comfort.
2. Visual acuity.
3. Visual field.
4. IOP.
5. A/C depth (Optional – assesses angle using gonioscope).
6. Optic nerve head appearance.
7. OCT/HRT
8. CCT (Pachymetry)
Describes optic nerve appearance in detail.
Normal optic disc-

Symmetry between two discs.

Pink colour to neuroretinal rim.

A cup which is usually centred in the upper temporal quadrant of the disc.

Thicker rim inferiorly (ISNT rule)

Intact nerve fibre layer.
Glaucomatous optic disc appearance –

Asymmetry between 2 discs.

Thinning of the neural retinal rim.

Loss of the nerve fibre layer.

Alteration of the blood vessels on the surface of the disc.

Discusses rational for requesting testing using
- Visual field analyser
- OCT/HRT
- Pachymetry
NORTHLAND DISTRICT HEALTH BOARD
TITLE: Glaucoma Assessment and Management – Nursing & Midwifery Workplace Competency.
FIRST ISSUED: MAY 2011 CURRENT ISSUE : July 2014
WRITTEN BY: CNS F. Bamforth
REVISION DATE:
REVIEWED BY:
July 2016
Dr D. Dalziel
AUTHORISED BY: N&M Workplace Competency Assurance Framework Governance Group
Page 3 of 4

Identifies glaucoma related changes identified by various diagnostic tests.
Demonstrates application of correct procedures following assessment.
Provides appropriate information to the patient.
Demonstrates knowledge of pharmacological treatments used for glaucoma.
- Stereo pair photography
- Gonioscopy

Discusses rational for findings of the following

Visual field analysis

OCT/HRT

Pachymetry

Stereo pairs

Gonioscopy

Identifies abnormalities or changes in the patient’s condition and seeks advice as appropriate.

Identifies the need for further follow-ups.

Educates the patient on glaucoma and their eye medication including provision of appropriate written material.

Allows time for the patient to ask questions and offers advice and/or answers to the patient regarding their condition.

Discusses classes of pharmacological therapeutic agent (topical & systemic), mode of action, side effects, drug interactions and contra-indications.

Documents assessment and care plan. Accurately documents
findings.
Takes responsibility for own professional development and scope or practice.

Provides evidence of on going education for competency attainment and maintenance

Provides evidence of participation in regular supervision and audit activities.
____________________________
Signature of nurse
____________________________
Signature of assessor
___________________________
Date
___________________________
Date
(Supervisors must be an Ophthalmologist).
NORTHLAND DISTRICT HEALTH BOARD
TITLE: Glaucoma Assessment and Management – Nursing & Midwifery Workplace Competency.
FIRST ISSUED: MAY 2011 CURRENT ISSUE : July 2014
WRITTEN BY: CNS F. Bamforth
REVISION DATE:
REVIEWED BY:
July 2016
Dr D. Dalziel
AUTHORISED BY: N&M Workplace Competency Assurance Framework Governance Group
Page 4 of 4