How Deal With Disabilities and Nursing Education

What are Disabilities

    The World Health Organization (WHO)
defines disability as an umbrella term that includes impairment (problems in
body function or structure), activity limitations (difficulties encountered by
an individual in executing a task or action), and participation restrictions
(problems experienced by an individual in involvement in life situations; WHO,
2001). The International Council of Nurses (ICN, 2010) defines disability as a
physical, mental, sensory, or social impairment that adversely affects
individuals’ ability to carry out normal day-to-day activities in the long
term.

Effect of Disestablishes In Education

    The care of persons with
disabilities, including intellectual and developmental disabilities, is an
essential topic for nursing education. The bio-psychosocial model of disability
(US Department of Health and Human Services [USDHHS], 2005) emphasizes the view
that disability arises from the interaction of physical, emotional, and
environmental factors. This model ensures that students learn to communicate
effectively and sensitively with persons with disabilities. Students learn to consider
the effect of the disability on the health condition. 

    In addition, they also
learn how treatment of the health condition affects the disability. In
selecting a model of disability, a key issue is the view of the role of
individuals with a disability in their health care. Other models of disability
( eg , medical and rehabilitation models) consider health care professionals as
the experts on disability, without recognizing the life experiences of
individuals living with the disability.

    Innovative approaches are needed to
ensure that nursing students have the requisite knowledge, attitudes, and
skills to provide quality care for patients with disabilities across health
care settings, from acute and long-term care facilities to outpatient facilities,
the home, and the community (Gardner, 2012).

Dealing With Disabilities

    The need for nursing education to
address disability is based on the sizable and growing population of people
with disabilities: almost 60 million people in the United States (US Census
Bureau, 2010) and more than a billion people worldwide (WHO and World Bank,
2011 ). Disability affects people across all age groups, both genders, and all
socioeconomic and racial and ethnic groups, and disproportionately affects
marginalized, disadvantaged, or at-risk groups, including women, older people,
and people who are poor. Despite having disabilities that can be severe, most
people with disabilities make significant contributions to their families,
communities, and work and educational settings (National Council on

    Disabilities, 2012). Although
people with disabilities have the same health needs as those without
disabilities for immunization, health promotion, preventive health screening,
and high-quality health care many encounter barriers to care. These barriers
include negative attitudes and lack of knowledge of health care professionals,
including nurses (Gardner, 2012; Smeltzer , Avery, & Haynor , 2012), and
environmental obstacles ( eg , inaccessible buildings, rest rooms, health
centers. and imaging centers, and absence of accommodations, such as height
adjustable and mammography equipment).

    The Americans with Disabilities
Act, enacted in 1990 and amended in 2008, prohibits discrimination because of
disability US Department of Labor, Office of Disability and Employment Policy
(1990). However, people with disabilities reported continued barriers to health
care. In response, multiple national and international agencies ( eg , the US
Surgeon General’s Office; USDHHS 2005; ICN, 2010: WHO, 2011) have called for
health care professionals to be better educated about disability. 

    The ICN’s
2000 position statement on disability, revised in 2010, explicitly states that
nurses are key to the health care of people with disabilities and need to be
involved in health promotion, teaching, and counseling of people with
disabilities and their families (2010). Nurse educators need to ensure that
students achieve competencies needed to provide care for people with
disabilities:

    The ICN (2010) also calls for
professional nursing organizations to advocate for public policy directed
toward improved health care of people with disabilities, despite the strong and
explicit position of the ICN about nurses’ role and the need for nursing to
address 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 of nursing care in the
United States or accredit nursing education programs identify care of people
with disabilities as part of those standards or criteria on which nursing
education is evaluated.

Impact of Disabilities on Educational Activities

    Students typically enter nursing
programs with little or no experience or previous contact with people with
disabilities. Their attitudes toward people with disabilities are similar to
those of the general population and are often negative. Thus, strategies that
expose nursing students to people with disabilities through clinical
experiences, simulations of patients with disabilities, or the use of
standardized patients with disabilities are recommended. Visits to persons with
disabilities in their homes can open students’ eyes to the ability of persons
with disabilities to live and function effectively and independently in their home
and community, a view that is often unexpected by students

    Use of disability days, in which
students are put in situations to experience a disability for an hour or two by
wearing glasses that impede vision or requiring them to move around in a
wheelchair, is not recommended by the disability community because it can
result in very negative attitudes about disability in students. Alternatively,
such short term experiences may result in an undesirable conclusion by students
that having a disability is not a significant issue. Having individuals with
disabilities participate in teaching of nursing students through panel
discussions or simulations with carefully planned standardized patient
experiences are likely to be more effective than the disability day
experiences.

    Faculty members knowledgeable or at
least interested in disability can serve as champions and review nursing
curricula to identify where disability related topics and experiences can be
integrated. Furthermore, they can also select from the array of resources,
materials that faculty can use to learn about and teach students about
disability, to promote positive attitudes toward patients with disabilities in
clinical practice, to provide care that is equal to that given to patients
without disabilities, and to advocate for public policy to improve care for
people with disabilities. Research is needed to test different teaching
approaches and their effect on care of people with disabilities.