Chapter 10
Chronic illness, disability and rehabilitation
219
Despite the availability of these federal programs, people
with disabilities often have health-related costs and other
expenses related to their disabilities that result in low-income
status. Furthermore, people must undergo a disability deter
mination process to establish eligibility for benefits, and the
process can be prolonged and cumbersome for those who may
need assistance in establishing their eligibility.
Disability in medical-surgical nursing
Disability is often considered an issue that is specific or
confined to rehabilitation nursing or to gerontological nursing.
However, as noted previously, disability can occur across the
lifespan, and it is encountered in all settings. Patients with
pre-existing disabilities due to conditions that have been
present from birth or due to illnesses or injuries experienced
as an adolescent or young adult often require healthcare and
nursing care in medical-surgical settings. Although in the past
many people with lifelong disabilities or adult onset of severe
disabilities may have had shortened lifespan, today most can
expect to have a normal or near normal lifespans and to live
a productive and meaningful life (Thomas & Barnes, 2010).
They are also at risk for the same acute and chronic illnesses
that can affect all people.
During hospitalisation, as well as during periods of acute
illness or injury or while recovering from surgery, patients with
pre-existing disabilities may require assistance with carrying
out ADLs that they could otherwise manage at home inde
pendently and easily. Patients should be asked preferences
about approaches to carrying out their ADLs, and assistive
devices they require should be readily available. Careful
planning with patients to ensure the hospital room is arranged
with their input enables them to manage as independently
as possible. For example, patients who have paraplegia may
be able to transfer independently from bed to wheelchair;
however, if the bed is left in an elevated position, they may be
unable to do so.
If patients usually use service animals to assist them with
ADLs, it is necessary to make arrangements for the accom
modation of these animals. If patients with hearing loss or
communication impairments are hospitalised, it is essential
to establish effective communication strategies (Lieu et al.,
2007). Alternative methods for these patients to communicate
with the healthcare team must be put in place and used, and all
staff members must be aware that some patients are not able to
respond to the intercom or telephone. If patients have vision
impairment, it is necessary to orient them to the environment
and to make an effort to talk to them in a normal tone of voice
(Rushing, 2007).
Negative attitudes, insensitivity and lack of knowledge may
make people with disabilities avoid seeking medical interven
tion or healthcare services because of unfavourable interac
tions with healthcare providers. Nurses are in key positions
to influence the architectural design of healthcare settings
and the selection of equipment that promotes ease of access
and health. Padded examination tables that can be raised
or lowered make transfers easier for people with disabilities.
Birthing chairs benefit women with disability during yearly
pelvic examinations and Pap smears and during urological
evaluations. Ramps, grab bars, self-help devices at the right
height to access, and raised and padded toilet seats benefit
many people who have neurological or musculoskeletal disabil
ities and need routine physical examination and monitoring
(e.g. bone density measurements). When a patient with a dis
ability is admitted to the hospital for any reason, the patient’s
needs for these modifications should be assessed and addressed
(Smeltzer, 2007b).
Men and women with disabilities may be encountered in
hospitals, clinics, offices and nursing centres when they seek
healthcare to address a problem related to their disabilities.
However, they may also be encountered in these settings when
they seek care for a health problem that is not related in any
way to their disabilities. For example, a woman with spina
bifida or polio might seek healthcare related to a gynaecolog
ical issue, such as vaginal bleeding. Although her disability
should be considered in the course of assessment and delivery
of health and nursing care, it should not become the overriding
focus or exclusive focus of the assessment or the care that she
receives. Furthermore, neither a severe physical disability that
affects a woman’s ability to transfer to an examination table for
a gynaecological examination nor a cognitive disability should
be a reason to defer a complete health assessment and physical
examination, including a pelvic examination.
Disability and sexuality issues
An important issue confronting patients with disabilities,
and a vital component of self-concept, is sexuality. Sexuality
involves not only biological sexual activity but also one’s
concept of masculinity or femininity. It affects the way people
react to others and are perceived by them, and it is expressed
not only by physical intimacy but also by caring and emotional
intimacy.
Sexuality problems experienced by patients with disabilities
include limited access to information about sexuality, lack
of opportunity to form friendships and loving relationships,
impaired self-image and low self-esteem. People with disabili
ties may have physical and emotional difficulties that interfere
with sexual activities. For example, diabetes and spinal cord
injury may affect the ability of men to have erections. Patients
who have suffered a heart attack or stroke may fear having
a life-threatening event (e.g. another heart attack or stroke)
during sexual activity. Some patients may fear loss of bowel or
bladder control during intimate moments. Changes in desire
for sex and in the quality of sexual activities can occur for the
patient and partner who may be too involved as a carer to have
the desire and energy for sexual activities.
However, a loss of sexual function does not necessarily cor
respond to a loss of sexual feeling. The physical and emotional
aspects of sexuality, despite physical loss of function, continue
to be important for people with disabilities. Unfortunately,
society and some healthcare providers contribute to these
problems by ignoring the patient’s sexuality and by viewing
people with disabilities as asexual. Healthcare providers’
own discomfort and lack of knowledge related to sexuality
issues prevent them from providing patients with disabilities
and their partners with interventions that promote healthy
intimacy. Nurses caring for people with disabilities must
recognise and address sexual issues to promote feelings of
self-worth. The nurse should give the patient ‘permission’ to
discuss sexuality concerns and show a willingness to listen
and help the patient overcome these concerns. In the case
of a couple coping with disability, this may take the form of
a simple comment, such as: ‘Other people in your situation
have expressed concern about how this disability may affect
their own sexuality, feelings towards each other and intimate
