Learning Objectives
By the end of this section, you will be able to:
- Identify the definitions of a disability
- Recognize the prevalence of disability
- Describe different categories and types of disability
Understanding the complexities of disability helps nurses care for specific individuals with single or multiple disabilities. Nurses must know how a physical, cognitive, or social impairment affects an individual, their interactions with others, and the appropriate level of care required. Nurses also must understand the prevalence of disability to create a culture of acceptance and inclusion for individuals with disabilities. Definitions of disability guide federal regulations and societal participation. The interplay between different types of disability is also vital in creating an individualized care plan.
Definitions of Disability
A mental or physical condition that limits an individual’s ability to engage in daily activities in a typical way is called a disability and affects individuals, interpersonal relationships, families, and communities. Nurses must recognize specific impairments and know how to respond to individuals with these impairments. Care planning maximizes the quality of life for individuals navigating an impairment, whether mental, physical, cognitive, or developmental. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) define a disability as a restriction of an individual's ability to perform specific physical or cognitive activities in their environment within the expected range for individuals of their same demographic group (CDC, 2020a).
Impairment
An impairment occurs when the loss of one’s physical or mental ability inhibits usual or expected functioning, such as vision loss, limb immobility, and memory loss. By this definition, an impairment may lead to a disability. Disability and impairment are closely related, with an impairment typically causing or resulting in a functional disability. The Americans with Disabilities Act (ADA) and the CDC further add that disability from physical or mental impairment limits at least one significant life activity and creates participation restrictions by limiting specific interactions with one’s environment and community (ADA National Network, 2024).
A structural impairment describes problems with an external or internal part of the body, whereas functional impairment describes restrictions or difficulties in the ability to perform activities effectively due to the loss of functioning in a body part. For example, structural impairments may include hearing damage, congenital blindness, or limb amputation, causing a patient to face hearing, seeing, or mobility challenges. Functional impairments may result from conditions such as chronic pain associated with arthritis or cognitive decline related to progressive disorders such as dementia, causing a patient to be unable to perform self-care or properly manage finances.
Societal Participation
Based on the International Classification of Functioning, Disability, and Health (ICF), individual activity level and social participation relate to specific functional abilities (CDC, n.d.). Activity level and societal involvement exist on a continuum. By understanding these concepts, nurses can identify barriers for individuals with specific disabilities and provide care plans and advocacy to improve care, quality of life, and overall community functioning. An individual’s activity level refers to their ability to perform specific actions, including:
- achieving transportation throughout the community
- applying newly learned information
- changing body positions
- managing home-care tasks
- managing self-care tasks
- moving independently within their home
- moving items within their environment
- performing activities of daily living (ADLs)
- using mobility assistance devices
An individual’s participation level often refers to their ability to function in the wider community and participate in activities and social roles such as:
- engaging in community events and activities
- engaging in social activities
- family care (e.g., cooking, cleaning, transportation)
- life roles (e.g., parenting)
- maintaining or obtaining employment
- managing finances
- seeking education (e.g., going to school, personal learning)
Because individuals with disabilities often encounter barriers, accommodations (adjustments and modifications in the physical environment to meet the needs of individuals with disabilities) are often necessary. These accommodations may include providing interpreters, modifying or adjusting a job or job site, providing headphones or other accessible technology to reduce challenges and allow individuals with disabilities to perform personal actions, maintaining independence, and engaging in the community and society effectively (CDC, 2020b).
Studies show that individuals experience many challenges associated with societal participation regardless of the type of disability (Kim & Namkung, 2023). Barriers may be socioeconomic or related to social policy and can affect the overall health and social inclusion of individuals with disabilities. Barriers can be seen in the accessibility of buildings, access to health care, social engagement, and discrimination (actions or beliefs that show an unjust distinction between people on the grounds of sex, age, ethnicity, or disability) behaviors of others (Kim et al., 2023). If an individual with a disability is restricted from entering a public university event because modifications are not in place to accommodate their disability, this is an example of discrimination. Although these barriers can lead to a sense of isolation, nurses can advocate for healthy interactions and appropriate accommodations to reduce barriers for those with disabilities (Kim et al., 2023). External support is crucial, and this is where nurses can work to empower individuals and community members to create an atmosphere of inclusion and acceptance (Figure 42.2). Nurses can empower individuals to seek out opportunities for social engagement. By embracing their disability, individuals can seize opportunities to enlighten others about their diverse spectrum of abilities and share their unique experiences in navigating daily life with these distinctive attributes.
Prevalence of Disability
The prevalence of disability among U.S. adults is high, with up to one-fourth of the population experiencing some physical, cognitive, functional, or sensory disability (CDC, 2021). The most common disabilities are related to impairments in mobility (1 in 7) from disease states such as multiple sclerosis (MS), arthritis, or cerebral palsy and impairments in cognition (1 in 10) from disorders such as dementia, autism spectrum disorder (ASD), and brain injury (CDC, 2016). This proportion is higher in rural communities, with up to one-third of these populations experiencing disability, particularly multiple disabilities (CDC, 2021). People living in rural settings may also lack support services, have limited healthcare access, and experience barriers related to long-distance transportation. In adults older than 65 years, the incidence of disability increases to nearly 40 percent in the general population (CDC, 2020). The CDC also reports that in adults, disability is more prevalent in women, older adults, and those of low socioeconomic status (CDC, 2020). Interestingly, despite a higher rate of disability, older adults may have increased access to support services and healthcare programs compared with younger adults, due to federally funded insurance programs.
Statistics show that 17 percent of children from toddlers to teens (aged 3-17 years) live with a disability, an many live with more than one condition (CDC, 2021; Health.gov, 2020). These disabilities encompass all types of impairments; however, there has been a shift in prevalence from physical conditions to developmental and behavioral disabilities (Health.gov, 2020). Some recent reports suggest that nearly one-fourth of teens struggle with a mental, emotional, developmental, or behavioral disability that affects their daily lives (Cornell University, 2018).
Multiple Disabilities
It is not uncommon for individuals to experience multiple disabilities simultaneously. Structural and functional impairments are often interrelated and create a wide range of disabilities; for example, a physical impairment associated with cerebral palsy may lead to a difficulty accessing buildings with stairs (Table 42.1). These may include sensory, mobility, self-care, and cognitive disability. Having multiple disabilities can affect individual activity levels as well as societal participation on many levels. Individuals may have difficulty performing day-to-day functions as well as accessing learning, employment, and healthcare opportunities in the community. Although disability does not equate to poor health, the CDC reports that individuals with disabilities have significantly higher rates of chronic illness as well (CDC, 2023). Specifically, individuals reporting at least one disability also have higher rates of depression, obesity, diabetes, and heart disease (CDC, 2023). Multiple disabilities can accumulate over time due to aging, injuries, or disease progression. Individuals may also have a simultaneous disability from a young age. These disabilities are typically related to conditions such as cerebral palsy, developmental delays, genetic disorders, intellectual disability, sensory impairments, and ASD.
| Impairment | Possible Resulting Disability |
|---|---|
| An individual is deaf or has a significant hearing impairment |
|
| An individual is blind, legally blind, or has a significant vision impairment |
|
| A person has trouble concentrating, remembering, and making decisions, because of a mental condition |
|
| A person struggles walking up and down stairs, maneuvering with an assistive device, has frequent falls related to physical weakness |
|
Federal Legislation
Federal laws, legislation, and rules are in place nationally and in most states in the United States to protect and provide an atmosphere of inclusion for individuals with disabilities. These laws protect the rights of individuals with disabilities to receive equal opportunities for services, employment, transportation, education, and health care. Sections of the Americans with Disabilities Act (ADA), initially signed in 1990, protect the rights of individuals with disabilities and prescribe requirements for appropriate accommodations. These accommodations are seen throughout the community in stores, hotels, schools, movie theaters, doctors' offices, and homeless shelters (U.S. Department of Justice, 2020). Federal legislation also mandates appropriate accommodations for communication through telecommunications relay services for those with hearing and speech disabilities. The ADA requires employers, schools, and places of business to provide accommodations such as:
- entrance for service animals
- furniture spacing
- interpreters
- ramps
- restroom modifications
- schedule flexibility
- screen reading and computer software
- video phones
In addition, multiple acts of legislation have been passed to ensure accommodations for voting access for individuals with disabilities, including assistance with filling out forms, accessing voting sites, and accessing electronic voting options. The Individuals with Disabilities Education Act (IDEA), enacted in 1975, requires that all children with disabilities receive appropriate and free education through the public education system. The regulations require special education and outline guidelines for creating individualized education plans (IEPs) for children with disabilities.
Link to Learning
IDEA requires that all children with disabilities receive an IEP as part of their inclusion in public school. This site details the school nurse’s role in creating an IEP.
Categories and Types of Disability
Although not all individuals experience disability in the same way, recognizing specific categories of disability will help nurses anticipate possible barriers and better address the environment to accommodate specific impairments. The ADA regulations cover many disabilities and impairments caused by chronic or progressive conditions. Disabilities covered include sensory impairment, mobility impairment, intellectual disabilities, developmental disabilities, and cognitive disabilities. The ADA also includes specific medical conditions that may cause specific impairments as well as cancer, diabetes, post-traumatic stress disorder (PTSD), human immunodeficiency virus (HIV), autism spectrum disorder, epilepsy, and depression, among other conditions and illnesses.
Disabilities may be acquired throughout life, or an individual may be born with impairments that lead to disability. Depending on the underlying condition or cause, individuals may have one or multiple impairments contributing to disability.
Link to Learning
Individuals with various disabilities struggle with digital accessibility, which creates significant barriers to communication and overall accessibility to information. The information at this link addresses these difficulties and helps nurses adjust communication and education techniques.
Sensory Disability
A sensory impairment includes any difficulty an individual has with one of their five senses. In contrast, sensory disability encompasses a broader range of limitations related to sensory processing and integration, affecting not only the reception but also the interpretation and response to sensory stimuli, potentially affecting various aspects of daily functioning. When an individual experiences loss of a sensory function, such as vision, the way they interact with the environment is affected. For example, when individuals gradually lose their vision, their reliance on other senses to receive information from the environment is often enhanced. Approximately one-half of individuals aged 75 years of older have hearing loss (NIDCD, 2024). Good hearing depends on a series of events that change sound waves in the air into electrical signals. The auditory nerve conducts these electrical signals from the ear to the brain through a series of steps. Age-related hearing loss (presbycusis) gradually occurs in most individuals as they age (Cheslock & De Jesus, 2023). Typically, low-pitched sounds are easiest to hear, but it often becomes increasingly difficult to hear normal conversation, especially over loud background noise. Hearing aids are commonly used to enhance hearing.
Vision impairment is also a common sensory impairment that can lead to disability. Specific impairments or vision disorders that affect vision include macular degeneration, cataracts, glaucoma, diabetic retinopathy, and presbyopia (loss of near vision).
Kinesthetic impairments, such as peripheral neuropathy, affect the ability to feel sensations. Symptoms of peripheral neuropathy include pain, burning, tingling, and numbness in the extremities that decrease a person’s ability to feel touch, pressure, and vibration. Position sense can also be affected, making it challenging to coordinate complex movements, such as walking, fastening buttons, or maintaining balance when one’s eyes are closed. Peripheral neuropathy is caused by nerve damage that commonly occurs in patients with diabetes mellitus or peripheral vascular disease. Physical injuries, infections, autoimmune diseases, vitamin deficiencies, kidney diseases, liver diseases, and some medications can also cause peripheral neuropathy.
Sensory impairments become disabilities when these impairments result in challenges and barriers to independence. Depending on the severity of the impairment, sensory disabilities require accommodations to assist individuals to function in their homes and the broader social environment. Individuals with sensory impairments are at increased risk for falls and injury, so it is essential to encourage basic safety features in the environment, including adequate lighting, availability of handrails and grab bars, hazard-free walkways, and appropriate settings on water heater controls.
Patient Conversations
Vision Impairment
Scenario: Joanna is an 81-year-old patient who lives next door to her daughter’s family. She lives independently, continues to drive, and does her own grocery shopping, housework, and yard work. She presents to her primary care provider’s office to discuss concerns about worsening eyesight. After the nurse, Summer, takes her vital signs, Joanna states she is worried that her family is going to take away her driver’s license.
Nurse: Tell me why your family is worried about you driving.
Patient: I was diagnosed with macular degeneration a few years ago, but I’m starting to notice more trouble with my vision. I am mainly worried about not being able to get to my activities because my daughter is so busy shuttling her children to activities. I’m so used to being independent, but I don’t want to get in an accident. I did hit our mailbox with my car a few weeks ago, pulling into the driveway.
Nurse: It sounds like you may also be worried about your driving ability, but you don’t want to lose your independence, is that right?
Patient: Yes, exactly. I take my vitamins and eat healthy, but my eye doctor says this is not curable. I’m wondering what else I can do.
Nurse: Our community has an excellent public transportation system, and buses are small and have grab bars for getting on and off. Let’s look at the map to see if it follows routes that would be helpful for you. Also, did you know that the community senior center offers a rideshare program?
Patient: I’m not sure I’ll be able to afford the bus passes, but I’m interested in the rideshare program.
Nurse: Based on your vision impairment, the provider may be able to help with paperwork to get you discounted access to public transportation. I will start the paperwork and get you the rideshare contact information.
Patient: Thank you for your help. This helps me feel less afraid. It’s hard enough to lose my vision slowly, but losing all my independence is just as hard.
Physical Disability
A physical disability refers to any condition that limits a person's physical functioning or mobility. Physical challenges commonly affect an individual's mobility, often stemming from impairments in their legs, arms, or fingers. According to the CDC (2020b), mobility disabilities are the most reported disability in adults. Physical disabilities are five times as common in adults with low socioeconomic status than in those with higher incomes (CDC, 2020b). These impairments and resulting disabilities may be short or long term and may be temporary or permanent. Because movement is impaired to some degree, these individuals struggle with walking, navigating stairs, reaching, lifting, carrying, and gripping.
Link to Learning
Learn more here about how you can assist your patients with mobility disabilities to obtain a disability parking permit, including where to find applications and state-specific eligibility criteria.
Permanent mobility impairments may be static or progressive but do not improve over time. Nursing care for these permanent disabilities focuses on the management of associated disease factors, achieving the highest possible quality of life, and managing complications associated with physical impairment. Injuries, disorders, and diseases that may lead to physical disability include arthritis paralysis, amputation, spinal injury, muscular dystrophy (MD), MS, cerebral palsy, and traumatic brain injury (TBI).
Clinical Safety and Procedures (QSEN)
Quality and Safety Education for Nurses (QSEN) Competency: Teamwork and Collaboration
Definition: Function effectively in an interdisciplinary team, focusing on appropriate communication and individualized patient care.
Knowledge: Nurses must collaborate with a team of other providers when providing care for individuals with physical disabilities. Team members will depend on individual patient circumstances. This may include collaboration for individuals with acquired physical disability, disease-related progressive disability, or congenital physical impairments. A team approach will enhance patient care options and strengthen relationships with specialized providers such as physical, occupational, speech, and psychological therapists.
Skill: Nurses can be alert for signs of progressive physical impairment, new barriers to mobility, and challenges in coping with physical disability. The nurse can show leadership by advocating for additional therapies, updated mobility assistance devices, and mental health support. The nurse focuses first on the patient's needs and desires. Incorporating patient input empowers patients with a physical disability with autonomy and independence.
Attitude: Effective and positive communication techniques enhance the relationship between the healthcare provider, patient, and nurse, creating an atmosphere of collaborative support.
Developmental Disability
A developmental disability (a condition due to an impairment in learning, language, behavior, or physical function) are often congenital (a condition present at birth) or develop during childhood and may be related to impairments from specific disorders such as ASD, cerebral palsy, Down syndrome, fetal alcohol syndrome and spina bifida. Developmental disabilities may also result from genetic disorders that are not known until later in childhood, brain injury, and intellectual differences. Developmental disabilities are those impairments that affect an individual’s ability to develop along a standard childhood timeline. These disabilities may make it difficult for them to learn, grow, and progress intellectually at expected rates. The CDC reports that one in six children has a developmental disability (CDC, 2021). Developmental disabilities may be related to fetal injury or infections during a mother's pregnancy, to chromosomal conditions, or birth complications. Developmental impairments may also be associated with disorders such as attention-deficit/hyperactivity disorder (ADHD), attention-deficit disorder (ADD), hearing and vision problems, and learning difficulties.
Autism spectrum disorder is both a developmental and neurological disorder (NIMH, 2024). The CDC recognized ASD as affecting social functioning, communication, and maintaining appropriate behavior (CDC 2024a). The condition has many variations in symptoms and severity. Autism spectrum disorder can be difficult to identify through physical attributes, and the severity of ASD varies widely between individuals. The CDC states that ASD symptoms typically begin before the age of 3 years; however, they may not be noticed or identified until much later, even into adulthood (CDC, 2024a). Some individuals live and function independently, whereas others may need constant support. Common comorbid disorders include depression, anxiety, ADHD, and learning differences.
Cognitive Disability
A cognitive disability refers to a condition in which a person has limitations in cognitive functioning and adaptive behavior stemming from disorders in brain functioning. Disorders that can cause cognitive disability include TBI, stroke, or dementia. In the case of dementia, cognitive disability is progressive and causes greater difficulty for the individual, caregivers, and family over time. Nursing care focuses on maintaining safety, autonomy, and quality of life. Acute damage to the brain, such as stroke or TBI, causes variable levels of disability depending on the severity of the injury and the part of the brain affected. Due to the complexities of brain functioning, damage to the brain and cognitive disability may also be associated with sensory and physical disabilities.
Link to Learning
Learn more about caring for older patients with cognitive impairment.
Intellectual Disability
An intellectual disability is a neurodevelopmental condition characterized by significant limitations in intellectual functioning and adaptive behavior, which manifest during the developmental period. These limitations affect areas such as reasoning, problem-solving, communication, and social skills, affecting an individual's ability to effectively navigate daily life and engage in age-appropriate activities. Intellectual disabilities share some commonalities with cognitive, developmental, and psychiatric disabilities. Intellectual disabilities are a type of developmental disability that affects cognitive rather than physical abilities. Intellectual disabilities such as ADHD, dyslexia, and other learning differences may affect one’s behavior, ability to learn on an expected timeline, and function as expected in social situations. Intellectual disabilities may arise from congenital and genetic disorders such as Down syndrome, birth trauma, prenatal infections, or even infections in the neonatal period. Intellectual disabilities often become more apparent as the child ages.
Psychiatric Disability
A psychiatric disability refers to a condition characterized by mental health challenges or disorders that significantly impact an individual's cognitive, emotional, or behavioral functioning, leading to difficulties in daily life and social interactions. Some mental health disorders may coexist with cognitive disorders, such as ASD, dementia, and brain injuries. Not all mental health disorders are disabilities. When mental health disorders begin to disrupt daily functioning at home, work, and in the community, disability may result. Examples of mental health disorders that can progress to a state of disability include eating disorders, PTSD, anxiety, depression, bipolar disorder, schizophrenia, obsessive compulsive disorders, and phobias.
Nurses must understand that psychiatric disabilities may have varying causes. For example, individuals may experience PTSD and anxiety related to childhood trauma, a car accident, or exposure to war. Triggers for these types of disabilities are highly dependent on each response. Two individuals experiencing the same traumatic event may have vastly different responses; one person may develop disabling PTSD and anxiety, and the other may not. Substance abuse disorders may also trigger short-term or long-term disability in individuals, based on the severity of the substance use disorder and the presence of other mental health disorders.
Psychiatric disabilities may affect how individuals interact in school, the workplace, or social situations. They may affect sleep and cause a variety of other symptoms, such as agitation, trouble concentrating, suicidal ideation, and appetite changes. A mental health disorder becomes a disability when someone is unable to manage the symptoms of the disorder to maintain normal daily function.
Acquired Disability
An acquired disability refers to physical, cognitive, sensory, or psychological impairments that occurs after birth, typically as a result of injury, illness, or environmental factors. Unlike congenital disabilities, which are present at birth, acquired disabilities develop later in life and can be caused by various factors such as accidents, trauma, infections, chronic health conditions, or degenerative diseases. These disabilities may vary in severity and can have significant impacts on an individual's functioning, independence, and quality of life. In injury-related disability, individuals experience a significant and often sudden change in functional ability. Examples of diseases and injuries that may result in acquired disabilities include head trauma, brain tumors, eye damage, ear damage, MS, stroke, amputation, musculoskeletal injury, emotional trauma, and severe infection.
Acquired disabilities may pose different physical and emotional challenges for individuals due to the significant change in their ability to function. These changes and perceived loss of function can result in a grief response. For individuals with progressive diseases, this can be an ongoing struggle to cope with declining function. Nurses not only must take care to address the functional aspect of an acquired disability but also the emotional impact the experience of loss has on an individual.