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Unit 3
Applying concepts from the nursing process
aspects of their relationship. If either of you has these kinds of
concerns, I am here to listen.’
The nurse also plays a key role in providing appropriate
patient education about how specific disabilities affect sexual
function. For example, arthritis produces fatigue and morning
stiffness, making planned afternoon sex a better alternative;
spinal cord injury impairs erections and ejaculations; and
traumatic brain injury may produce an increased or decreased
interest in sexual behaviour. Classes, books, movies and
support groups are useful tools to help patients learn about
sexuality and disability. When open discussion and education
about disability and sexuality do not result in the patient
achieving his or her sexuality goals, the nurse should refer the
patient for ongoing counselling with a sex counsellor or thera
pist. The patient may need training in communication and in
social and assertiveness skills to develop desired relationships.
Support and advocacy groups can provide excellent informa
tion resources that relate to issues such as sexuality for patients,
families and nurses.
Fatigue
People with disabilities frequently experience fatigue, which
may impede functional recovery and full reintegration into
family and community roles. For example, patients with
altered mobility may experience fatigue and a subsequent lack
of endurance that affects their ability to participate in normal
daily activities (Ray & McAnally, 2008). Physical and emo
tional weariness may be caused by discomfort and pain associ
ated with a chronic health problem, as well as de-conditioning
associated with prolonged periods of bed rest and immobility,
impaired motor function requiring excessive expenditure of
energy to ambulate, and the frustrations of performing ADLs.
Ineffective coping with the disability, unresolved grief, dis
ordered sleep patterns and depression can also contribute to
fatigue, which may interfere with active engagement in the
rehabilitation process. The patient is encouraged to use coping
strategies to manage the psychological impact of the disability
and pain management techniques to control the associated dis
comforts (see Chapter 9 for a discussion of pain management).
In addition, the nurse can teach the patient to manage fatigue
through priority setting and energy-conserving techniques.
Complementary and alternative therapies
People with disabilities may seek a variety of different ther
apies. For some people, therapeutic horseback riding affects
all body systems. Instructors are certified through the Riding
for the Disabled Association of Australia (see
.
au for more information). Pet therapy and canine companion
programs have reduced stress and promoted coping for many
people with disabilities (Barker & Wolen, 2008). The service
animals provide companionship as well as physical assistance
for elderly people and people with disabilities who may live
alone. Nurses can encourage people with disabilities to take
advantage of community programs and participate in regular
exercise.
Tai Chi classes improve muscle strength, balance and
coordination and can help prevent falls in the elderly. People
with disabilities, including wheelchair users, can participate
in Tai Chi classes for improved balance, coordination, muscle
strength and control, and a sense of well-being (Wooton,
2010). Daily journal writing has helped depressed people and
their families overcome many emotionally draining reactions
to adverse circumstances (Jorm et al., 2009). Nurses are instru
mental in teaching patients and family members this cost-
effective technique. Relaxation exercises can also be taught
by the nurse and encouraged in all settings, including the
hospital, rehabilitation setting, outpatient areas and the home.
Health promotion and prevention
Healthcare providers often neglect health promotion concerns
of people with disabilities, who may be unaware of these
concerns. For example, people who have had hearing loss
since childhood may lack exposure to information about
AIDS through radio and television. People with lifelong
disabilities may not have received information about general
health issues as children, and people with new-onset as well
as lifelong disabilities may not receive encouragement to
participate in health promotion activities. Therefore, nurses
should take every opportunity to emphasise the importance of
participation, both in health promotion activities (e.g. healthy
diet, exercise, social interactions) and in preventive health
screening.
General health promotion strategies and health screening
recommendations for all men and women also apply to those
with disabilities. Although physical limitations, cognitive
impairments and structural and attitudinal barriers that exist
in clinical facilities may make it difficult for some men and
women to obtain healthcare and preventive health screening,
the presence of a disability should not be used as a reason or
excuse to defer recommended screening. Rather, the presence
of a disability may increase the risk of
secondary conditions
(any physical, mental or social disorders resulting directly or
indirectly from an initial disabling condition; a condition to
which a person with a disability is more susceptible because of
having a primary disabling condition) that require screening
and follow-up (AIHW, 2010b). Just as people without disabili
ties should have regular screening tests, such as mammography
or testicular and prostate examinations, so should people with
disabilities.
The management of some disabilities increases the risk of
illness, and in some people, health screening (e.g. bone density
testing, gynaecological examinations, mammography) may
be required earlier in life or more frequently (Srikanth et al.,
2011). For example, the risk of osteoporosis may be increased
in women and men whose disabilities limit their ability to
participate in weight-bearing exercise or who use medications
that contribute to bone loss (Srikanth et al., 2011). Although
people with disabilities have an increased risk of osteoporosis
at a younger age than people without disabilities, little atten
tion is given to prevention, detection and treatment of osteo
porosis, despite the increased risk for falls associated with many
disabling disorders.
Referrals by nurses to accessible sites for screening may be
needed, because many imaging centres are inaccessible. In
addition, nursing consultation with physical therapists may
be needed to identify creative ways of enabling people with
disabilities to exercise safely, because exercise facilities are also
often inaccessible for people with disabilities.
Nurses can provide expert health promotion education
classes that are targeted to people with disabilities and refer
them to accessible online resources. Classes on nutrition and
weight management are extremely important to people who
are wheelchair users and need assistance with transfers. Safer
sex classes are needed by adolescents and young adults who
