Textbook of Medical-Surgical Nursing 3e

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Chapter 10

Chronic illness, disability and rehabilitation

(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

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