Textbook of Medical-Surgical Nursing 3e

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Chapter 10

Chronic illness, disability and rehabilitation

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