Racial Discrimination
Racial discrimination among patients can cause care providers to feel hurt and angry. For instance, an African-American man of seventy might act in a curt and angry manner to his white care providers if he distrusts them. An elderly Irish-American woman, with a diagnosis of dementia, is verbally abusive to an African-American nursing assistant. She probably has feared people of color from childhood, and so she is frightened and acts out in negative ways.
Racial discrimination is rooted in fear and has a negative cultural history in America. Different ethnic groups have been taught by word and example to fear each other because they have a different skin color or religious preference. Fear and distrust remain when people need health care services. Nursing assistants learn how to cope with those fears in positive ways.
In Review
- Culture is integrated into all forms of human endeavor.
- Cultural differences are influenced by beliefs about social customs and ethical and moral behavior.
- Cultural differences include biases about age, sex, race, and religion.
People with special needs have physical, mental, emotional, and/or spiritual problems that can cause disabilities that might interfere with their desire to live independent lifestyles. Their chronic, often complex health problems have many causes that can include: intrauterine distress (lack of oxygen to a fetus during pregnancy), birth injuries, childhood illnesses, accidents and injuries, infectious diseases, and adult-onset chronic illnesses.
Physical Disabilities
Chronic physical problems are generally caused by genetic tendencies, disease, or injury. Parkinson's disease is caused by a wearing down of neurons within the nervous system. Janet Reno, attorney general during the Clinton years, has Parkinson's disease and actively functioned in her job. In future years, she probably will require some assistance with daily living tasks (bathing, dressing, eating, etc.). Some children have physical disabilities caused by genetically linked diseases, like childhood cancer or sickle cell anemia.
Developmental Disabilities
Developmental disabilities happen prior to conception or birth or during or after the birth process. Symptoms become evident during infancy and early childhood. Physical disabilities can be caused by central nervous system dysfunction. Cerebral palsy and epilepsy are examples of chronic physical disorders caused by the inability of the brain to work with the body.
Cerebral palsy is caused by the inability of the brain to coordinate and control body movement. People who have cerebral palsy may have mild, moderate, or severe physical problems. Epilepsy is caused when the brain's electrical impulses fail to connect central nervous system nerve cells with muscle nerves and sensory organs (eyes, ears, nose, tongue, fingers, and toes). This central nervous system disorder may cause mild to severe seizures.
Handicapped or disabled: A case study
Cathy J., aged twenty-two, has severe physical problems due to the effects of cerebral palsy. Cathy's problems have existed since birth, and she must cope with involuntary and irregular muscle movements called spasms. Muscle spasms cause her to shake (violently, at times) and interfere with motion activities so severely that she walks sideways and cannot stand still or maintain her balance. She wears an indwelling catheter (a small tube inserted inside her bladder) to send urine from her bladder into a plastic drainage bag that is attached to her wheelchair.
Possessing above average intelligence, Cathy can hear and listens well. She has earned her high school diploma and attends classes at the local community college, where she uses a specially designed wheelchair to get around. Unable to speak, Cathy uses a communication device that allows her to express her thoughts and feelings. She lives in an apartment with a home health aide/companion who assists her with her activities of daily living and drives her to college classes. Cathy is friendly and enjoys being with other people. She loves horses and recently learned how to ride. Her future goals, she says, are to be a writer and someday marry and have children. Cathy is a real person who has chosen an interesting lifestyle, in spite of living with severe physical problems. She may be disabled but, as she says, "I'm not handicapped."
Many people live with chronic physical health problems that cause them to require health care services. They are often cared for at home by home health or personal care aides.
Mental Disabilities
Mental disabilities can interfere with mental functions that involve thinking, learning, recall, and reasoning. According to the American Association of Mental Retardation, mental disabilities can be linked to genetic predispositions: illnesses, accidents, or injuries prior to conception or during or after the birth process. Symptoms can become evident during infancy and early childhood. These children have learning problems and are often retarded. Mental retardation involves intelligence and the inability to think. I.Q. tests for these children show below-average intelligence. Many retarded people can learn to live independent lives; they work and receive counseling about financial matters, social interactions, marriage, and raising a family. Some retarded people work in sheltered workshops and earn a salary. They may remain living at home supervised by family members, or they may choose to live in group homes where they have professional supervision and counseling, enjoy lifetime friendships, and participate in many social activities. Severely retarded people often cannot learn, need daily supervision and assistance with activities of daily living, and can participate only in limited life activities. They usually live at centers designed to give them the special care they require. Retarded people are living until old age; many will require nursing assistant services. The retarded are loving and caring people. Special training is required for certified nursing assistants who want to work with the mentally retarded.
Some mental disabilities are caused by personality disorders that can create faulty thinking patterns. Immature behavior can interfere with some patients' ability to interact in positive ways with their health care providers.
Some people have not met the psychological tasks of childhood or adolescence and enter adulthood with immature personality development. These people often cannot cope with negative situations in positive ways. They tend to avoid personal responsibility for their actions and blame others for their mistakes.
Janet M. is a thirty-five-year-old woman with severe physical problems due to the effects of multiple sclerosis, a genetically linked muscular disorder that affects the body's muscle groups and the nerves that work with them. She has been placed in a neighborhood nursing home because her family members wanted to have her nearby. Janet does not deal well with angry feelings about her physical disabilities. She is sarcastic and sometimes uncooperative when she is cared for by nursing assistants whom she considers to be about her age. Wheelchair bound and assisted with eating, Janet refused to chew or swallow her food when she was displeased with the person who provided her care. She was nasty and demanding whenever short-staffed conditions existed. After many unsuccessful attempts by the unit staff to help Janet deal with her anger, a thirty-six-year-old nurse in charge told her that her negative behaviors were unacceptable and she needed to change her attitude. In response, after Janet was wheeled into her room, she deliberately pulled a wooden wardrobe closet on top of herself. When the staff ran to her assistance she laughed and said "I'm OK, but you guys will be in big trouble now!"
The staff followed established procedures to deal with this incident. Janet's social worker met with her alone. A second meeting was held with Janet and staff members who often cared for her. After these discussions, Janet was told she was an adult of sound mind who was behaving in immature ways and that, in the future, she would be given time out opportunities to deal with her anger and was expected to cooperate with the staff interventions on her behalf.
Addictive Personalities
Medical scientists have discovered that chronic use of drugs like alcohol, cocaine, and heroin most probably have genetic links that are activated by the use of these drugs on a regular basis. Recreational use of these drugs can develop into addictions. Tobacco is an example of a drug that has addictive properties and hooks those who use it. Smoking causes chronic lung and heart diseases and is a causative factor for memory loss because its use often elevates blood pressure. Statistics show that smoking hastens death.
Mental Illnesses
Schizophrenia and manic-depressive psychosis are two major mental illnesses that remain asymptomatic (without symptoms) until the late teen years or at the onset of early adulthood (about age twenty-one), ac-cording to The Encyclopedia of Schizophrenia and the Psychotic Disorders. Onset is aggravated by extreme stress situations that cause fear and anxiety and render those affected unable to cope or function in rational ways.
Schizophrenia is a severe mental dysfunction that affects forty million Americans. It causes irrational thinking and reasoning, feelings of low self-worth, and suicidal tendencies, faulty attitudes, and unreasonable behavior. Some schizophrenics have paranoid tendencies and believe that others are out to harm them. Some experience hallucinatory episodes, have visions, or hear imaginary voices. Schizophrenia can be controlled by psychiatric therapies, supervision, and medication. Schizophrenics can live normal lives. Some schizophrenics experience psychotic episodes that require placement and treatment at psychiatric centers.
Manic-depressive psychosis (also called bi-polar disease) is a severe mental process dysfunction that causes irrational thinking and the inability to make valid decisions, and alternates between mental excitability and mental depression. Manic depressives experience thirty-day mood swings, which means that they are happy for thirty days and sad for the next thirty days. Sometimes they act in erratic ways, one minute laughing and the next minute crying. The onset is aggravated by extreme stress. This mental illness can be supervised and treated by psychiatrists through counseling and medication. Manic-depressives can live normal lives, but some of them experience psychotic episodes that require placement and treatment at psychiatric centers.
Psychiatric Episodes
Psychiatric episodes are periods of time when people cannot think or function in rational ways. Psychiatric episodes can be caused by extreme stress that causes mental process breakdowns and the inability to deal with thoughts and feelings in rational ways. Some psychiatric episodes cause hallucinations and/or delusions. Hallucinations are illusions (figments of imagination) about people, places, and things that are not real and do not exist. Delusions are false beliefs. Persons who are experiencing delusional mental states might believe that they are Madonna, Supreme Court Justice Clarence Thomas, or Mother Teresa. Psychiatric episodes can be caused by chronic use of illegal drugs or alcohol.
Some forms of cancer or illnesses that produce high fevers like malaria can create chemical imbalances within the body that cause temporary psychiatric episodes. Chronic psychiatric episodes require placement in psychiatric centers because rational thinking is impossible. People who experience chronic psychiatric episodes are treated by psychiatrists and other mental health professionals; they are often cared for on a daily basis by nurses and nursing assistants.
Emotional Disorders
Chronic depression and autism are examples of emotional illnesses that have genetic links. People who are depressed often cannot function independently, have low self-esteem, and can be suicidal. Chronic depression happens among many different social groups from children to the aged and can create serious mental dysfunctions that require psychiatric interventions. Recent findings show that chronic depression is also related to the environment and personal reactions to others' behaviors.
Autism is an emotional illness that often occurs in males. Its cause is unknown. Problems during pregnancy and the birth process could be implicated as causative factors. Autism's onset happens by the second birthday. Symptoms include a lack of responsiveness. Examples of lack of responsiveness include the failure of babies to laugh, play, coo, or reach out to touch parents or siblings. Delayed abilities in infants to roll over, sit up alone, crawl, walk unassisted, or speak have been associated with autism.
Early psychiatric treatment is necessary and achieves good results. However, some autistic adults have not benefited from treatment and have difficulty expressing emotions of love, hate, fear, joy, and sorrow in socially acceptable ways. For example, a six-foot-two, twenty-two-year-old autistic man could respond like an angry ten year old when he is frustrated or angry, or may suddenly grab and fondle an unsuspecting and unwilling woman when he is feeling sexually aroused. Some autistic children and adults require housing at special schools where they receive ongoing treatments and learning programs especially designed for them.
Eating Disorders
Parents, family members, and the media who send messages to preteen and teen-aged girls that they must remain slender to be socially accepted set the stage for eating disorders such as bulimia and anorexia. Eating disorders are serious emotional dysfunctions that can be prevented and treated.
Nursing assistants who want to care for people with mental/emotional disabilities must complete a special training course conducted by mental health professionals.
