Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

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

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 http://rda.org. 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