Nursing Education For Dealing Disabilities What are Disabilities?
The World Health Organization (WHO) defines disability as a broad term encompassing impairments (problems in body function or structure), activity limitations (difficulties encountered by an individual in executing a task or action), and participation restrictions (challenges faced by an individual in involvement in life situations; WHO, 2001). Similarly, the International Council of Nurses (ICN, 2010) describes disability as a physical, mental, sensory, or social impairment that adversely affects an individual’s ability to carry out normal day-to-day activities over the long term.
Disabilities can vary widely in nature, including physical disabilities such as paralysis or loss of limb, sensory disabilities like blindness or hearing impairment, cognitive disabilities including intellectual or developmental disorders, and psychiatric or emotional disabilities such as anxiety disorders or depression. Each type of disability presents unique challenges for the affected individuals, particularly in settings like nursing education where both physical and cognitive capabilities are often critical.
Effect of Disabilities in Education
Nursing education plays a crucial role in preparing healthcare professionals to care for people with disabilities, including those with intellectual and developmental disabilities. According to the biopsychosocial model of disability (US Department of Health and Human Services [USDHHS], 2005), disability results from an interaction of physical, emotional, and environmental factors. This model is important in nursing education as it ensures that students learn to communicate effectively and sensitively with individuals with disabilities.
Nursing students learn to consider both the effect of the disability on the health condition and the impact of the health condition on the disability. When selecting a model of disability, a key issue is whether the approach acknowledges the role of individuals with disabilities in their health care. Traditional models of disability, such as medical and rehabilitation models, often consider healthcare professionals as the sole experts on disability, neglecting the lived experiences of individuals with disabilities.
Given the growing and diverse population of people with disabilities, innovative approaches in nursing education are needed to ensure that future nurses have the requisite knowledge, attitudes, and skills to provide quality care across various health care settings, from acute and long-term care facilities to outpatient settings, homes, and communities (Gardner, 2012).
Dealing with Disabilities
Addressing disability in nursing education is crucial due to the increasing number of people living with disabilities: nearly 60 million people in the United States alone (US Census Bureau, 2010) and more than a billion people worldwide (WHO and World Bank, 2011). Disabilities can affect individuals across all age groups, genders, socioeconomic statuses, and racial and ethnic groups. They disproportionately impact marginalized, disadvantaged, or at-risk populations, including women, older adults, and those living in poverty. Despite potentially severe disabilities, many people with disabilities make significant contributions to their families, communities, workplaces, and educational settings (National Council on Disabilities, 2012).
Unfortunately, people with disabilities often encounter numerous barriers to accessing healthcare, including negative attitudes and a lack of knowledge among healthcare professionals, including nurses (Gardner, 2012; Smeltzer, Avery, & Haynor, 2012). Environmental barriers, such as inaccessible buildings, restrooms, and healthcare centers, and the absence of appropriate accommodations like height-adjustable examination tables or mammography equipment, further complicate their access to care.
The Americans with Disabilities Act (ADA), enacted in 1990 and amended in 2008, prohibits discrimination on the basis of disability (US Department of Labor, Office of Disability and Employment Policy, 1990). Despite this, individuals with disabilities continue to report barriers to healthcare access. In response, multiple national and international agencies, such as the US Surgeon General’s Office (USDHHS 2005), the ICN (2010), and WHO (2011), have called for improved education for healthcare professionals about disabilities.
The ICN’s 2010 position statement on disability specifically emphasizes that nurses play a key role in the healthcare of people with disabilities and need to be involved in health promotion, teaching, and counseling for both individuals with disabilities and their families. Nurse educators must ensure that students acquire the competencies necessary to provide high-quality care to people with disabilities (ICN, 2010). The ICN also urges professional nursing organizations to advocate for public policies aimed at enhancing healthcare for people with disabilities.
However, despite the clear stance of the ICN regarding the nursing profession’s role in addressing disability, the topic remains largely invisible in nursing education (Betz, 2013; Gardner, 2012; Smeltzer, Dolen, Robinson-Smith, & Zimmerman, 2005). None of the organizations that establish standards for nursing care in the United States or that accredit nursing education programs explicitly include care for people with disabilities as part of their standards or evaluation criteria.
Impact of Disabilities on Educational Activities
Nursing students typically enter their programs with little or no experience or previous contact with people with disabilities. Consequently, their attitudes toward people with disabilities often mirror those of the general population, which can be negative. It is essential to employ strategies that expose nursing students to individuals with disabilities through clinical experiences, simulations involving patients with disabilities, or the use of standardized patients with disabilities.
Visits to people with disabilities in their homes can help students understand how these individuals live and function effectively and independently in their home and community environments, challenging preconceived notions about disability. Conversely, activities like “disability days,” where students simulate disabilities for short periods (e.g., wearing glasses that impair vision or using a wheelchair), are not recommended by the disability community because they may lead to negative attitudes or trivialize the challenges of living with a disability.
Alternatively, having individuals with disabilities participate in teaching nursing students — through panel discussions, guest lectures, or carefully planned standardized patient experiences — is likely to be more effective. This approach provides a more accurate and empathetic understanding of the lived experiences of people with disabilities and promotes a more nuanced perspective on their needs.
Faculty members who are knowledgeable about or at least interested in disability issues can serve as champions in reviewing nursing curricula to identify where disability-related topics and experiences can be integrated. These faculty members can also select from a variety of resources and materials available to teach students about disabilities, promote positive attitudes toward patients with disabilities in clinical practice, provide equitable care, and advocate for public policies that improve care for people with disabilities.
Research and Future Directions
More research is needed to test various teaching approaches and assess their impact on the care of people with disabilities. Innovative teaching methods should be evaluated for their effectiveness in improving nursing students’ knowledge, attitudes, and skills in working with this population. Research should also focus on developing comprehensive educational strategies that foster empathy, understanding, and competence in caring for people with disabilities.
Conclusion
Disabilities encompass a broad range of impairments that affect individuals’ abilities to perform daily activities and engage fully in life. The care of people with disabilities is an essential topic in nursing education, given the growing population of individuals affected by disability worldwide. Effective nursing education must ensure that future nurses are well-prepared to provide quality care to people with disabilities across various healthcare settings.
Dealing with disabilities in nursing education involves integrating disability-related topics into the curriculum, fostering positive attitudes through exposure and engagement with people with disabilities, and advocating for policies that support equitable healthcare access. By employing innovative teaching strategies and fostering a comprehensive understanding of disability, nursing educators can better prepare students to provide compassionate, competent care to all individuals, regardless of ability.