smiling senior patient in wheelchair talking with nurse
Profiles and Features May 5, 2017

Nurse Tips for Working With Patients With Disabilities

As a nurse, you're likely to have frequent contact with patients with disabilities and may be concerned about ensuring these interactions are positive for everyone involved. How do you distinguish yourself as a caregiver who offers medical services and advocacy with compassion and respect? Follow these tips, below. 

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7 Nurse Tips On Caring For Patients With Disabilities

1. Recognize that nonverbal does not equal lack of cognition

When faced with a patient who is nonverbal, it can be easy to assume the lack of verbal communication is an indication they are not aware of their surroundings or do not understand their situation. Unfortunately, this mistake can lead to uncomfortable responses and reduce the patient's trust in the caregiver. 

"Many times, these patients may have behavioral episodes precisely because their caretaker or clinician began some procedure without letting them know beforehand," says Rafael E. Salazar II, MHS, OTR/L, President and CEO of Rehab U Practice Solutions. "I always tell people that, even if they think it doesn't matter, as clinicians we need to treat every patient we work with as if they are fully aware of what's going on."

2. Maintain constant communication with patients who are blind

Patients with vision impairments or blindness cannot rely on environmental cues or those given through body language. Every action must be explained verbally to prevent startling your patient or provoking a defensive reaction. This can also help your patient retain some control over the situation by offering empowerment through knowledge and understanding. 

Robert Sollars, a blind patient who has experienced these situations, explains, "For anyone who is disabled and depending on their senses to tell them what is going on, this can be quite disconcerting."

A few nurse tips Sollars offers include:

1. Speak to the patient rather than their family member when asking questions.

2. Do not touch the patient unannounced.

3. Verbally communicate any action you plan to take.

4. Talk to a blind person the same way you would a patient with full vision.

5. Don't enter or leave the room without a verbal announcement.

3. Ask the advice of patient or the caregiver

Patients with disabilities and those assigned with their regular care will have extensive knowledge of preferences and things to avoid. This is especially true when it comes to young patients with disabilities. "If the patient has a disability, I ask that patient or parent how they usually do something or prefer to do it," says Kirstin Kent, RN CRRN, CPST, at Shriners Hospitals for Children. "They are often already experts in their own care."

4. Consider the impact of your language

Be aware of the many terms patients with disabilities are subjected to, and never assume what your patient will feel if you use any of them. Some will prefer to be referred to as disabled, while others may take offense to it. Also, try not to inadvertently define your patients by their disability and lean towards "people-first" language. Rather than labeling someone as an "autistic child," change the wording to be "child with autism." This puts the emphasis on the patient's humanity and forces the nature of the disability to be secondary. If you're unsure of how a patient wishes to be addressed, just ask.

5. Make use of communication and assistive tools available in the facility

Many hospitals and clinics have tools and staff available to help ease the communication barriers when caring for patients with disabilities. With patients who are nonverbal or deaf, most facilities will have picture cards to help nurses communicate directly or access to an employee who is fluent in American Sign Language (ASL). For patients who are blind, hospital directional signs on walls are often imprinted with braille to help them navigate the halls. Offer or point out these services to give your patients the option of taking advantage of them.

6. Ask before helping with mobility

When working with a patient with a mobility impairment, it may be instinctual to give assistance. However, it's important to ask the patient if they want assistance before taking any action and respect their wishes if they decline the offer. For many patients with disabilities, retaining independence is important, and the assumptions made by those with good intentions can inadvertently make the patient feel defensive. Taking a moment to ask the patient if they want your help gives them the option to decline with dignity or accept while still maintaining control over their lives.

7. Be mindful of unapparent disabilities

There are many disabilities that are not easily recognizable, especially for those with conditions or abnormalities that affect the brain or nervous system and those with developmental delays. When caring for patients with disabilities of this type, keep their condition in mind when interpreting behavior. It's common for these patients to display unusual behavior that is actually quite normal for their situation. Also make sure you keep your focus on the patient and communicate clearly. Those with brain impairments may have difficulty understanding complex sentences but will still be the best source of information for you to provide care.

The most important nurse tip to remember is to treat patients with disabilities as individuals. Just as able-bodied patients have a spectrum of preferences and triggers, patients with physical or mental impairments do as well. Keep communication clear and directed at your patient, be sensitive to possible language triggers and take the time to ask about anything you are unsure of. When caring for patients with disabilities, these nurse tips can help you avoid some of the more obvious pitfalls and give you an opportunity to earn your patient's trust.

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