Chapter 10
Chronic illness, disability and rehabilitation
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have spinal cord injury, traumatic brain injury or develop
mental disabilities, because the threats of sexually transmitted
infections (STIs) and an unplanned pregnancy exist for these
populations just as they do for the population in general.
Other healthy behaviours about which people with neurolog
ical disabilities need education include avoiding alcohol and
non-prescription medications while taking antispasmodic and
anti-seizure medications.
Significance of person-centred language
It is important to all people, both those with and those without
disabilities, that they not be equated with their illness or
physical condition. Therefore, it is important to refer to all
people using person-centred language. This language means
referring to the person first: ‘the patient with diabetes’ rather
than ‘the diabetic’ or ‘the diabetic patient’; ‘the person with a
disability’ rather than the ‘disabled person’; ‘women with dis
abilities’ rather than ‘disabled women’; and ‘people who are
wheelchair users’ rather than ‘the wheelchair-bound’. This
simple use of language conveys the message that the person,
rather than the illness or disability, is of greater importance
to the nurse.
Stereotypical thinking often leads to the conclusion that
disability is associated only with being elderly. However, ageing
is an important issue that affects people with pre-existing dis
abilities. In addition, the process of ageing has been described
as accelerated in people with disabilities because they often
develop changes associated with ageing at a younger age than
do those without disabilities Therefore, it is important that the
nurse consider the effects of ageing on a pre-existing disability
and in turn the effects of disability on ageing. The following
examples may be useful:
•
People who use crutches for ambulation because of polio
often experience muscle problems as they age because
of long-time overuse of the upper extremities; symptoms
may not occur for many years but may cause discomfort
and interfere with the person’s ability to perform ADLs.
•
People who experienced respiratory compromise with the
onset of polio decades earlier may experience increasing
respiratory symptoms with ageing (National Institute of
Neurological Disorders and Stroke [NINDS], 2012).
•
Women with long-standing mobility limitations and
lack of weight-bearing exercise may experience bone loss
and osteoporosis prior to menopause (Bowers, Bigby &
Webber, 2009)
Therefore, people with a pre-existing disability should be
evaluated for early onset of changes related to ageing. Concern
about what the future holds is common in people ageing with
pre-existing disabilities who may have questions about what
physical, financial and emotional supports they will have
as they age (Dowse, McDermott & Watson, 2009). If their
disability becomes more severe in the future, they may be con
cerned about placement in an assisted living facility or a long-
term care facility. The nurse should recognise the concerns of
people with disabilities about their future and encourage them
to make suitable plans, which may relieve some of their fears
and concerns about what will happen to them as they age.
Parents of adult children with developmental disabilities
often fear what will happen when they are no longer avail
able and able to care for their children (Physical Disability
Council of New South Wales [PCDN], 2008). Limited long-
term care resources, increased life expectancy for people with
developmental disabilities, changing family patterns, and
competition with the elderly population for similar resources
increase the fears of these parents. Thus, there is a need for the
nurse to identify needed community resources and services.
Identifying these issues and concerns and assessing arrange
ments made by ageing parents of adult children with disabili
ties can help reduce some of their fears about their children’s
futures.
Continuing care
When caring for patients with disabilities and helping them
plan for discharge and continuing care in the home, it is
important to consider how a particular disability affects a
patient’s ability to adhere to recommended treatment regimens
and to keep follow-up appointments. Furthermore, it is import
ant to consider how the health issue or treatment regimen
affects the disability. Although many people with disabilities
are independent and able to make decisions, arrangements for
transportation and appointments to accessible facilities, others
may have difficulty doing so, particularly if they are experienc
ing a health problem. The nurse should recognise the effect the
disability has on the patient’s ability to follow-up. The nurse
should ask the patient whether he or she anticipates having
any difficulties arranging for follow-up care.
It is important for the nurse to assist the patient with dis
abilities to identify unmet needs and to find and use resources
(community and social resources, financial and transportation
services) that enable the patient to obtain needed services
while remaining in his or her home, if preferred. The nurse
should have a list of accessible sites and services available and
share those resources with the patient and family. In collab
oration with other healthcare providers (occupational and
physical therapists, speech therapists), the nurse can identify
needed home modifications, including those that are simple
and inexpensive that will enable the patient to participate in
self-care at home.
With the management of chronic illness, rehabilitation is
an integral part of nursing because every major illness or injury
carries the threat of disability or impairment, which involves
a loss of function or an abnormality in body structure or
function. Rehabilitation services are required by more people
than ever before because of advances in technology that save
or prolong the lives of seriously ill and injured patients and
patients with disabilities. Increasing numbers of patients who
are recovering from serious illnesses or injuries are returning to
their homes and communities with ongoing needs. Significant
disability caused by war and terrorism also increases the
demand for rehabilitation services. All patients, regardless of
age, gender, ethnic group, socioeconomic status or diagnosis,
have a right to rehabilitation services.
Rehabilitation
Rehabilitation
, making able again; relearning skills or abilities
or adjusting existing functions,
is a dynamic, health-oriented
process that helps people with acute or chronic disorders or
people with physical, mental or emotional disabilities (restric
tions in performance or function in everyday activities) to
achieve the greatest possible level of physical, mental, spir
itual, social and economic functioning. The rehabilitation
process also helps patients achieve an acceptable quality
of life with dignity, self-respect and independence. During
