Chapter 10
Chronic illness, disability and rehabilitation
215
ASSESSMENT
Strategies to ensure quality healthcare for people with disabilities
Communication strategies
• Does the patient with a disability require or prefer
accommodations (e.g., a sign interpreter) to ensure
full participation in conversations about his or her own
healthcare?
• Are appropriate accommodations made to communicate
with the patient?
• Are efforts made to direct all conversations to the patient
rather than to others who have accompanied the patient to
the healthcare facility?
Accessibility of the healthcare facility
• Are clinics, hospital rooms, offices, restrooms, laboratories,
and imaging facilities accessible to people with disabilities,
as legally required by the Disabilities Act (Australia) and
Human Rights Act (New Zealand)?
• Has accessibility been verified by a person with a disability?
• Is a sign interpreter other than family member available
to assist in obtaining a patient’s health history and in
conducting a physical assessment?
• Does the facility include appropriate equipment to permit
people with disabilities to obtain healthcare (including
mammography, gynaecological examination and care, dental
care) in a dignified and safe manner?
Assessment
Usual health considerations
• Does the health history address the same issues that
would be included when obtaining a history from a person
without disabilities, including sexuality, sexual function and
reproductive health issues?
Disability-related considerations
• Does the health history address the patient’s specific
disability and the effect of disability on the patient’s ability
to obtain healthcare, manage self-care activities, and obtain
preventive health screening and follow-up care?
• What physical modifications and positioning are needed to
ensure a thorough physical examination, including pelvic or
testicular and rectal examination?
Abuse
• Is the increased risk for abuse (physical, emotional,
financial, and sexual) by a variety of people (family, paid care
providers, strangers) addressed in the assessment?
• If abuse is detected, are men and women with disabilities
who are survivors of abuse directed to appropriate
resources, including accessible shelters and hotlines?
Depression
• Is the patient experiencing depression? If so, is treatment
offered just as it would be to a patient without a disability,
without assuming that depression is normal and a result of
having a disability?
Ageing
• What concerns does the patient have about ageing with a
pre-existing disability?
• What effect has ageing had on the patient’s disability and
what effect has the disability had on the patient’s ageing?
Secondary conditions
• Does the patient have secondary conditions related to his or
her disability or its treatment?
• Is the patient at risk for secondary conditions because of
environmental barriers or lack of access to healthcare or
health promotion activities?
• Are strategies in place to reduce the risk for secondary
conditions or to treat existing secondary conditions?
Accommodations in the home
• What accommodations does the patient have at home to
encourage or permit self-care?
• What additional accommodations does the patient need at
home to encourage or permit self-care?
Cognitive status
• Is it assumed that the patient is able to participate in
discussion and conversation rather than assuming that he
or she is unable to do so because of a disability?
• Are appropriate modifications made in written and verbal
communication strategies?
Modifications in nursing care
• Are modifications made during hospital stays, acute illness
or injury and other healthcare encounters to enable a
patient with disability to be as independent as he or she
prefers?
• Is person-centred language used in referring to a patient
with disability, and do nurses and other staff talk directly
to the patient rather than to those who accompanied the
patient?
• Are all staff informed about the activities of daily living
(ADLs) for which the patient will require assistance?
• Are accommodations made to enable the patient to use his
or her assistive devices (hearing/visual aids, prostheses,
limb support devices, ventilators, service animals)?
• If a patient with disability is immobilised because of
surgery, illness, injury or treatments, are risks of immobility
addressed and strategies implemented to minimise those
risks?
• Is the patient with a disability assessed for other illnesses
and health issues (e.g., other acute or chronic illness,
depression, psychiatric/mental health and cognitive
disorders) not related to his or her primary disability?
Patient teaching
• Are accommodations and alternative formats of teaching
materials (large print, Braille, visual materials, audiotapes)
provided for patients with disabilities?
• Does patient teaching address the modifications (e.g., use
of assistive devices) needed by patients with disabilities to
enable them to adhere to recommendations?
• Are modifications made in teaching strategies to address
learning needs, cognitive changes, and communication
impairment?
Health promotion and disease prevention
• Are health promotion strategies discussed with people with
disabilities along with their potential benefits: improving
quality of life and preventing secondary conditions (health
problems that result because of pre-existing disability)?
• Are patients aware of accessible community-based facilities
(e.g., healthcare facilities, imaging centres, public exercise
settings, transportation) to enable them to participate in
health promotion?
CHART
10-6
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