Disabilities of Patient In Nursing Education and Dealing With
Whats are Intellectual Disabilities
Intellectual disabilities are among the most common developmental disabilities, affecting approximately 6.5 million people in the United States alone (Center for Parent Information and Resources [CPIR], 2015). An intellectual disability is a condition that originates before the age of 18 and results in impaired reasoning, learning, problem solving, and adaptive behavior (American Association on Intellectual and Developmental Disabilities, 2012).
A score of less than 75 on an IQ test is one of the major indicators of intellectual disability; use of such an instrument for diagnosis is typically supplemented with tests to assess limitations in conceptual, practical, and social skills (CPIR, 2015).
Intellectual disabilities have multiple causes. First, intellectual disability is a major characteristic of several syndromes such as Down syndrome, fragile X syndrome, and fetal alcohol syndrome. Second, any factor that affects the developing neurological system of the fetus can result in intellectual disability for example, drugs, disease, and trauma.
Third, birth trauma. low birth weight, disease, and other factors that negatively affect the newborn or young child can cause intellectual disability (WebMD, 2016). Finally, intellectual disability can occur as a result of social factors such as lack of education and lack of stimulation from adults not being responsive to infants and young children (Jha, 2012)
Nurses are likely to encounter a child or adult with an intellectual disability in a variety of settings and circumstances. Their teaching needs will range from simple explanations of medical procedures to more complex assessment and instruction in areas such as health promotion. In some areas, nurses may find that bias, misunderstanding, and lack of knowledge have resulted in the educational needs of these individuals being ignored.
For example, although individuals with intellectual disabilities have the same needs for love, companionship, and sexual gratification as other people, sex education is often overlooked, sometimes with negative consequences (Bernert & Ogletree, 2015; Gurol, Polat, & Oram, 2014 ; Schaafsima , Kok, Stoffelen , VanDoorn, & Curfs , 2014).
When planning a teaching intervention with an individual who has an intellectual disability. the nurse must keep in mind the patient's developmental stage, not his or her chronological age. It is important to remember that intellectual abilities can vary significantly from individual to individual so assessment is critical.
If the patient does not communicate verbally, the nurse should note whether certain nonverbal cues, such as gestures, signing, or other symbols, are used for communication purposes. Most people with intellectual disabilities are incapable of abstract thinking, although the majority can understand simple explanations, concrete examples must be given.
For example, instead of saying, “Lunch will be here in a few minutes,” the nurse could show a clock and point to the time. Both adults and children with intellectual disabilities benefit from short, clear explanations and demonstrations prior to treatments to avoid misunderstandings and unnecessary anxiety.
When communicating with patients, nurses must always remember that facial expression and voice tone are more important than words spoken. They should talk with family members or other caregivers to learn about unique ways in which the patient communicates, including words they may use for body parts or any non verbal cues for a “yes” or “no” response.
Nurses should praise any positive behavior with great praise. They should keep the information simple, concrete, and repetitive, and they should be consistent, but firm, setting appropriate limits. Avoid dominating any teaching session, but rather let patients actively participate and gain a sense of accomplishment. Nurse educators must assign simple tasks with simple directions and show what is to be done, rather than relying on verbal commands. They should only give one direction at a time.
A reward system often works very well as, for example, giving children stickers with familiar childhood characters to place on their bed or pajamas that will remind the child of a job well done. For adults, rewards that are important to that individual will work as well.
Asperger Syndrome/Asperger Profile/Autism Spectrum Disorder
Asperger syndrome is a pervasive developmental disability that falls at the high end of the autism spectrum and is characterized by impaired communication, impaired social interaction, and repetitive or restrictive patterns of thought and behavior (National Institute of Neurological Disorders and Stroke, 2017).
The statistics surrounding Asperger syndrome are uncertain as many individuals, particularly adults, remain undiagnosed. It is estimated that 1 in 250 to 1 in 5,000 children are affected, which is approximately 1% of the population worldwide (Asperger/Autism Network, 2017; US National Library of Medicine, 2017). Asperger syndrome is a brain dysfunction that is caused by a combination of genetics and environmental factors (US National Library of Medicine, 2017). The exact genetic abnormality has yet to be identified.
In recent years, the title and classification of Asperger syndrome has been the subject of some controversy and change. The American Psychiatric Association voted in December 2012 to eliminate Asperger syndrome as a distinct diagnosis in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, in DSM-5, the condition falls under the umbrella term “autism spectrum disorder” (Autism Research Institute, 2013).
This decision was somewhat controversial, particularly among the Asperger syndrome community. Therefore, although the actual diagnostic label has changed, it is likely that the term “Asperger syndrome” will continue to be used for some time. Also, advocates within the autism community suggest that referring to this disability as a “syndrome” implies that it is a pathology.
As such, it fails to acknowledge the many positive abilities, talents, and potentials of people with Asperger syndrome. As a result, there is a movement to change the title to Asperger profile, which is viewed as a more positive and accurate term (Asperger/Autism Network, 2017).
Children with Asperger syndrome, in addition to having impaired language, communication, and social interaction skills, exhibit distinguishing characteristics such as repetitive rituals, clumsiness, and obsessive interest in a single topic (National Institute of Neurological Disorders and Stroke, 2017).
Although they have good cognitive skills, with average or above average vocabularies, these children may have difficulty modulating the pitch of their voice and speaking in a flat, monotone man (Medical News Today, 2015). Asperger syndrome cannot be cured, but with treatment, many children with this condition can learn to grow into functioning adults.
However, adults with Asperger syndrome may continue to display subtle symptoms of the disorder, particularly in relation to social interactions (Asperger/ Autism Network, 2017; Hughes, 2016).
Teaching individuals with Asperger syndrome presents many challenges, particularly with children. Although the symptoms are typically less severe in adults, teaching involves social interaction between two people, so the adult with Asperger may struggle when communicating with the nurse.
When teaching an adult or child with Asperger, it is important to remember that intellectual disability is typically not present. Therefore, the following teaching strategies should be used by the nurse to help individuals with this syndrome focus and communicate:
Provide multiple cues and a lot of repetition. Children have significantly more difficulty following verbal instructions than do children who do not have Asperger's ( Saalasti et al., 2008). For adults the stress of having to engage in an interaction with the nurse may make it difficult for them to attend to the information being presented (Hughes, 2016).
Avoid using facial expressions, body languages, changes in the tone or volume of speech. People with Asperger tend to miss or misinterpret nonverbal cues (Asperger/ Autism Network, 2017: Falkmer , Bjallmark , Larsson, & Falkmer , 2012).
Things Nursing Educator Should Avoid
Be direct, avoid vague or ambiguous expressions, and stick to relevant topics. Individuals with Asperger syndrome tend to interpret communication in a very literal way and they also have difficulty understanding subtlety in communication. Therefore, when teaching the client, the nurse should be direct, avoid vague or ambiguous expressions, and stick to relevant topics (Hughes, 2016).
Teach skills in context. Individuals with Asperger's often have difficulty generalizing what they have been taught to other situations. For example, if working on specific motor skills, they have practice climbing the steps on the bus or using equipment in the playground (Hayhurst, 2008).
Ask directive questions rather than open-ended questions requiring a lengthy response. Children with Asperger's have limitations in narrative competence; thus, when asked to tell a story, their tale tends to be shorter and less coherent than other children's stories (Rumpf & Becker, 2012).
As with other developmental disabilities, when the patient with Asperger syndrome is a child, parents are often a valuable resource for suggestions on how to relate to their child. Most children will have a treatment plan in place, and parents are taught how to help their children overcome their challenges in communicating, interacting with others, and learning. It is important that the nurse talk about the child's plan with the family to implement strategies that have proven effective.
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