Expert answer:Define and discuss in your own words the definitio

  

Solved by verified expert:Population affected by disabilities.Rural and migrant health.Read chapter 21 and 23 of the class textbook and review the attached PowerPoint presentations. Once done, answer the following questions.1. Define and discuss in your own words the definitions and models for disability.2. Discuss the difference between illness and disability.3. Compare and contrast the characteristics of rural and urban communities.4. Discuss the impact of structural and personal barriers on the health of rural aggregates.As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 8 discussion questions” for grading and in the tab titled “Week 8 assignment” in Turnitin to verify originality. A minimum of 2 evidence-based references besides the class textbook must be used. You must post two replies to any of your peers sustained with the proper references and make sure that the references that you use in your assignment are properly quoted in it. A minimum of 700 words is required. 2. Discuss the difference between illness and disability.
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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-Assessment





What comes to mind when you 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
Functioning, Disability, and Health



Disability is an umbrella term covering
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 Elsevier Inc.
7
Quality of Life Issues






Transportation to a needed service
Cost 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 Constructed
Issue


Disability is a complex, multifaceted, culturally
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

Nurse 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 Inc.
11
“Medicalization” Issues (Cont.)

Nurse’s interaction with PWD and families

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 of Elsevier Inc.
12
Historical Perspectives






Long history of 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
Historical Context for Disability

Early attitudes toward PWD

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, 1993 by Saunders, an imprint of Elsevier Inc.
14
Historical Context

18th and 19th century attitudes

No scientific model for understanding and treating
➢ Disability seen as an irreparable condition caused
by supernatural agency
➢ Viewed as sick and helpless
➢ Expected to participate in whatever treatment was
deemed necessary to cure or perform

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 (Cont.)

20th century attitudes





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 by Saunders, an imprint of Elsevier Inc.
16
Historical Context (Cont.)

20th century 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 Context (Cont.)

Contemporary conceptualization

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 Disability

Americans with Disabilities 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.


Major life activities: ability to breathe, walk, see,
hear, speak, work, care for 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 Saunders, an imprint of Elsevier Inc.
19
Examples of Disabilities







Physical 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
Measurement of Disability

Survey of Income and Program Participation
(SIPP)

Functional activities
➢ Activities of daily living (ADLs)
➢ Instrumental activities of daily living (IADLs)

American Community Survey (ACS)


Surveys for disability limitation in 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
Prevalence of Disability




In 2010, approximately 18.7% of civilian
noninstitutional 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 Saunders, an imprint of Elsevier Inc.
22
Prevalence of Disability in Children

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 Care Needs (2009/2010)

A disability is defined by a communication-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 imprint of Elsevier Inc.
23
Recommendation for the Nurse

Listen to parental concerns




“Something is not right”
Establishes an important bond with parents
Nurse can serve as an intermediary
Regularly assess for key developmental
milestones

Compare with predicted values
➢ Work with team of resource providers on IEP

Be 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
Disabilities

Individuals with Disabilities Education
Act (IDEA) (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 Act of 2008

ADA: Landmark civil rights 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
Americans with Disabilities Act of 1990
and ADA Amendments Act of 2008 (Cont.)

ADA (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 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 Work Incentives
Improvement Act (TWWIIA)



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 Inc.
28
Public Assistance Programs

Cash assistance





Supplemental Security 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 imprint of Elsevier Inc.
29
Health Disparities in Quality and
Access

Disparities are caused by …

Differences in access to care
➢ Provider biases
➢ Poor provider-patient communication
➢ Poor health literacy

Persons with disabilities experience …



Higher 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 Elsevier Inc.
31
The Experience of Disability


PWD may be largest minority group in the
United States
Different experiences, depending on …




Temporary disability
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 Disabilities (CWD)

Family and caregiver responses



Redefine image and 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





Established various benefits, amid challenges
Families with satisfying emotional 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
Knowledgeable Client

A person who lives with a disability commonly
becomes an expert at knowing what works
best for his or her body.
Knowledgeable Nurse

The nurse who has 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
Strategies for the CH Nurse






Do not assume anything.
Adopt the client’s perspective.
Listen to and learn from client. Gather data
from the perspective of the client 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, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36
Dealing With Ethical Issues




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 Disability



Education programs and employers must
provide reasonable 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
Chapter 23
Rural and Migrant Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Rural Populations



The largest rural population in 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 …




in the South (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
Rural Populations (Cont.)

Economic base is shifting



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 Populations (Cont.)




Poverty continues to 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 pr …
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