Students with disabilities are increasing in number at nursing schools throughout the world. Although they may initially encounter discrimination and other obstacles, students with hearing loss, vision loss, paralysis, learning disabilities, mental illness, chronic illness, limb differences and other disabilities have been not only been admitted to nursing programs but have successfully completed them.
If you are someone who loves helping others, nursing is one of the most rewarding careers you could consider. But if you are also a person with a disability, there is important “homework” to do before you make the decision to become a nurse. Nursing is a physically and emotionally demanding educational experience and profession. As you complete your homework, make a list of the pros and cons. Your decision shouldn’t be based on what you “think” a nurse does or what you viewed on a television program. The best way to find out what nurses do is to spend some time with nurses. Learn as much as possible about a nurse’s responsibilities and the technical skills that nurses and nursing students typically perform.
You can gather this information by talking to nurses and nursing students, observing nurses at work, volunteering in a clinic or hospital, spending a day on the job with a nurse or working a part-time job in a health care facility. Doing volunteer work with a nurse at a camp for children with special needs or at a clinic for the homeless can also provide great insights. High school students should consider joining the future nurses organization at their school or taking a health occupations course and joining a chapter of the Health Occupations Students of America.
Additional information about what is involved in nursing careers can be obtained from colleges, universities, technical schools, libraries, nursing journals, nursing associations and the Internet. Some helpful Internet sites to visit include:
ExceptionalNurse.com is a nonprofit resource network for nurses and nursing students with disabilities (www.ExceptionalNurse.com).
The Association of Medical Professionals with Hearing Losses (AMPHL), www.AMPHL.org, provides information, advocacy and support for individuals with hearing loss who are interested in or working in health care fields.
Begin networking with nurses, nursing students or other health care professionals who have a disability similar to yours. Ask these contacts about their experiences and about accommodations that helped them succeed. Find a nurse or student who can mentor you. Do a library search and read all you can about the experiences of other nursing students with disabilities.
Know your rights under the Americans with Disabilities Act and the Rehabilitation Act. Be knowledgeable about reasonable accommodations and the differences in legal protections for students with disabilities in high school and in college–i.e., the differences between IDEA, ADA and Section 504.
Keep abreast of new programs and developing technology, such as standing wheelchairs that will enhance mobility for nurses who use wheelchairs. Clear surgical face masks will allow a nurse to read lips when other members of the surgical team are wearing masks. (The development of clear face mask products is being monitored closely by the AMPHL.) The University of Salford, in England, opened the first nursing program for students who are deaf.
Understanding Admissions Standards
Another important part of your homework is learning about the different educational options available to prospective nursing students and about how to navigate the nursing school admissions process.
There are several different types of nursing programs offered. Registered nurses (RNs) are educated in baccalaureate degree programs (bachelor of science in nursing or BSN), two-year associate degree programs and three-year hospital diploma programs (rare in the United States). Licensed practical nurses (LPNs) are educated in technical schools and community colleges. In general, a BSN program is usually less focused on technical skills.
There are no universal standards for admission to nursing programs, and requirements under state Nursing Practice Acts can vary from state to state. Furthermore, admission decisions can differ from program to program and can be dramatically inconsistent. The same student can be rejected at one school and welcomed at another. Decisions will be made on a case-by-case basis.
Some nursing programs have technical or core performance standards. Examples may include critical thinking, interpersonal skills and communication, mobility, motor skills, hearing, visual and tactile skills. Other programs may have more specific standards, such as being able to lift 25 pounds, physical ability to perform CPR, hearing ability to understand normal speech without viewing the speaker’s face, and manual dexterity to draw up solutions in a syringe.
It is important to recognize that even though you may have a career goal of working in an area of nursing that does not require direct patient care–such as case management, research or teaching–you must still complete nursing courses that will require you to demonstrate a wide range of technical skills, including some that you may not plan to use after you graduate.
If you will need accommodations for your disability in nursing school–such as special equipment, a sign language interpreter, books on audiotape or someone to take notes for you–you will need to provide documentation from your physician, audiologist, psychologist or other health care professional.
Above all, be prepared, be prepared and be prepared. Anticipate a wide range of responses to your disability from administrators, faculty, other students and patients. To deny that you may meet with a negative attitude or response isn’t being fair to yourself or realistic. The important thing is to move forward with your head held high.
Rehearse Your Responses
Mentally rehearse responses to questions you may be asked during nursing school admissions interviews. Always focus on your positive attributes, previous accomplishments and life experiences. Be professional and enthusiastic. Practice interviewing by having someone role-play with you.
You may be asked about how you will perform technical skills with or without accommodations. Some skills you may not be familiar with. Be honest in your responses. Keep the following examples of questions and answers in mind as you plan for interviews.
A student who uses a wheelchair might be asked, “How will you perform CPR?” Sample answer: “First, I will call for help, which is the first recommendation of the American Heart Association when working with adults. Then, I will get up out of my wheelchair. It’s not something that I use all the time; in an emergency like CPR, I would not use the wheelchair.”
A student with one hand might be asked, “How will you give an injection?” Sample answer: “I have developed excellent compensatory abilities and can be creative when learning new skills. I learned to tie my shoes with one hand when I was four years old. When I am required to learn or demonstrate how to give an injection, I will seek extra assistance from the laboratory instructor and practice different methods.”
A student with low vision might be asked, “How will you read a medical chart?” Sample answer: “I will use an optical reading aid.”
A student with a back injury and lifting restrictions might be asked, “How will you make a bed or turn a patient in bed?” Sample answer: “I will ask a colleague/peer for help. In return, I will negotiate work that I can do to help my colleague/peer out.”
A student with hearing loss might be asked, “How will you hear a patient’s beeping monitor?” Sample answer: “I’ve never worked in a hospital. I don’t know if I will be able to hear the monitors. I may need assistive technology that will activate my vibrating pager when a monitor beeps.”
A student with hearing loss may also be asked, “Will you be able to hear the sound of a needle penetrating a patient’s skin?” Answer: “No, I won’t be able to.” (You may be asked this type of question to see if you will respond honestly.)
These examples are not meant to be verbatim responses that applicants should use, unless the response is appropriate. They are included simply as examples of answers that are honest and show that the applicant has researched or thought about the topic.
Go For It!
The future promises to find more and more nurses with disabilities working successfully in this exciting and fulfilling profession. Nurses can practice in a wide variety of settings, such as telephone triage, nursing education, home care, legal nurse consulting, case management, hospital nursing, school nursing, camp nursing, travel nursing, parish nursing, research and more. If you know in your heart that nursing is what you want to do, then do your homework…and go for it!
Today’s nursing workforce needs practitioners from a diverse range of cultures, backgrounds and life experiences to meet the needs of an increasingly diverse patient population, both in the U.S. and around the world. We need you in the ranks of nursing professionals, where you will be a vital part of the health care team. Through your unique contributions and strengths, you will enrich patient care, share your gifts and experiences, and add greater harmony to our profession.
1. Bueche, M.N, and Haxton, D. (1983). “The Student with a Hearing Loss: Coping Strategies.” Nurse Educator, Vol. 8, No. 4, pp. 7-11.
2. Chickadonz, G.H., Beach, E.K., and Fox, J.A. (1983). “Breaking Barriers: Educating a Deaf Nursing Student.” Nursing Health Care, Vol. 4, No. 6, pp. 327-333.
3. Creamer, B. (2003). “Wheelchair Fails to Deter Paraplegic from Nurse’s Life.” The Honolulu Advertiser. Available at http://the.honoluluadvertiser.com/article/2003/Dec/28/ln/ln10a.html.
4. Eliason, M. (1992). “Nursing Students with Learning Disabilities: Appropriate Accommodations.” Journal of Nursing Education, Vol. 31, No. 8, pp. 375-376.
5. Huyer, S. (2003). “The Gift of ADD.” Advance for Nurse Practitioners, Vol. 11, No. 4, p. 92.
6. Kolanko, K. (2003). “A Collective Case Study of Nursing Students with Learning Disabilities.” Nursing Education Perspectives, Vol. 24, No. 5, pp. 251-256.
7. Maheady, D. (1999). “Jumping Through Hoops, Walking on Eggshells: The Experiences of Nursing Students with Disabilities.” Journal of Nursing Education, Vol. 38, No. 4, pp. 162-170.
8. Pischke-Winn, K., Andreoli, K., and Halstead, L. (2003). Students with Disabilities: Nursing Education and Practice (Proceedings Manual). Rush University College of Nursing.
9. Americans with Disabilities Act (1990), Public Law, No. 101-336, 42 U.S.C. 12101.
10. Matt, S.B. (2003). “Reasonable Accommodation: What Does the Law Really Require?” Journal of the Association of Medical Professionals with Hearing Losses, Vol. 1, No. 3.
Because immigrants from Asian countries with large Buddhist populations are a rapidly growing minority group in the U.S., it’s important for nurses to understand Buddhist patients’ beliefs about health, illness and food.
The love of nature and maximum enjoyment of what nature provides us is necessary in order to live a truly natural life. This is the main belief in many Asian cultures, such as those of China, Japan, Taiwan, Korea, Tibet, Sri Lanka, Thailand, India and the Philippines. While Christianity is the dominant religion in many of these countries, there are also significant numbers of Buddhists, along with Muslims, Hindus and atheists.
In the Buddhist faith, life revolves around nature with its two opposing energy systems, known in Chinese philosophy as yin and yang energy. Examples of these opposing energy forces, which are cyclical, include heat/cold, light/darkness, good/evil and sickness/health. Although a simple illness, such as a cold or flu, may be considered an imbalance of yin and yang energy, many Buddhists-though not all-believe that the best way to live a healthy life is to be a vegetarian.
The Buddhist tradition of vegetarianism has gained a great deal of popularity around the globe, as both a diet and a way of life. In the United States alone, there are about 20 million vegetarians. At the same time, in certain Asian cultures there has been a strong movement away from the traditional strict vegetarian diet as a result of these countries’ exposure to Islam and Christianity.
Part of being a culturally competent health care professional is being careful not to make blanket generalizations about patients from unfamiliar cultures-such as assuming that if a patient is an immigrant from an Asian country, he must be a Buddhist. Even if it is known for a fact that the patient’s religion is Buddhism, this does not necessarily mean that he or she strictly follows all Buddhist religious practices to the letter. It is vitally important for nurses to initiate dialogue with patients and their families in order to determine what, if any, cultural/religious needs and dietary restrictions must be accommodated to ensure the best possible healing process for the patient.
Understanding Buddhist Beliefs
The Buddha was born in what is now Nepal and founded Buddhism in India during the sixth century B.C. After Buddha’s death, his followers considered him a divine entity with the ability to lead them to Heaven.
This is a faith of supreme optimism that teaches self-control as a means to search for true happiness. Buddhists practice yoga and meditation as a means to reach spiritual emancipation or true liberation. Through mastering self-control, a Buddhist can reach full potential toward a journey of self-improvement during this life in order to achieve reincarnation, or rebirth after life. The rebirth process requires a desirable state of freedom or purity from primitive human desires and wishes.
The Buddhist code of morality is set forth in the Five Moral Precepts, which are:
1. Do not kill or harm living things.
2. Do not steal.
3. Do not engage in sexual misconduct.
4. Do not lie.
5. Do not consume intoxicants such as alcohol, tobacco or mind-altering drugs.
Buddhists believe that being careful in selecting the food one eats correlates with the amount of light in one’s body and the degree of power necessary to climb up the spiritual ladder-i.e., to reach the desirable state of relaxation and of being sincere to oneself and others. By following this path, one’s soul reaches harmony, the desirable spiritual status and/or the power of virtue necessary to attain the reincarnation process.
Buddhist Dietary Practices
In the teachings of Buddha, this concept of making the right food choices for spiritual enlightenment is exemplified by the “Five Contemplations While Eating.” Essentially, this means that Buddhists are exercising a special force related to “stopping and thinking” about the food they are eating.
(Interestingly, it is believed that the Buddha himself actually died from food poisoning.) A Buddhist asks himself these five basic but essential questions:
1. What food is this? = The origin of the food and how it reached me.
2. Where does it come from? = The amount of work necessary to grow the food, prepare it, cook it and bring it to the table.
3. Why am I eating it? = Do I deserve this food or not? Am I worthy of it?
4. When should I eat and benefit from this food? = Food is a necessity and a healing agent because I am subjected to illness without food.
5. How should I eat it? = Food is only received and eaten for the purpose of realizing the proper way to reach enlightenment.
A Buddhist GlossaryVegetarianism: A diet that includes no meat. In the Buddhist religion, eating a vegetarian diet is a natural and logical ramification of the moral precept against the taking of life. Veganism: A philosophy of life that should be thought of as entirely separate from vegetarianism. It is concerned with an entire lifestyle rather than just a dietary regime. Veganism prohibits not only the eating of animals, animal products and their derivatives-including milk, cheese and honey-but also the use of animal furs, leathers, skins, etc. Vegans believe these products-and even their by-products-must be avoided at both the physical and mental levels to ensure true liberation that facilitates the attaining of enlightenment.Ahimsa: The act of not killing or harming. It refers to the compassionate, non-violent treatment of living things and the acknowledgment of all sentient creatures’ right to live and be reborn. Practicing ahimsa will keep the Buddhist on the right spiritual path and enforces “a better life and better health.”Karma: A sort of spiritual bank account that is accumu-lated through one’s actions in life. Good karma occurs for those who follow Buddhism’s moral precepts; it will lead to being reborn as a higher being, such as a god or wealthy human. Bad karma, which can result from forbidden acts such as killing living things, can cause one to be reborn as a lesser being, such as an animal, insect or demon. Once you pay off your karmic “debts,” you can be reborn as human.
Buddhists who are strict adherents to their faith depend not only on these Five Contemplations but also on the Five Moral Precepts to determine which foods are appropriate to consume and which are considered forbidden. In general, Buddhism prohibits the eating of any and all meat, because (1) the killing of animals violates the First Moral Precept and (2) meat is considered an intoxicant to the body, which violates the Fifth Moral Precept.
According to the Fifth Precept, consuming any type of intoxicants will reflect negatively on a Buddhist’s life and afterlife in the following ways:
o Effects on Self: It will distort and cloud one’s samadhi-i.e, it will hinder one’s judgment and decrease proper concentration necessary for meditation, which is the path to enlightenment.
o Effects on Others: It will increase one’s susceptibility to commit crimes and do wrong to others, which means loss of the desirable self-control.
o Religious/Spiritual Effects: It can cause bad karma (see Glossary) that harms other sentient beings and later on will haunt the original being.
Buddhists believe that whoever lives only for pleasure loses his soul’s harmony and the power of virtue. According to the “no killing” precept, whoever kills animals or eats meat will lose the “purity of both body and mind”-i.e., one gets all mixed up with the meat one eats and loses purity, clarity and the power of self-control. Buddhists also believe that causing the suffering of living creatures just to satisfy our taste buds is not a justifiable reason to eat meat. In Buddhists’ eyes, hunger is the minimal expression of compassion that can be offered and becoming a vegetarian is a choice-i.e., choosing not to kill animals (out of kindness) and not to eat them (out of compassion).
In addition to the physical suffering of animals, Buddhists believe that eating meat also causes another type of suffering: bad karma. Killing a sentient being forces it to begin a painful process of rebirth. Since Buddhists believe it is possible for animals to attain enlightenment, killing them deprives them of that chance. Eating a vegetarian diet helps ensure that the cycle of karmic retribution will be purified:
If you don’t eat animals, they won’t eat you. If you don’t kill them, they won’t kill you.
Other foods that may fall into the “forbidden” category include “the Five Pungent Spices.” This refers to onions, scallions, chives, garlic, etc. Traditionally, Buddhists have believed that a person who eats these foods will suffer the following ill effects:
His blood and flesh will be rejected by the gods, and the heavens will distance themselves far from him.
His breath is always foul; therefore, all gods and saints will reject him.
If eaten cooked, these foods will arouse lust and cause explosive temper.
If eaten raw, they will increase one’s anger and cause bad body odor that will not please the gods but will stimulate interested “hungry ghosts” who will hover around and kiss one’s lips. Being near ghosts is believed to hinder one’s enlightenment.
Today, however, many vegetarians around the world, including some Buddhists, may eat the Five Pungent Spices without reservation. For Buddhists, this depends on such factors as the person’s degree of adherence to their faith, whether they are practicing Buddhism along with other faiths, and their geographic location.
Health Benefits of the Buddhist Diet
Examples of permitted foods that are staples of the traditional Buddhist diet in many Asian cultures include:
1. Boiled or stir-fried noodles flavored with aromatic spices. Raw or cooked vegetables, seaweed and home-prepared dried food items can also be added.
2. Rice, which can be cooked and flavored in many different ways-e.g., salty, sweet, neutral, sticky, colored or mixed with vegetables.
3. Soy sauce is an essential tasty ingredient that is added to almost every dish, in much the same way as Americans flavor many of their foods with butter and/or salt.
4. Sesame oil is also used heavily in preparing food. Unlike soy sauce, it contains no sodium.
5. Buddhists who are not strict vegetarians will eat fish on an almost daily basis and/or will add it to many of their meals.
6. Herbal tea is a popular and healing drink that originates from various types of tea plants.
For centuries Buddhists have believed that when meat is eaten it accumulates in the body, turning into harmful toxins. Today, modern medicine seems to be proving them right. A number of recent scientific studies have discovered a high incidence of cancer within populations that consume large amounts of meat. Other negative health consequences that have been linked with eating meat include arterial sclerosis, heart disease, high blood pressure, encephalitis, stroke, gallstones and cirrhosis of the liver. All of these conditions are directly related to consuming fat and cholesterol.
According to the Encyclopaedia Britannica, meat does in fact contain wastes and toxins, such as uric acid, that have negative effects on blood and body tissues. In contrast, vegetable proteins obtained from nuts, beans and legumes are decidedly healthier and safer. Furthermore, meat, meat products, poultry and seafood all spoil easily within a few hours, but most vegetables stay fresh for several days. Although beans may become rancid relatively quickly, the deterioration is much easier to detect and recognize compared to spoilage in meat, which may not always be detectable by smell or taste.
Cultural Competence Tips for Nurses
When caring for patients who are followers of the Buddhist religion, nurses need to understand that the patient’s main goal is to bring back the body’s yin/yang equilibrium that was disrupted because of illness. It is helpful to first discuss the patient’s illness and care plan in relation to this concept before volunteering a medical or patho-physiological explanation. Because of the supreme importance of nature in Buddhists’ lives, a culturally sensitive medical team will want to prescribe both herbal medicine and pharmaceutical medications, if appropriate. Remember, in these patients’ eyes the goal is not curing but rather maintaining peace of body and mind that will ensure the rebirth process after death.
In terms of dietary assessments, the first step is obviously to find out whether the patient is a vegetarian, how strict or liberal he/she is in following the traditional vegetarian diet and whether there are any other dietary restrictions the patient must observe. The risk of vitamin B12 deficiency among pure vegetarians can be managed by increasing their daily intake of the different types of vegetable proteins.
Buddhist patients staying in a hospital that only serves American-style food may appreciate being provided with a bottle of soy sauce that they can keep in their room to flavor their meals in the way they are accustomed to. The rule of thumb is: When in doubt, ask the patient what he or she would prefer. Be sure to check the labels on different soy sauce products for their sodium content, which can range from 300 grams to as much as 1,080 grams.
Gihan ElGindy, MSN, RN, is an educator and independent consultant on health, nursing, cultural competence, education and business entrepreneurship issues. She is the executive director of the Transcultural Education Center (TEC) in McLean, Virginia. For more information about TEC, visit www.tecenter.org.
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