Chapter 9

Educating
Learners with
Disabilities and
Chronic
Illnesses
 Scope of the Problem
• Fifteen percent of people worldwide live
with a disability.
– This number is expected to increase as
populations age and incidence of debilitating
conditions continues to grow.
• Approximately one in five Americans
have a disability; almost half are severe.
– Many are limited in ability to work.
 Scope of the Problem (cont’d)
• Not all disabilities are readily visible.
• Individuals with disabilities are more
likely than those without them to
– Have more illnesses and greater health needs
– Be less likely to receive preventive health
care and other social services
– Be more likely to suffer from poverty
 Scope of the Problem (cont’d)
• Avoid making assumptions about people
in this population.
• Some disabilities are associated with
additional chronic health problems.
• Other health disparity factors
– Fear
– Lack of understanding
– Physical barriers
– Cost
 Models and Definitions
• Models/perceptions of disabilities that
influence how disabilities are addressed in
society:
– The moral model
– The medical model
– The rehabilitation model
– The disabilities (social) model
 Models and Definitions (cont’d)
• The moral model
– Views disabilities as sin
– Old model that persists in some cultures
– Individuals and their families may
experience guilt, shame, denial of care.
– United Nations established Standard Rules
on the Equalization of Opportunities for
Persons with Disabilities specifying
fundamental right of access to care.
 Models and Definitions (cont’d)
• The medical and rehabilitation models
view disabilities as problems requiring
intervention to cure.
– The belief that people with disabilities must
be “cured” has been criticized by advocates.
– Medical model: disability as defect/sickness
– Rehabilitation model: disability as deficiency
 Models and Definitions (cont’d)
• The disabilities model (social model) is
most influential on current thinking.
– Embraces disability as a normal part of life
– Views social discrimination, rather than the
disability itself, as the problem
 Models and Definitions (cont’d)

• Disability
– “A complex phenomenon, reflecting an
interaction between features of a person’s
body and features of the society in which he
or she lives.” (WHO, 2016)
– U.S. Social Security Administration defines
disability in terms of an individual’s ability to
work.
 Americans with Disabilities Act
(ADA)
• Enacted in 1990, this legislation has
extended civil rights protection to
millions of Americans who are disabled.
• The ADA defines a disability as a physical
or mental impairment that substantially
limits one or more of the major life
activities of the individual.
 The Language of Disabilities

• Since the late 1970s, disabilities

• Additional considerations
– Use “congenital disability,” not “birth defect.”
– Avoid terms with negative connotations such
as “invalid” or “mentally retarded.”
– Speak of the needs of people with disabilities
rather than their problems.
– Avoid phrases like “suffers from,” “victim of.”
– When comparing groups, avoid phrases such
as “normal” or “able bodied.”
 Roles and Responsibilities of
Nurse Educators
• Focus on wellness and strengths of the
individual, not weaknesses
• Teaching skills to maintain or restore
health and maintain independence
– Habilitation
• Teaching skills to relearn or restore skills
lost through illness or injury
– Rehabilitation
 Roles and Responsibilities of
Nurse Educators (cont’d)
• Carefully assess the degree to which families
can and should be involved.
• Interdisciplinary team effort is often
required.
• Nurse should serve as mentor to patient and
family in coordinating and facilitating
multidisciplinary services.
 Roles and Responsibilities of
Nurse Educators (cont’d)
• Assessment always done before teaching
– Nature of problem/needs
– Short-/long-term consequences or effects of
disability
– Effectiveness of their coping mechanisms
– Type of extent of sensorimotor, cognitive,
perceptual, and communication deficits
– Knowledge of and readiness to learn about a
new disability
 Types of Disabilities
• Sensory disabilities
• Learning disabilities
• Developmental disabilities
• Mental illness
• Physical disabilities
• Communication disorders
• Chronic illness
 Sensory Disabilities: Hearing
Impairments
• Total or partial auditory loss (complete loss
or reduction in sensitivity to sounds),
etiology related to either a conduction or
sensory–neural problem
• Incidence increases with age.
 Sensory Disabilities: Hearing
Impairments (cont’d)
• Hearing loss described by type, degree,
and configuration
• Types of hearing loss
– Conductive (usually correctable, loss in
ability to hear faint noises)
– Sensorineural (permanent, damage to
cochlea or nerve pathways)
– Mixed
 Sensory Disabilities: Hearing
Impairments (cont’d)
• Modes of Communication to Facilitate
Teaching/Learning:
a. American Sign Language (ASL)
b. Lipreading
c. Written materials
d. Verbalization by client
e. Sound augmentation
f. Telecommunication devices for the deaf
(TDD)
 Sensory Disabilities: Hearing
Impairments—Teaching Guidelines
• Use natural speech patterns; do not overarticulate.
• Use simple sentences and a moderate pace.
• Get client’s attention with a light touch on arm.
• Face the client; stand no more than six feet away.
• Minimize environmental noise.
• Make sure hearing aid is turned on.
• Avoid standing in front of bright light, which
obscures your face.
• Minimize motions of your head while speaking.
• Refrain from placing IV in hand client needs for sign
language.
 Sensory Deficits: Visual
Impairments
• Over 23 million Americans are blind or
visually impaired.
• Etiology: infection, trauma, poisoning,
congenital condition, degeneration
• Common healthcare barriers encountered
– Lack of respect
– Communication problems
– Physical barriers
– Information barriers
 Sensory Deficits: Visual
Impairments (cont’d)
• Common Eye Diseases of Aging
– Macular degeneration
– Cataracts
– Glaucoma
– Diabetic retinopathy
Sensory Deficits: Visual Impairments—
Teaching Guidelines
• Assess patients to avoid making needs
assumptions.
• Speak directly to patients rather than to
sighted companions.
• Secure services of a low-vision specialist to
obtain adaptive optical devices.
• Avoid the tendency to shout.
• Use nonverbal cues.
• Always announce your presence and identify
yourself.
Sensory Deficits: Visual Impairment—
Teaching Guidelines (cont’d)
• Allow client to touch, handle, and
manipulate equipment.
• Be descriptive in explaining procedures.
• Use large font size for printed or
handwritten materials.
• Use bold color or rely on black and white
for printed materials.
• Use alternative instructional tools that
stimulate auditory and tactile senses.
Sensory Deficits: Visual Impairment—
Teaching Guidelines (cont’d)
• Use proper lighting.
• Provide large-print watches and clocks.
• Use audiotapes and cassette recorders.
• Computer features
– Screen magnifiers, high contrast, screen-
resolution features
– Text-to-speech converters
– Braille keyboards, displays, and printers
• Sighted guide technique
 Learning Disabilities
• Heterogeneous group of disorders of
listening, speaking, reading, writing,
reasoning, or mathematical abilities
• Approximately 20% of the American
population is affected.
• The majority have language, integrative
processing, or memory deficits.
• Multiple definitions exist; controversial
area of debate
 Learning Disabilities (cont’d)
• Varied and often unclear causes
• Most individuals have normal or superior
intelligence.
• Disorders include:
– Dyslexia
– Auditory processing disorders
– Dyscalculia
Learning Disabilities—Teaching
Guidelines
• Eliminate distractions; provide a quiet
environment.
• Conduct an individualized assessment to
determine how client learns best.
• Adapt teaching methods and tools to
client’s preferred learning style.
• Ask questions of parents about
accommodations needed if client is a
child.
Learning Disabilities—Teaching
Guidelines (cont’d)
• Use repetition to reinforce messages.
• Ask client to repeat or demonstrate what
was learned to clear up any possible
misconceptions.
• Use brief but frequent teaching sessions
to increase retention and recall of
information.
• Encourage client’s active participation.
 Developmental Disabilities
• A severe chronic state that is present
before 22 years of age, is caused by mental
and/or physical impairment, and is likely
to continue indefinitely
• Include:
– Attention-deficit/hyperactivity disorder
– Intellectual disabilities
– Asperger syndrome/autism spectrum
disorder
 Developmental Disabilities
(cont’d)
• Public laws providing for special
education needs
– Developmental Disabilities Assistance and
Bill of Rights Act of 2000
– Education of All Handicapped Children Act
1975
• Individuals with Disabilities Education Act of
1990 (IDEA)
– Updated in 2004
 Developmental Disabilities—
Teaching Guidelines
• Recognize the role of parents and
caregivers, and time and stress involved.
• Keep in mind developmental stage, not
chronological age.
• Careful assessment is critical.
• Provide concrete examples and
explanations, preferably in context.
• Use verbal and nonverbal cues.
• Simplify tasks.
 Developmental Disabilities—
Teaching Guidelines (cont’d)
• Be consistent; use repetition.
• Encourage active participation.
• Praise positive behaviors and
accomplishments.
• Consider individual learning styles.
• Eliminate unnecessary distractions.
• Ask direct questions.
• Consider using stress reduction
techniques.
 Mental Illness
• Estimated to affect 20% of adult Americans
• Advances in mental illness care since 1950s
• Teaching guidelines
– Begin with comprehensive assessment.
– Be aware of communication and learning
challenges.
– Teach using small words, repeating information.
– Keep sessions short and frequent.
– Involve all possible resources, including client and
family.
Physical Disabilities: Traumatic
Brain Injury
• Falls are leading cause
– Greater awareness with combat and sports
• Includes closed and open head injuries
• Treatments
– Acute care
– Acute rehabilitation
– Long-term rehabilitation
• Ultimate goal of independent living
 Physical Disabilities: Traumatic
Brain Injury—Teaching Guidelines
• Obstacles to learning readiness
– Denial or loss of identity
– Lack of physical endurance
– Role changes of patient and caregivers
– Feelings of isolation
• General teaching strategies
– Use group teaching approach.
– Involve immediate caregiver.
– Invite rehabilitated patients to share
experiences.
Physical Disabilities: Traumatic Brain
Injury—Teaching Guidelines (cont’d)
• General teaching strategies
– Use simple sentences.
– Use gestures to enhance what you are saying.
– Give step-by-step instructions.
– Allow time for responses.
– Praise all communication efforts.
– Use listening devices.
– Keep written instructions simple.
 Physical Disabilities: Memory
Disorders
• Causes include:
– Brain injury
– Amnesia
– Alzheimer’s disease
– Parkinson’s disease
– Multiple sclerosis
– Brain tumors
– Depression
• Short-term or long-term memory deficits
 Physical Disabilities: Memory
Disorders—Teaching Guidelines
• Emphasize memory techniques that focus
on the need for attention, repeating
information, and practicing retrieval.
• Encourage client to take notes.
• Assist client in creating a system of
reminders.
Physical Disabilities: Memory Disorders—
Teaching Guidelines (cont’d)
• Incorporate pictures and visualization.
• Teach clients to “chunk” information.
• Arrange brief, frequent repetitive sessions
to provide constant reinforcement.
• Involve family or caregiver in teaching
sessions to reinforce information.
 Communication Disorders
• Deficits affect perception and/or language
production abilities.
• Most common residual communication
deficits
• Global aphasia
• Expressive aphasia
• Receptive aphasia
• Anomic aphasia
• Dysarthria
 Communication Disorders:
Aphasia—Teaching Guidelines
• Be sure you have the patient’s attention.
• Establish a consistent communication system.
• Teach patient to point to certain objects for
common needs.
• Use simple sentences, speaking slowly.
• Avoid jumping between topics.
• Teach patient to exaggerate expressions to improve
communication.
• Support speech therapy programs.
• Use communication boards.
 Communication Disorders:
Dysarthria—Teaching Guidelines
• Reduce environmental distractions.
• Pay attention to patient.
• Let patient know when understanding is difficult
and which part of the message is not understood.
• Encourage client to speak slower and louder.
• Ask yes/no questions or have patient write
message when understanding is difficult.
• Conduct teaching when patient is rested.
 Chronic Illness
• Leading cause of death in U.S.
• Permanent condition lasting three plus months,
often a lifetime
• May cause a disability but is not a disability itself
• Affects every aspect of life—physical, social,
psychological, economic, and spiritual
• Successful management is a life-long process.
• Development of good learning skills is matter of
survival.
• The learning process must begin with illness onset.
• There is often a conflict between feelings of
dependence and the need for independence.
 Chronic Illness: Problem Areas
for Patients and Families
• Prevention of medical crises and management of
problems once they occur
• Control of symptoms
• Carrying out prescribed regimens
• Prevention of or living with social isolation
• Adjustment to disease changes
• Keeping interactions with others normal and
maintaining one’s lifestyle
• Funding
• Confronting related psychological, marital, and
family problems
 The Family’s Role in Chronic
Illness or Disability
• Families are usually the care providers
and support system.
• Their reactions and perceptions influence
adjustment.
• Note what learning needs the family
considers important.
• Communication between family is key.
• Consider family strategies for coping.
• Denial may be present.
 Assistive Technologies
• Technological tools (computers and
communication devices) available to persons
with disabilities to live more independently
– Provide access to education, employment,
recreation, communication
• Impact
– Has liberated people with disabilities from social
isolation and feelings of helplessness
– Increases feelings of self-worth, independence
– Useful tool for health promotion
 Assistive Technologies (cont’d)
• Advocacy role of nurses
– Recommend that clients use computer
technology
– Assist in obtaining appropriate equipment and
training, possibly with multidisciplinary team
 State of the Evidence
• Growing awareness of rising costs of
healthcare
– Rising cost of managing long-term health
problems
– Debate over responsibility for cost of care
• Need for health education is at all-time
high.
• Healthy People 2020 spotlights reducing
risk factors for chronic illness and
disability.