Textbook of Medical-Surgical Nursing 3e

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Chapter 10

Chronic illness, disability and rehabilitation

ASSESSMENT Strategies to ensure quality healthcare for people with disabilities

CHART 10-6

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?

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