NCM 102 (CHAP 9)

• Fifteen percent of people worldwide live with a disability
• The number of people with disabilities is expected to increase as populations age and incidence of debilitating conditions continues to grow
• Approximately one in five Americans have a disability; almost half are severe
• Many people with disabilities are limited in ability to work
• Not all disabilities are readily visible
• Individuals with disabilities are more likely than those without them to have more illnesses and greater health needs, be less likely to receive preventive health care and other social services, and be more likely to suffer from poverty
• Avoid making assumptions about people with disabilities
• Some disabilities are associated with additional chronic health problems
• Other health disparity factors

  • Fear
  • Lack of understanding
  • Physical barriers
  • Cost
• Moral model


  Views disabilities as sin
• The moral model is an old model that persists in some cultures, and individuals and their families may experience guilt, shame, denial of care
• The United Nations established Standard Rules on the Equalization of Opportunities for Persons with Disabilities specifying fundamental right of access to care
• Medical model


  Disability as defect/sickness
• Rehabilitation model


  Disability as deficiency
• Disabilities (social) model


  Embraces disability as a normal part of life, views social discrimination, rather than the disability itself, as the problem
• Disability


  A complex phenomenon, reflecting an interaction between features of a person's body and features of the society in which he or she lives
• Disability (U.S. Social Security Administration definition)


  Defined in terms of an individual's ability to work
• The Americans with Disabilities Act (ADA) enacted in 1990 has extended civil rights protection to millions of Americans who are disabled
• Disability (ADA definition)


  A physical or mental impairment that substantially limits one or more of the major life activities of the individual
• Since the late 1970s, disabilities advocates and the government have encouraged people- or person-first language, which "puts the person before the disability" in writing and speech
• Recently, person-first language has become controversial because some prefer identity-first language, which affirms what they see as an identity characteristic
• Guidelines for language use

  • Try to determine preference when writing about a group
  • Do not confuse disability with disease
  • Unless one format is accepted by an entire group, avoid using one format exclusively
  • Do not make assumptions
• Additional language considerations

  • Use "congenital disability," not "birth defect"
  • Avoid terms with negative connotations such as "invalid" or "mentally retarded"
  • Speak of the needs of people with disabilities rather than their problems
  • Avoid phrases like "suffers from," "victim of"
  • When comparing groups, avoid phrases such as "normal" or "able bodied"
• Habilitation


  Teaching skills to maintain or restore health and maintain independence
• Rehabilitation


  Teaching skills to relearn or restore skills lost through illness or injury
• Careful assessment of the degree to which families can and should be involved is required
• Interdisciplinary team effort is often required
• The nurse should serve as mentor to patient and family in coordinating and facilitating multidisciplinary services
• Assessment before teaching


  • Nature of problem/needs
  • Short-/long-term consequences or effects of disability
  • Effectiveness of their coping mechanisms
  • Type of extent of sensorimotor, cognitive, perceptual, and communication deficits
  • Knowledge of and readiness to learn about a new disability
• Types of disabilities


  • Sensory disabilities
  • Learning disabilities
  • Developmental disabilities
  • Mental illness
  • Physical disabilities
  • Communication disorders
  • Chronic illness
• Hearing impairment


  Total or partial auditory loss (complete loss or reduction in sensitivity to sounds), etiology related to either a conduction or sensory–neural problem
• Incidence of hearing impairment increases with age
• Types of hearing loss

  • Conductive (usually correctable, loss in ability to hear faint noises)
  • Sensorineural (permanent, damage to cochlea or nerve pathways)
  • Mixed
• Modes of communication to facilitate teaching/learning for hearing impairment

  • American Sign Language (ASL)
  • Lipreading
  • Written materials
  • Verbalization by client
  • Sound augmentation
  • Telecommunication devices for the deaf (TDD)
• Teaching guidelines for hearing impairment

  • Use natural speech patterns; do not overarticulate
  • Use simple sentences and a moderate pace
  • Get client's attention with a light touch on arm
  • Face the client; stand no more than six feet away
  • Minimize environmental noise
  • Make sure hearing aid is turned on
  • Avoid standing in front of bright light, which obscures your face
  • Minimize motions of your head while speaking
  • Refrain from placing IV in hand client needs for sign language
• Over 23 million Americans are blind or visually impaired
• Common causes of visual impairment

  • Infection
  • Trauma
  • Poisoning
  • Congenital condition
  • Degeneration
• Common healthcare barriers for visually impaired

  • Lack of respect
  • Communication problems
  • Physical barriers
  • Information barriers
• Common eye diseases of aging

  • Macular degeneration
  • Cataracts
  • Glaucoma
  • Diabetic retinopathy
• Teaching guidelines for visual impairment

  • Assess patients to avoid making needs assumptions
  • Speak directly to patients rather than to sighted companions
  • Secure services of a low-vision specialist to obtain adaptive optical devices
  • Avoid the tendency to shout
  • Use nonverbal cues
  • Always announce your presence and identify yourself
  • Allow client to touch, handle, and manipulate equipment
  • Be descriptive in explaining procedures
  • Use large font size for printed or handwritten materials
  • Use bold color or rely on black and white for printed materials
  • Use alternative instructional tools that stimulate auditory and tactile senses
  • Use proper lighting
  • Provide large-print watches and clocks
  • Use audiotapes and cassette recorders
  • Use computer features like screen magnifiers, high contrast, screen-resolution features, text-to-speech converters, Braille keyboards, displays, and printers
  • Use sighted guide technique