1. MDC Medical Model and Social Construct Questions
Chapter 23 Rural and Migrant Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
history of United States is now. 75% of counties are classified as rural; they contain only
20% of the U.S. population Number/size of rural counties are highest … ➢➢➢
(35%) in the Midwest and West (23%) in the Northeast (19%) Census data ➢➢➢20% of
nation’s children under 18 15% of nation’s elderly More than 50% of nation’s poor
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2
➢➢➢Agriculture is the “food and
fiber system” All aspects of agriculture (core materials to wholesale and retail and food
service sectors) are included Poverty in rural areas greater than in urban areas Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Rural
be greater in rural America than in urban
areas. Aging-in-place, out-migration of young adults, and immigration of older persons from
metro areas. Greater diversity among residents: a country of immigrants historically and
today. Health disparities exist—rural population more likely to be older, less educated, live
in poverty, lack health insurance, and experience a lack of available health care providers
and access to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of El
of U.S. physicians practice in rural areas Ratio of physicians in rural population is
36:100,000 (nearly double in urban settings) More often assess their health as fair or poor
More disability days resulting from acute conditions More negative health behaviors
(untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess
deaths and chronic disease and disability rates Higher number of unintentional injuries
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
➢
2500 or in open country [farm/nonfarm] Density ➢➢Rural = fewer than 45 persons per
square mile Frontier = less than 6 people per square mile Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Defining Rural Populations
-Urban Continuum uses population and adjacency to metropolitan areas
➢Core Based Statistical Areas (CBSAs) • Metropolitan areas = county with at least one
urbanized area of 50,000 or more people • Micropolitan area = area contains a cluster of
10,000 to 50,000 persons • Outside CBSAs = noncare areas Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Describing Rural Health and

2. include key indicators of health: ➢Employment ➢Income ➢Education ➢Health insurance ➢
Mortality ➢Morbidity ➢Access to care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Context: characteristics of places of residence ➢
and economic institutions Composition: collective health effects that result from a
concentration of persons with certain characteristics ➢Age, education, income, ethnicity,
and health behaviors – Braveman (2010) Copyright © 2015, 2011, 2007, 2001, 1997, 1993
downward spiral may exist: ➢people leave → services are lost → tax base becomes
insufficient → fewer services are provided → long distances to get health care → jobs
become scarce and more people leave → the cycle continues Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Context: Health Disparities
Related to
physicians General health services lacking Health insurance coverage … ➢Varies according
to race and ethnicity; age and residence (rural or urban) ➢Influences health patterns ➢May
create financial barriers to health care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 11 Composition: Health Disparities Related to Persons
➢➢➢➢➢One of the most important indicators of the health and
wellbeing of all Americans, regardless of where they live. Regional differences—highest in
the South Racial and ethnic minorities—rates among rural racial minorities two to three
times higher than for rural whites Family composition—female-headed families have
highest rates Children—among the poorest citizens in rural America Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Composition:
njury, and death ➢
factors ➢
usage, suicide, vehicular accidents; lower rates of seat belt use Age, education, gender, race,
ethnicity, language, and culture Education and employment Occupational health risks
Perceptions of health (gender, race, ethnicity) Copyright © 2015, 2011, 2007, 2001, 1997,
injuries caused by: ➢Environmental conditions ➢Geographic isolation and working alone ➢
Use of agricultural machinery ➢
chronic illnesses: ➢Musculoskeletal discomfort, acute and chronic respiratory conditions,
hearing loss, hypertension ➢Chemical exposure (pesticides, herbicides, etc.) ➢Secondary
conditions related to demanding farm work Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 14 Migrant and Seasonal Farm Workers
ties ➢➢
migratory status Cultural, linguistic, economic, and mobility barriers ➢➢Minimal or no
preventive care • Mobile clinic sites form a central link to health services Migrant Health
Program (MHP) bases services on enumeration of MSFW • Migrant and Seasonal Farm
Worker Enumeration Profile Study (MSFWEPS) (2000) Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 “Thinking Upstream” Concepts
applied to Rural He -based problems at their roots Emphasize

3. the “doing” aspects of health Maximize the use of informal networks Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Rural Health Care
Delivery Sy ➢➢➢Rural shortages likely to become
worse Need to “grow their own” Telemedicine • Cost-effective alternative to face-to-face
care • Telehealth includes telephones, fax machines, email, and remote monitoring •
Telemedicine permits two-way, real-time, interactive communication between patient and
provider Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
environment ➢➢Possible benefits: • Potential to lower primary care costs • Improve the
quality of care • Help stabilize the local rural health care system Risks • Probable high start-
up and administrative costs • Volatile effect of large, urban-based, for-profit managed care
companies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 18 Community-
an institution ➢ health programs,
community mental health programs, ambulatory care services, school health programs,
faith-based care, elder services (adult day care) Community participation in decisions about
health care services Focus on all three levels of prevention An understanding that the
hospital is no longer the exclusive health care provider Copyright © 2015, 2011, 2007,
Nurse case management and development of local resources ➢➢➢➢Often hospital based in
rural areas Use county extension services as a bridge for outreach services Improve home
care for these patients and provide support for their families A partnership between the
public health nurse and county extension service could provide support, as well as
information groups and caregiving classes, for the important informal provider network.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
religious faith Integrating nursing expertise and faith-based knowledge to provide holistic
care to members of congregations Involved in case management and coordination of
services Collaboration with other organizations to extend limited rural community health
resources Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
-reliance and self-help traits
of rural residents Include people who have assumed the role of caregiver based on their
individual qualities, life situations, or social roles Provide direct help, advice, or information
Need to identify and combine informal services with formal systems Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Rural Public
Health Departments Public health nurses are often the core providers of public health
services in rural areas. ➢➢Collaboration of services is key—need to develop partnerships
with other heath provider agencies. Environmental health, maternal and child health, and
communicable disease control are the three highestpriority programs. Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Rural Mental
provided by primary care providers without adequate preparation or support. Perceived
stigma prevents individuals from seeking mental health services. Copyright © 2015, 2011,

4. 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Emergency Services
Getting patients from the place of injury to the trauma center within the “golden hour” is
frequently not possible because of distance, terrain, climatic conditions, and communication
methods. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
➢➢➢
➢➢Shortage of volunteers and lower levels of training Training curricula that often do not
reflect rural hazards (e.g., farm equipment trauma) Lack of guidance from physicians Lack
of physician training and orientation to EMS Also contributing to difficult public access for
emergency care: • Low population density • Large, isolated, or inaccessible areas • Sever
weather • Poor roads • Lower density of telephone/communication methods Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Emergency
Preparedness in Rural Co ➢➢➢➢Resource
limitation • Human, financial, and social capital Separation and remoteness • Longer
response times Low population density • Impacts funding Communication • Warning
systems often absent or neglected in remote areas; burden on individuals Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Legislation
and services ➢➢➢➢Community Health Centers (CHC) program Migrant Health Clinic
(MHC) program and the Migrant Health Program (MHP) Medicare’s Rural Hospital
Flexibility (RHF) grant program Primary care cooperative agreements Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Rural Community
Health Nursing “CH nursing along the rural continuum” Nonmetropolitan Areas
Metropolitan Areas Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 29 Rural Nursing … … is the practice of professional nursing within
the physical and sociocultural context of sparsely populated communities. It involves the
continual interaction of the rural environment, the nurse, and his or her practice. Rural
nursing is the diagnosis and treatment of a diversified population of people of all ages and a
variety of human responses to actual (or potential) occupational hazards or actual or
potential health problems existent in maternity, pediatric, medical/surgical and emergency
nursing in a given rural area. –– Bigbee (1993), Lee & Winters (2004), Rosentahl (2005),
Williams et al. (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 30 Characteristics of Rural Nursing Should rural nursing practice be
designated as a specialty or subspecialty area because of factors such as isolation, scarce
resources, and the need for a wide range of practice skills that must be adapted to social and
economic structures? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
➢➢➢
➢➢➢
with the community and with coworkers Enjoy rural lifestyle Autonomy and professional
status Being valued by the agency and community Negative aspects ➢Professional isolation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32
The newcomer practices nursing in a rural setting, unlike the more experienced nurse, who
practices rural nursing. Somewhere between these extremes lies the transitional period of
events and conditions through which each nurse passes at her or his own pace. It is within

5. this time zone that nurses experience rural reality and move toward becoming
professionals who understand that having gone rural, they are not less than they were, but
rather, they are more than they expected to be. Some may be conscious of the transition,
and others may not, but in the end, a few will say, “I am a rural nurse.” – Scharff (1998, p.
38) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
➢The capacity of rural
public health to manage improvements in health ➢Information technology capacity in rural
communities ➢Developing and monitoring performance standards in rural public health ➢
Developing leadership and public health workforce capacity within rural public health ➢
Interaction and integration of community health systems, managed care, and public health
in rural America – Berkowitz, Ivory, & Morris (2002) Copyright © 2015, 2011, 2007, 2001,
1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Capacity of Rural Public Health to
strategies Information Technology in Rural Communities ➢➢➢➢EHR and reimbursement
Preparedness strengthens infrastructure Continuing education and advanced education
Telehealth impact on public health • Skills via distance learning? • Costs and infrastructure
of IT? • Gaps in epidemiology and surveillance capacity? Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Performance Standards in
describe an optimal level of performance by public health systems regardless of location.
Used to improve collaborations among key public health partners, educate participants
about public health, strengthen the network of public health partners, identify strengths
and weaknesses, and provide benchmarks for public health practice improvements
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36
—
preparing public health workforce for 21st century CDC Public Health Improvement
Initiative (2012)—accreditation support Medicaid impact on interaction and integration of
community health systems, managed care, and public health New models of health care
delivery for rural and frontier areas being tested Copyright © 2015, 2011, 2007, 2001,
1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 Chapter 21 Populations Affected by
Disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. Most people whose lives do not end abruptly will experience disability. – Nies
& McEwen (2015) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc. 2 Doing a Self-
think of someone with a disability? Picture yourself as a person with a disability. Imagine
yourself as a nurse with a visible disability, or a client receiving care from a nurse with a
disability. Think about living in a family affected by disability. What is the experience of
living with disability within your community? Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions for Disability Disability is the
interaction between individuals with a health condition and personal and environmental
factors. – World Health Organization, 2012 Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an imprint of Elsevier Inc. 4 WHO International Classification of

6. impairments, activity limitations, and participation restrictions (individual level). An
impairment is a problem in body function or structure—activity limitation or participation
restriction (micro level). A handicap is a disadvantage resulting from an impairment or
disability that prevents fulfillment of an expected role (macro level). Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Table 21-1
Characteristic Definition Measurability Illustrations Level of analysis Impairment Disability
Physical deviation from May be objective and measurable normal structure, function,
physical organization, or development Objective and measurable May be objective and
measurable Micro level (e.g., body organ) Individual level (e.g., person) Handicap Not
objective or measurable; is an experience related to the responses of others Not objective or
measurable; is an experience related to the responses of others Spina bifida, spinal Cannot
walk Reflects physical and cord injury, amputation, unassisted; uses psychological and
detached retina crutches and/or a characteristics of the manual or power person, culture,
and wheelchair; blindness specific circumstances Macro level (e.g., societal) Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 National
Agenda for Prevention of Disabilities (NAPD) Model Figure 21-1 Reprinted with permission
from Pope AM, Tarlov AR, editors: Disability in America: toward a national agenda for
prevention, Washington, DC, 1991, Institute of Medicine, National Academy Press. Copyright
© 1991 by the National Academy of Sciences. Courtesy National Academy Press,
Washington, DC. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint
of care Appointment challenges Language barriers Financial issues Migrant/noninsured
issues Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
Inc. 8 Models for Disability 1. Medical model—a defect in need of cure through medical
intervention 2. Rehabilitation model—a defect to be treated by a rehabilitation professional
3. Moral model—connected with sin and shame 4. Disability model—socially constructed
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
Disability: A Socially Construct
rich concept that cannot be readily defined, explained, or measured (Mont, 2007). Whether
the inability to perform a certain function is seen as disabling depends on socio-
environmental barriers (e.g., attitudinal, architectural, sensory, cognitive, and economic),
inadequate support services, and other factors (Kaplan, 2009). Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 “Medicalization” Issues
e needs to differentiate … ➢A person who has an illness and becomes disabled
secondary to the illness versus … ➢A person who has a disability, but may not need
treatment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier I
➢Approach on an eye-to-eye level ➢Listen to understand ➢Collaborate with the
person/family ➢Make plans and goals that meet the other’s needs and draw on strengths
and improve weaknesses ➢Empower and affirm the worth and knowledge of the
person/family with a disability ➢Promote self-determination and allow choices Note: PWD
= persons with disabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint

7. institutionalization/segregation Often viewed as sick and helpless In the 20th century,
special interest groups emerged to advocate for PWD (e.g., ARC) Tragedies include Hitler’s
euthanasia program Deinstitutionalization began in 1960s-1970s Stereotypical images still
common in literature and media; these images influence prevailing perceptions of disability
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13
➢Set apart from others ➢
Viewed as different or unusual ➢Documented in carvings and writings ➢Infanticide or left
to die (not in Jewish culture) ➢Viewed as unclean and/or sinful ➢Served as entertainers,
circus performers, and sideshow exhibitions Copyright © 2015, 2011, 2007, 2001, 1997,
attitudes ➢No scientific model for understanding and treating ➢Disability seen as an
irreparable condition caused by supernatural agency ➢Viewed as sick and helpless ➢
Industrial Revolution stimulated a societal need for increased education ➢➢If not third-
grade level = feeble-minded Special schools established in early 1800s Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Historical Context
➢➢➢➢➢Special interest groups were formed First federal
vocational rehabilitation legislation passed in early 1920s Involuntary sterilization of many
with intellectual disabilities ARC (Association for Retarded Children) began to advocate for
children with intellectual disabilities—today is Association for Retarded Citizens ARC is
“world’s largest community-based organization of and for people with intellectual and
developmental disabilities” (ARC, 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993
b
attitudes ➢One of the most horrendous tragedies under Hitler’s euthanasia or “good death”
program • Killed at least 5000 mentally and physically disabled children by starvation or
lethal overdoses • Killed 70,274 adults with disabilities by 1941 • Over 200,000 people
exterminated because they were “unworthy of life” ➢Deinstitutionalization movement in
1960s and 1970s • Community-based Independent Living Centers established Copyright ©
2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Historical
➢Stereotypical images remain common
in literature and media • Population portrayed as a burden to society or from pity/pathos
or heroic “supercrip” perspectives • “just as the paralytic cannot clear his mind of his
impairment, society will not let him forget it.” (Murphy, 1990, p. 106) ➢Societal stigma still
exists • Teasing or bullying often occurs in schools • Rehabilitation Act of 1973 and
American with Disabilities Act of 1990 prohibit “disability harassment” Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Characteristics of
ities Act (ADA) of 1990 and Rehabilitation Act of 1973
defined disability according to limitations in a person’s ability to carry out a major life
activity. ➢
oneself, perform manual tasks, and learn U.S. Census Bureau (2006) defines disability as
long-lasting physical, mental, or emotional condition that creates a limitation or inability to
function according to certain criteria. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by

8. disabilities Sensory disabilities Intellectual disabilities Serious emotional disturbances
Learning disabilities Significant chemical and environmental sensitivities Health problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20
➢
Functional activities ➢Activities of daily living (ADLs) ➢Instrumental activities of daily
➢
six areas that affect function or activity (sensory, physical, mental/emotional, self-care,
ability to go outside the home, employment) Other organizations also collect disability data
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21
population aged 5 years and older had a long-lasting condition or disability. Of those with a
disability, 12.6% had a “severe” disability. Prevalence varies by race, age, and gender. It is
important for health care policymakers and health care providers to recognize that the
prevalence of disability is increasing. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Approximately 15.2% of households with children have at least one child with a special
health care need (disabling condition). – National Survey of Children with Special Health
-related difficulty,
mental or emotional condition, difficulty with regular schoolwork, difficulty getting along
with other children, difficulty walking or running, use of some assistive device, and/or
difficulty with ADLs Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an
tal concerns ➢➢
➢
an intermediary Regularly assess for key developmental milestones ➢Compare with
predicted values ➢ cognizant of
disability within the context of culture and aging Copyright © 2015, 2011, 2007, 2001,
1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Legislation Affecting People with
(1975); reauthorized in
1997, 2004 ➢➢Ensured a free appropriate public education (FAPE) in the least-restrictive
setting to children with disabilities based on their needs Parents, students, and
professionals join together to develop an Individualized Education Program (IEP), including
measurable special educational goals and related services for the child. Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Americans with
Disabilities Act of 1990 and ADA Amendments
legislation that prohibits discrimination toward people with disabilities in everyday
activities ➢➢Guarantees equal opportunities for people with disabilities related to
employment, transportation, public accommodations, public services, and
telecommunications Provides protections to people with disabilities similar to those
provided to any person on basis of race, color, sex, national origin, age, and religion
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26
(Cont.) ➢➢Refers to a “qualified individual” with a disability as a person with a physical or
mental impairment that substantially limits one or more major life activities or bodily

9. functions, a person with a record of such an impairment, or a person who is regarded as
having such an impairment. Qualifying organizations must provide reasonable
accommodations unless they can demonstrate that the accommodation will cause
significant difficulty or expense, producing an undue hardship. Copyright © 2015, 2011,
2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Ticket to Work and
Increases access to vocational services;
provides new methods for retaining health insurance after returning to work Increases
available choices when obtaining employment services, vocational rehabilitation services,
and other support services needed to get or keep a job Became law in 1999, amended in
2008 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier
➢➢
Income—SSI Social Security Disability Insurance—SSDI Food stamps Public/subsidized
housing Costs associated with disability ➢Gaps in employment, income, education, access to
transportation, attendance at religious services Copyright © 2015, 2011, 2007, 2001, 1997,
1993 by Saunders, an impri
Disparities are caused by … ➢Differences in access to care ➢Provider biases ➢Poor
provider-patient communication ➢
experience … ➢➢ er rates of chronic illness Increased risks for medical, physical,
social, emotional, and/or spiritual secondary issues People with intellectual disabilities are
➢Undervalued and disadvantaged Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by
Saunders, an imprint of Elsevier Inc. 30 Systems of Support for People With Disabilities
Figure 21-2 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
United States Different experiences, depending on … ➢➢➢
Permanent disability from accident or disease Disability from progressive decline of a
chronic illness Benchmark event is acceptance of the label of “disabled” Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Children With
➢➢
expectations for child and self Sibling response influenced by age, coping, peer
relationships, parents, impact on family Levels of parental adjustment ➢➢➢➢The ostrich
phase Special designation Normalization Self-actualization Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Family Research Outcomes
support experience fewer potentially negative effects of unplanned or distressing events.
Parents may grieve the loss of idealized or expected child over time. Supportive relationship
is needed. Empowerment and enabling decision making on behalf of CWD is important.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34
monly becomes an expert
information about the disability and the available community and governmental resources.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35
perspective. Listen to and learn from client. Gather data from the perspective of the client

10. and family. Care for the client and family, not for the disability. Be well informed about
community resources. Become a powerful advocate. Copyright © 2015, 2011, 2007, 2001,
Spiritual perspectives Quality of life (QOL) and justice perspectives Proper use of scientific
advances Self-determination, deinstitutionalization, and disability rights Copyright © 2015,
2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 37 When the Nurse
Has a Disabil
accommodations for qualified students and nurses. Technical aspects of nursing tend to
discriminate; nursing should emphasize “humanistic” capacities. Type of setting influences
functionability. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of
Elsevier Inc. 38 Nurses Can … … become familiar with a variety of ethical frameworks for
decision making. … help the patient and family access needed information to make informed
decisions. … help educate the public on health care issues. … participate in the development
of institutional policies and procedures related to disability. … take a position on an ethical
issue. … work to influence government policies and laws. Copyright © 2015, 2011, 2007,
2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 39