218
Unit 3
Applying concepts from the nursing process
life within the limitations imposed by their disabling condi
tions. Men and women with disabilities have the same needs
and same rights for healthcare and preventive health screening
as others, although in some cases, the consequences of their
disability increase rather than decrease their need for health
screening and for participation in health-promoting activities
(Yankaskas et al., 2010).
Many people with disabilities encounter barriers to full
participation in life, including healthcare, health screening
and health promotion (Smeltzer et al., 2007). Some of these
barriers are structural and make certain facilities inaccessible.
Examples of structural barriers include stairs, lack of ramps,
narrow doorways that do not permit entry of a wheelchair,
and restroom facilities that cannot be used by people with dis
abilities (e.g. restrooms that lack grab bars and those that lack
larger restroom stalls designed for people using wheelchairs)
(Kirschner, Breslin & Iezzoni, 2007). Structural barriers to
accessibility are most easily identified and eliminated. Other,
less visible barriers include negative and stereotypical attitudes
(e.g. believing that all people with disabilities have a poor
quality of life and are dependent and non-productive) on the
part of the public (Giddings et al., 2007). Healthcare provid
ers with similar negative attitudes make it difficult for people
with disabilities to obtain healthcare equal in quality to that of
people without disabilities.
People with disabilities have reported they often encoun
ter barriers that prevent them from obtaining recommended
healthcare screening and care. They have also reported lack
of access to information and transportation difficulties. Others
report inability to pay because of limited income, with 36%
of people with chronic illness reporting they have not filled a
prescription, missed a dose, not visited a doctor or skipped a
test (ADHA, 2009b). Difficulty finding a healthcare provider
knowledgeable about their particular disability, previous
negative healthcare encounters, reliance on carers, and the
demands of the disability itself are also reported (ADHA,
2009b; Smeltzer et al., 2007).
These issues affect both men and women who have severe
disabilities; however, women appear to be at higher risk for
receiving a lower level of healthcare than men. Women with
disabilities are significantly less likely to receive pelvic exam
inations than women without disabilities; the more severe
the disability, the less frequent the examination. In particular,
minority women and older women with disabilities are less likely
to have regular pelvic examinations and Papanicolaou (Pap)
tests. Reasons given by women for not having regular pelvic
examinations are difficulty transferring onto the examination
table, belief that they do not need pelvic examinations because
of their disability, difficulty in accessing the office, healthcare
centre or clinic, and difficulty finding transportation (Smeltzer
et al., 2007). Healthcare providers may underestimate the effect
of disabilities on women’s ability to access healthcare, including
health screening and health promotion, and they may focus
on women’s disabilities while ignoring women’s general health
issues and concerns. Furthermore, women with disabilities have
also reported a lack of knowledge about disability and insen
sitivity on the part of healthcare providers (Smeltzer et al.,
2007). It is essential that nurses and other healthcare providers
take steps to ensure that clinics, offices, hospitals and other
healthcare facilities are accessible to people with disabilities
because of the persistence of these barriers.
CLINICAL REASONING CHALLENGE
EBP
A 41-year-old woman with quadriplegia due to
spinal cord injury (SCI) has never had a mammography
and has not had a gynaecological examination in more
than 15 years before the SCI. During a recent admission
for treatment of a secondary condition due to her disability,
you decide to encourage her to undergo preventive health
screening, including screening for breast, cervical and colon
cancer, as well as for low bone density. In discussing these
issues with her, what evidence will you use to provide rec
ommendations for screening? What is the research evidence
about the patterns of women with disabilities undergoing
preventive health screening and barriers to screening? How
would you help prepare her for the health screening tests?
Federal legislation
The Australian and New Zealand governments have enacted
legislation to address healthcare disparities because of wide
spread discrimination against people with disabilities. This leg
islation includes the
Disabilities Act 1992
(Australia) and the
Human Rights Act 1993
(New Zealand). Both Acts contain law
that protects people from discrimination based on their dis
abilities. The Acts apply to employers and organisations that
receive financial assistance from any federal department or
agency; this includes many hospitals, long-term care facilities,
mental health centres, and human service programs. The leg
islation forbids organisations from excluding or denying people
with disabilities equal access to program benefits and services.
It also prohibits discrimination related to availability accessi
bility and delivery of services, including healthcare services.
The Acts mandate that people with disabilities have access
to job opportunities and to the community. They require that
employers evaluate an applicant’s ability to perform the job
and not discriminate on the basis of a disability.
According to the Acts, communities must provide public
transportation that is accessible to people with disabilities.
The Acts also requires provisions to facilitate employment
of a person with a disability. Facilities used by the public
must be accessible and accommodate those with disabilities.
Examples of reasonable accommodations in healthcare settings
include accessible facilities and equipment (e.g. accessible
restrooms, adjustable examination tables, access ramps, grab
bars, elevated toilet seats) and alternative communication
methods (e.g. telecommunication devices and sign interpret
ers for use by people who are deaf). Although the Acts took
effect in 1992 and 1993, compliance has been variable, and
some facilities continue to be inaccessible. However, all new
construction and modifications of public facilities must address
access for people with disabilities.
Federal assistance programs
Lack of financial resources, including health insurance, is an
important barrier to healthcare for people with chronic illness
and disabilities.
In Australia, some programs such as the MBS Chronic Illness
Managed (CDM) items enabled higher incentives for general
practitioners to provide services for those with chronic and
complex needs (ADHA, 2009a). A trial of a National Disability
Scheme is soon to be undertaken.
