CARE OF THE COMPROMISED POPULATION:
Physical compromised may be due to different causes:
Injuries.
Developmental disabilities & chronic diseases.
Definitions & concepts:
A disability: any restriction or lack of ability to perform an activity within the normal range of the
human being. Characterized by excess or deficiencies of activity, performance & behavior. These may
be temporary, permanent, reversible or irreversible.
 Impairment: - Is any loss or abnormality of psychological or anatomical structure function.
Impairment is more inclusive than disorder. It means loss the loss of a leg is impairment not disorder.
• Functional limitations: - function of hearing, seeing, grasping. Level of function impaired e.g.
impairment in the strength or range of motion, of the arm could lead to functional limitations in grasping
or reaching, other functions are getting dressed, hair care.
A handicapped: - Is a disadvantage for a given individual resulting from impairment or a disability that
limits or prevents the
fulfillment of a role. Depending on age, sex and others, it is painful physically; emotionally
dealing great of time, effort and money needs include re-defining family and community roles
relationships.
• NEEDS OF THE HANDICAPPED
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Financial stability: many of the handicapped are financially dependent, rely on assistance programs.
 Employment: chronic conditions limit a person’s ability to work. Any discriminating against the
handicapped are prohibited. Work is important to identify the person’s self, and how identified by
others. Work improving persons’ and family quality and life and self-esteem
 Access to resources and services: it is a major barrier occurs to aids and modified transportation.
Health care: they require more services than the general population.
• They can not offer regular medical care, transportation, or expensive or not available. Provide dignity,
privacy, special positioning and comfort.
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Social recreational opportunities: mentally retarded, find great enjoyment in participating in social
recreational activities.
• Community residential opportunities: a handicapped need specialized form of housing and live in the
community independently. After institutional settings the community should be prepared for the person
return, if not the person will be exposed to adjustment’s problems. Families need assistance too. They need
help to re-establish their relationship. Family may have to decide how to ensure adequate care and
responsibilities,
• help him/ her decaling with the guilt feeling inadequacy regarding financial and other responsibilities.
• Factors Affecting the Health of the Handicapped
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Social attitudes: the weakness of the person is not coming from the condition but from the
manner in which others define the respond to it. Negative social attitude may increase their social
isolation, lack of knowledge. Handicapped are being helpless, suffering, dependent and emotionally
unstable.
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The family: families cope differently with the handicapped, making decision regarding
family goals and priorities, use of time family roles and carry-out life activities and
responsibilities such as school, work, and household maintenance
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The stage of grief and mourning: The handicaps have suffered a loss. Loss of health,
independence, control over life, financial stability, grieving is personal experience and of
significant others.
• Rehabilitation and adaptation cannot be successful unless grieving has been
successfully carried out.
The process of grief and mourning •
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Denial: not prepared to accept the reality of the handicap and deny that it is occurring.
• Awareness: the individual/ family realizes
• that handicap is real and feeling of hostility can rise in response to it
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Mourning: active grieves for the loss.
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Depression: realizing the permanent, long-term nature of the condition, and then experiencing
feeling of rejection, helplessness, altered self-esteem. It may take time to recover.
• A deputation: the individual / family become capable of coping with the handicap. The goal is
equilibrium and rehabilitation
• Grieving: is the concept of chronic sorrow, long-term sadness and depression in relation to chronic
illness. It is a form of unresolved grieving\
The age: The age, at which a handicapping occurs also critical to adaptation, it becomes more difficult
after the age of development. Child born without an arm will have a different adjustment process than
a child who loses the arm at the age of 5. The internalized body image makes it difficult to accept
body alteration. Within the age group some problems are normal and usual. (Hearing impairment of
old age people is accepted more than at school age.)
• The rapidity of conditions onset: developing of handicap gradually giving enough time to
develop skills. If occurrence is sudden with trauma there is little or no time to adapt, and even
delay in rehabilitation. With sudden onset body image will be influenced
• The level of disability: the higher level of disability, the more difficult it is to adjust, and how to
conduct all the developmental tasks occupation, utilizing leisure time.
• the visibility of the condition: visible signs and symptoms are more reacted by people
visible condition enhancing more discriminating individual and societal responses
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The value of the handicapped part: the person will be influenced according the part of
body which is more valued.
This is also varying from individual to other. E.g. facial disfigurement.
Attitudes regarding self and about one held by significant others: if such attitudes
are negative, their impact can be detrimental to the outcome of the condition. It has an
effect on the social and psychological adjustment to the person who is handicapped.
Community resources: the handicap will be impeded or altered if the rehabilitation
resources are not available or not accessible
Coping ability: depend on the family coping with the situation. Effective coping help
to reduce tension and maintain equilibrium. That avoids the use of negative selfevaluation, control stressors.
The prognosis of the condition: if prognosis delayed and not show much hope it can
be discouraging client and family. And when the prognosis is more, this will facilitate
the coping adaptation
REHABILITATION
Is the process of restoring an individual to the fullest physical, mental, social,
vocational, and economic usefulness possible?
The goals are to integrate the individual in to society, and provide normal life.
Vocational rehabilitation aims to place a client in a job with a stable employer and good
benefits.
• It involves; assessment of client potential, vocational, education and training.
Providing assistive devices, counseling, long-term care and out-patient setting.
Comprehensive rehabilitation program is multidisciplinary and combine treatment with
physical and occupational therapy and others.
• PROCESS OF REHABILITATION
• The program involves:
• case-finding, inter disciplinary assessment, planning, intervention, and evaluation
• vocational rehabilitation, counseling and placement
• restorative services and retraining
• follows the same process as nursing process
• involves, data gathering, formation of
• diagnosis, rehabilitation prognosis, goals, follow-up and evaluation
• maintain records and plan for discharge
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Program should start as early as possible, to minimize the consequences of the
condition with the family involvement.
THE COMMUNITY HEALTH NURSING ROLE
Resources coordinators, counseling, case-finder, health educator, care provider,
planner, providing primary, secondary, and tertiary care. Use participation. Guidance, plan
long-term implications
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Use self-management techniques, provide support, knowledge and assistance
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Allowing meaningful expression of feelings
Do not use your empathy and encourage dependency
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Utilize community resources for referral
Collaborates with other rehabilitation
members to ensure participation of therapeutic regimen
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Assist client and family to adjust to the changes enhance ability of cope, grow and
adaptation
Support and encouragement and implement care activities
Use of client satisfaction survey for evaluation for better decision making
Encourage explore employment and funding possibilities available
Establish goal for residential placement and evaluation
Help client experience a healthy grieving process and grief resolution
Identify the attitude of client and others and help for positive attitude, which can help in
successful adjustment
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