GENDER,

SOCIOECONOMIC,
CULTURAL ATTRIBUTES,
DISABILITIES & CHROMIC
ILLNESS OF THE LEARNER
 Learning Objectives
• Identify gender related characteristic of the
learner.
• Define the various terms associated with
diversity.
• Compare various definitions of the term
disability.
• Summarize the roles & responsibilities of the
nurse educator in teaching learners with
disabilities.
 Gender Characteristics

• Interaction of genetics and environment

• Brain structure in males and females
• Brain functioning in males and females
– affective responses
– cognitive processing
• Gender-related cognitive abilities
– general intelligence
– verbal ability
– mathematical ability
– spatial ability
– problem solving
– school achievement
• Gender-related personality traits
– Aggression
– Conformity and dependence
– Emotional adjustment
– Values and life goals
– Achievement orientation
• Teaching Strategies
– Males and females use different symbols, belief
systems, and ways to express themselves, much in
the same manner that different ethnic groups
have distinct cultures.
– Although stereotypical, males and females have
some general qualities that need to be taken into
consideration when teaching.
 Socioeconomic Characteristics
• Variables affecting health status and health
behaviors
– educational level
– family income
– family structure
• All three variables affect health beliefs, health
practices, and readiness to learn.
• Social Class
– types of indices for measurement
• occupation of parents
• income of family
• location of residence
• educational level of parents
• Social Class (cont’d)
– Poverty circle, low education level results in
occupations with lower levels of pay, prestige, and
intellectual demand; families living at this level
become part of the cycle that does not allow one
to easily change a pattern of life.
• Impact of socioeconomics on health
– Lack of financial resources has a negative impact on
prevention of illness, compliance with treatment, and
motivation to learn; focus is on
day-to-day survival.
• Impact of illness on socioeconomics
– The cost of medical care and supplies can negatively
impact a person’s/family’s financial well-being, especially if
socioeconomic level is already low.
• Teaching Strategies
– directed toward attaining and maintaining
health
– focus on
• avoiding health risks
• reducing illness episodes
• establishing healthful environmental conditions
• how to access healthcare services
Purnell Model for Cultural Competence

Macro level of the paradigm:

1. Global society (outermost sphere)

2. Community (second sphere)
3. Family (third sphere)
4. Individual (innermost sphere)
 Giger & Davidhizar’s Model
Six cultural phenomena:

1. Communication
2. Personal space
3. Social organization
4. Time
5. Environmental control
6. Biological variations
Price & Cordell’s Nurse-Client Negotiations Model

Four steps:

1. Examine personal culture

2. Familiarity with client culture
3. Identify adaptations made by client
4. Modify client teaching based on data
from earlier steps.
The Culturally Competent Model of
Care (Campinha-Bacoste, 1995)
Four components:

1. Cultural awareness
2. Cultural knowledge
3. Cultural skill
4. Cultural encounter
 General Assessment and Teaching
Interventions
• Observe interactions between client and
family members.
• Listen to the client.
• Consider communication.
• Explore customs or taboos.
• Determine the notion of time.
• Be aware of cues for interaction.
 Preparing Nurses for Diversity Care

• Increase minority representation in nursing.

• Strengthen multicultural perspective in
nursing curricula.
• Improve relationship between nurses and
clients from different cultural backgrounds.
 In Summary

There is much more for nurses to know

about how…..gender, socioeconomics and
culture affect the teaching-learning process
before we can competently, confidently,
and sensitively deliver care to satisfy the
needs of our socially, intellectually, and
culturally diverse clientele.
 Definition of Terms

Habilitation: Includes all activities/ interactions

that enable an individual with a disability to
develop new abilities to achieve his or her
maximum potential.
Rehabilitation: The relearning of previous
skills, which often requires an adjustment to
altered functional abilities and altered
lifestyle.
 Educator’s Role in Assessment of
Client Needs
• Nature of problem
• Short- and long-term consequences of a
disability
• Coping mechanisms
• Type and extent of deficits
• Extent of client’s knowledge deficits
• Client’s readiness to learn
• Client’s support system
 Types of Disabilities
• Sensory deficits
• Learning disabilities
• Developmental disabilities
• Mental illness
• Physical disabilities
• Communication disorders
• Chronic illness
Sensory Deficits: Hearing Impairments

• This refers to type of hearing loss (complete

loss or reduction in sensitivity to sounds), the
etiology of which may be related to either a
conduction or sensory–neural problem.
• 1.8 million Americans are deaf and an
additional 10% of people have some degree
of hearing loss.
• Etiology: congenital defect, trauma, or
disease
• Factors Affecting Communication
a. degree of hearing loss
b. length of impairment
 Hearing Impairments (cont’d)
• Modes of Communication to Facilitate
Teaching/Learning:
a. American Sign Language (ASL)
b. lip reading
c. written materials
d. verbalization by client
e. sound augmentation
f. telecommunication devices for the deaf (TDD)
 General Guidelines for Teaching
• Use natural speech patterns; do not over
articulate.
• Use simple sentences.
• Get attention of the client by a light touch on arm.
• Face the client, standing no more than 6 feet away.
• Avoid standing in front of bright light, which
obscures your face.
• Minimize motions of your head while speaking.
• Refrain from placing IV in hand that the client
needs for sign language.
 Sensory Deficits: Visual Impairments
Legal Blindness: defined as vision of 20/200 or
less in the better eye with correction or if
visual field limits in both eyes are within 20
degrees diameter
• More than 2.5 million Americans over age 65
are severely impaired.
• Etiology: infection, trauma, poisoning,
congenital, degeneration
• Factors influencing functionality
a. degree of impairment
b. length of impairment
• Common Eye Diseases of Aging
a. macular degeneration
b. cataracts
c. glaucoma
d. diabetic retinopathy
 General Guidelines for Teaching
• Secure services of a low-vision specialist to
obtain adaptive optical devices.
• Avoid the tendency to shout and to use
nonverbal cues.
• Always announce your presence and
identify yourself.
• Allow the client to touch, handle, and
manipulate equipment.
• Be descriptive in explaining procedures.
• Use large font size for printed or handwritten
materials.
• Avoid color; rely on black and white for
printed materials.
• Use alternative instructional tools that
stimulate auditory and tactile senses.
 Learning Disabilities
• Heterogeneous group of disorders of
listening, speaking, reading, writing,
reasoning, or mathematical abilities
• Other Terms for Learning Disability
– minimal brain dysfunction
– Attention Deficit Disorder (ADD)
– dyslexia
– hyperactivity
 Learning Disabilities (cont’d)

• Approximately 10 to 15% of the American

population is affected.
• The majority have language, integrative
processing, or memory deficits.
• Most have normal or superior intelligence.
 Categories of Learning Disabilities

Input disabilities
• Difficulty receiving and recording information
in brain
• Types of input disabilities
• visual perceptual disorders
• auditory perceptual disorders
• integrative processing disorders
• short-term or long-term memory disorders
Output disabilities
• Difficulty responding orally and/or
performing physical tasks
• Types of output disabilities
• language disorders
• motor disorders
Attention deficit disorders
 General Teaching Strategies for
Clients with Learning Disabilities
• Eliminate distractions; provide a quiet
environment.
• Conduct an individualized assessment to
determine how client learns best.
• Adapt teaching methods and tools to
client’s preferred learning style.
• Ask questions of parents about
accommodations needed if client is a child.
• Use repetition to reinforce messages.
• Ask client to repeat or demonstrate what
was learned to clear up any possible
misconceptions.
• Use brief but frequent teaching sessions to
increase retention and recall of
information.
• Encourage client’s active participation.
 Developmental Disability
• A severe chronic state that is present before
22 years of age, is caused by mental and/or
physical impairment, and is likely to
continue indefinitely
• Public Laws Providing for Special Education
Needs
• Education of All Handicapped Children Act
1975
• Developmental Disabilities Act of 1978
• Individuals with Disabilities Education Act
of 1990 (IDEA)
• General Teaching Strategies
– Keep in mind developmental stage, not
chronological age.
– Provide concrete examples and explanations.
– Simplify tasks.
– Use verbal and nonverbal cues.
– Be consistent; use repetition.
– Encourage active participation.
– Praise positive behaviors and
accomplishments.
 Mental Illness
• Advances in Mental Illness Care
• General Teaching Strategies
– Convey information in a nonthreatening manner.
– Use a straightforward, didactic approach.
– Use various teaching methods to reinforce
information and hold learner’s attention.
– Use humor.
– Provide for frequent break times.
– Practice skills in an informal manner.
 Physical Disabilities

Spinal cord injury

• It occurs most frequently in adolescent and
young adult males.
• Advanced technologies have increased
survival and quality of life.
• Interventions are driven by the goal of
independent living.
• Obstacles to learning readiness
– denial
– lack of physical endurance
– role changes of patient and caregivers
– feelings of isolation
• General teaching strategies
– Use group teaching approach.
– Involve immediate caregiver.
– Invite rehabilitated patients to share experiences.
Brain injury
• Trauma causes changes in behavior,
personality, and/or cognitive ability.
• It occurs most frequently in adolescent and
young adults.
• Cognitive deficits may include poor attention
span, slower processing, confusion, loss of
memory, distractibility, impulsiveness, difficulty
with problem solving.
• General teaching strategies
– Conduct family group sessions.
– Focus on client safety and family coping.
– Give step-by-step instructions.
– Allow time for responses.
– Provide small amounts of information.
– Keep sessions short.
 Communication Disorders

• Deficits affect perceptual and/or language

abilities.
• Most common residual communication
deficits
• expressive aphasia
• receptive aphasia
• dysarthria
• laryngectomy
General Teaching Strategies for Clients
with Aphasia
• Encourage and praise participation.
• Acknowledge client’s frustrations.
• Keep distractions to a minimum.
• Speak slowly using a normal tone and short
sentences.
• Have only one person speak at a time.
• Stand where the client can see your face.
• Check to be sure each message is understood.
• Allow each person time to respond.
 General Teaching Strategies for Clients
with Dysarthria
• Ensure a quiet environment.
• Encourage concentration and intention to improve
speech clarity.
• Ask questions that need only short replies.
• Use alternative methods of communication.
• Encourage client to speak slower and louder.
• Do not simplify message because the client’s
comprehension is not affected.
 General Teaching Strategies for Clients
with Laryngectomy
• Provide a quiet environment.
• Watch client’s lips for clues to articulation of message.
• Do not simplify message because the client’s
comprehension is not affected.
• If client’s speech is not understood, repeat what you
think was said and ask for clarification.
• Use alternative methods of communication.
 Chronic Illness
• Is permanent
• Affects every aspect of life—physical, social,
psychological, economic and spiritual
• Successful management is a life-long process.
• Development of good learning skills is a matter of
survival.
• The learning process must begin with onset of illness.
• Often there is conflict between feelings of
dependence and need for independence.
 General Teaching Strategies

• Acknowledge loss or change in roles.

• Recognize effects of illness on self-esteem.
• Emphasize regimens that match physical
strength.
• Individualize instruction relevant to problems
encountered.
• Encourage integration of new knowledge for
problem-solving.
 Impact of Chronic Illness or
Disability on Family

A. Family Role Adjustments

B. Family Participation in Teaching and
Learning
 Assistive Technologies
Refers to the professional services and the
hardware and software that make computer
technology accessible to persons with
disabilities
• Impact on lives of disabled persons
– has liberated people with disabilities from social
isolation and feelings of helplessness
– enables independence leading to increase in
feelings of self-worth
– useful tool for health promotion
 – Benefits persons with almost any type of disability
• Advocacy role of nurses
– Recommend that clients use computer technology.
– Assist in obtaining appropriate equipment and
training.
• Barriers to computer access
• Types of technologies available
 Summary

• A disability has a tremendous impact on the

lives of clients and their families.
• Successful habilitation or rehabilitation means
acquiring and applying new knowledge and
skills.
• A nurse as educator needs to be well prepared
to help clients learn to live independently.
Thank You!