Right to Access to Health Care and Health Promotion
For years, people with disabilities have been discriminated against in employment, public accommodations, and public and private services including health care. The needs of the disabled in health care settings produce many challenges to health care providers: how to communicate effectively if there are communication deficits, the additional physical demands for mobility, and time required to provide assistance with self-care routines during hos-pitalization. Physicians and nurses may not know the specific needs of individuals with disability and may fail to provide ser-vices for them. For example, an obstetrician may advise a woman with a spinal cord injury not to become pregnant because the physician lacks experience and knowledge in this area of care. The physician and nurses caring for an expectant woman with dis-ability may not know specific transfer techniques to help her onto an examining table or how to advise her on bowel, bladder, and skin care issues during pregnancy. Before labor and delivery, the medical team needs to be educated about the special needs of a woman with a cervical spinal cord injury in regard to manage-ment of autonomic hyperreflexia. Often, the person with dis-ability must educate the health care professionals.
Because of unfavorable interactions with health care providers, including negative attitudes, insensitivity, and lack of knowledge, people with disability may avoid seeking medical intervention or health promotion programs and activities. For this reason, and because the number of individuals with disability is increasing, nurses must acquire knowledge and skills and be accessible to as-sist these individuals in maintaining a high level of wellness.
Nurses are in key positions to influence the architectural de-sign of health care settings and the selection of equipment that promotes ease of access and health. Padded examination tables that can be raised or lowered make transfers easier for the dis-abled. Birthing chairs benefit women with disability during yearly pelvic examinations and Pap smears and for urologic evaluations. Ramps, grab bars, and raised and padded toilet seats benefit many persons who have orthopedic disabilities and need routine physical examination and monitoring (eg, bone density measure-ments). Just as people without disability should have regular screening tests, such as mammography or testicular and prostate examinations, so should people with disability. The health care professionals who provide these screening and monitoring pro-cedures are in a position to influence decisions about how equip-ment and procedures can be adapted to meet the special needs of their patients, whether these needs are cognitive, motor, or communicative.
Nurses can provide expert health promotion education classes that are targeted to the disabled. Classes on nutrition and weight management are extremely important to individuals who are wheelchair dependent and need assistance with transfers. Safe sex classes are needed by adolescents and young adults who have spinal cord or traumatic brain injury, because the threats of acquired immunodeficiency syndrome (AIDS) and unplanned pregnancy exist for these populations just as they do for the population in general. Other healthy behaviors about which neurologically disabled persons need education include avoiding alcohol and non-prescription medications while taking antispasmodic and anti-seizure medications. Nurses should teach all stroke survivors and patients with diabetes how to monitor their own blood pressure or glucose levels. The warning signs and symptoms of stroke, heart attack, and cancer, as well as how to access help, should also be taught to all disabled persons.
As active members of society, people with disabilities are no longer an invisible minority. An increased awareness of the needs of people with disabilities will bring about changes to improve their access and accommodate their needs. Modification of the physical environment permits access to public and private facili-ties and services, including health care, and nurses can serve as ad-vocates for the disabled to eliminate discriminatory practices.
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