B.

P KOIRALA INSTITUTE OF HEALTH

SCIENCES
COLLEGE OF NURSING
DHARAN, SUNSARI.

LESSON PLAN

“Care of Handicapped in Community”

Submitted To: Submitted By:

Ms Dewa Rijal Sugam Pokharel

Assistant Prof. Roll no: 468

Community Health Nursing B. Sc. Nursing, 4th year

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INTRODUCTION OF SESSION
Subject: Community Health Nursing

Unit 4 : Care of Special group

Topic: “Care of Handicapped in Community”

Venue: Classroom of B.sc Nursing 2nd year

Date: 19-01-2023

Time: 11am

Duration: 1 hour

Number of participants: 34

Level of participants: B.Sc. Nursing 2nd year students

Language: English and Nepali

Name of Supervisor: Mrs.Deva Rijal, Assistant Professor

Name of Student Teacher: Sugam Pokhrel, B.Sc Nursing 4th year

GENERAL OBJECTIVES
At the end of this teaching-learning session, B.Sc Nursing 2nd year students will be able to describe about
care of handicapped in community.

SPECIFIC OBJECTIVES
At the end of this teaching-learning session, B.Sc Nursing 2nd year students will be able to:

 define handicap
 explain about magnitude of disability and handicap
 describe the classification of disability in Nepal
 list out the causes of disability and handicap
 describe about prevention of disability and handicap condition
 explain about role of community health nurse in care of disabled and handicapped in community
 list out the specific plans and programs for people with disabilities in Nepal
 list out various organizations working for disable and handicapped in Nepal.

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HANDICAP

Definition
It is defined as "a disadvantage for a given individual, resulting from impairment or a disability that limits or
prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for
that individual”.
According to WHO, the sequence of events leading to disability and handicapped conditions are as follows:

Injury or disease

Impairment

Disability

Handicap

The WHO has defined these terms as follows:

IMPAIRMENT: Impairment is defined as “any loss or abnormality of psychological, physiological

or anatomical structure or function.” E.g., loss of foot, defective vision, or mental retardation. An
impairment may be visible or invisible, temporary, or permanent, progressive or regressive.
Furthermore, one impairment may lead to the development of another.
DISABILITY: Because of an impairment, the affected person may be unable to carry out certain
activities considered normal for this age, sex. etc. This inability to carry out certain activities is
termed "disability". A disability has been defined as “any restriction or lack of ability to perform an
activity in the manner or within the range considered normal for a human being.” E.g., loss of limbs
results in inability to walk.

Taking accidents as an example, the above terms can be explained further as follows:

Event Classification

Accident Disease or Disorder

Loss of foot Impairment

Cannot walk Disability

Unemployed Handicap

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Magnitude of Disability and Handicap
According to WHO, an estimated 1.3 billion people or 1 in 6 people around the world live with some form
of disability, making up around 16% of the global population, of whom 2-4% experience significant
difficulties in functioning. Most people with disabilities live in developing countries.

According to World Report on Disability the number of people with disabilities is increasing. This is
because populations are ageing (older people have a higher risk of disability) and because of global increase
in chronic health conditions associated with disability, such as diabetes, cardiovascular disease, and mental
illness. Other environmental factors, such as road accidents, natural disasters and conflicts also contributes
to increase in disability.

In Nepal 1.94% of the people are suffering from some kind of disability (Census 2011). The leprosy affected
are 2.4/10,000 population. Physical disability: 36.3 percent of the disabled population

Blindness/Low vision: 18.5 percent

Deaf/Hard of hearing: 15.4 percent

Speech problem: 11.5 percent

Multiple disabilities: 7.5 percent

Mental disability: 6 percent

Intellectual disability: 2.9 percent

Deaf-Blind: 1.8%

According to NDHS survey 2022, Among the household population age 5 and older, the most common
disability reported is difficulty seeing (15%) followed by difficulty walking or climbing steps (12%).

Classification of Disability in Nepal

A) Persons with disabilities according to the problem and difficulty in any organ or system of the
body:

1. Physical disability: Problem that arises in operation of physical parts, use and movement in a person
due to problems in nerves, muscles and composition and operation activities of bones and joints (for
example, disability that arises due to polio, lack of a physical organ, effect of leprosy, muscular
dystrophy, permanent problem associated with joints and backbone, reversal of clubfeet, problem
associated with rickets bones), and a person whose height is excessively lower than the average
height that a person having attained sixteen years of age has according to the age.
2. Disability related to vision: the condition where there is no knowledge about an object’s figure,
shape, form, and color in an individual due to the following problem with vision:

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(a) Blindness: A person who cannot distinguish fingers of hand by both eyes from a ten feet distance or
who cannot read the letters on the first row of the Snellen chart , even upon utilization of medicines,
operation, lenses, or lens.

(b) Low vision: A person who cannot distinguish fingers of hand by both eyes from a twenty feet
distance or who cannot read the letters on the fourth row of the Snellen chart (6/18), even upon utilization of
medicines, operation, lenses, or lens.

(c) Total absence of sight: A person who cannot differentiate brightness or darkness.

3. Disability related to hearing: Problems arising in an individual who cannot discriminate composition
of the parts of hearing and voice, rise, and fall of position, and level and quality of voice,
(a) Deaf: A person who cannot hear voice above eighty decibels or who needs sign language for
communication.

(b) Hard of hearing: A person who needs a hearing device to hear or who can hear voice from sixty-five
to eighty decibels.

4. Deaf-Blind: A person who is without both hearing and vision or who has joint interaction of
disabilities in two organs.
5. Disability related to voice and speech: Difficulty produced in parts related to voice and speech and
difficulty in rise and fall of voice to speak, unclear speech, repetition of words and letters.
6. Mental or psycho-social disability: A person with problems in the brain and mental organs and
problems with respect to intellectual functions such as awareness, orientation, refreshment, memory,
language, calculation, etc.
7. Intellectual disability: A person who is in a condition that results in the problem in doing activity
relative to the age or environment due to lack of intellectual development resulting from the lack of
development of intellectual awareness along with the increase in age (for example, Down syndrome).
8. Disability associated with hemophilia: A person who has such physical condition that there arises
problem in the clotting of blood due to deflection in factors in blood because of genetic effect.
9. Disability associated with autism: A person who has problem in the development of veins or tissues
and functionality thereof (for example, a person who has difficulty to communicate, to understand
and apply general social rules, and who does not show normal behavior along with the age, who
shows abnormal reaction, repeats the same activity, does not assimilate with others, or makes
reaction instantly).
10. Multiple disability: A person who has a problem of two or more than two types of disability
mentioned above (for example, cerebral palsy).
(B) Classification of disabilities based on severity of disability:

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(1) Profound disability: A person who is in such a condition that he or she has difficulty with
performing his or her day-to-day activities even with continuous support of others.

(2) Severe disability: A person who is in such a condition that he or she needs support of others
continuously to perform personal activities and involve in social activities.

(3) Moderate (mid-level) disability: A person who is in such a condition that he or she can regularly
participate in his or her daily activities and in social activities if physical facility is available, environmental
barrier is ended or education or training provided.

(3) Mild disability: A person who is in such a condition that he or she can regularly participate in his or
her daily activities and social activities if there exists no physical and environmental barrier.

Causes of disability and handicap

1) Poverty

Poor people are most vulnerable to disability because they are forced to live and work in unsafe
environments with poor sanitation, crowded living conditions, and with little access to education, clean
water, or enough good food. This causes diseases such as tuberculosis and polio.

2) Chronic disease condition

Illnesses like cancer, heart attack or diabetes cause the majority of long-term disabilities.

3) War and Explosions

It causes people to become deaf, blind, and lose their limbs, as well as causing other injuries to muscular-
skeletal system. Their mental health is also badly affected by the violence. The destruction of homes,
schools, health centers, and means of livelihood that results from conflicts and wars leads to increased
disability, poverty, and disease.

4) Poor access to health care

Good health care can prevent many disabilities. Difficult labor and birth can cause a baby to be born with a
disability such as cerebral palsy.

4) Inherited disabilities

Some disabilities are known to be inherited, such as spinal muscular atrophy and muscular dystrophy.
Children born to mothers 40 years of age or older are more likely to have Down syndrome.
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Prevention of disability and handicap condition

A) PRIMARY PREVENTION

Primary prevention reduces the incidence of disabilities by preventing risk factors which cause
impairment. If primary prevention efforts succeed, they completely eliminate any possibility that
disability will occur. Primary prevention is aimed at the general population rather than at an
identified "high risk" group.

• Genetic counseling: optimum maternal age for providing normal babies is between 20 to 35 years,
this information should be explained to the couples along with prevention and different aspects of
genetic and chromosomal problems.
• Genetic screening of 'at-risk' people to prevent inherited diseases like chromosomal or sex-linked
congenital anomalies.

• Reduction of consanguineous marriages by creating health awareness.

• Adequate antenatal, intra-natal and post-natal care.

• Universal immunization coverage especially for poliomyelitis and MMR.

• Improvement of nutritional status of mother and children especially for girl child, the future mother.

• Avoidance of teratogenic agents in antenatal periods and special care of high-risk mothers and
children.

• Improvement of health awareness about the preventive measures of handicapped conditions in

children by elimination of causes like malnutrition, accidental injuries, etc.

B) SECONDARY PREVENTION
• Early diagnosis and treatment of the particular cause of disability should be promoted.
• The aim of management is to safeguard against or halt the progression of the disease process from
impairment to disability and handicap.
• Secondary prevention targets an existing risk factor and removes or reduces it.
• Careful history, thorough physical examination, and necessary investigations for early detection of
handicapped conditions are important.
• Regular medical supervision and developmental assessment help to identify the abnormal condition
early in initial stage by MCH or school health services.
• Treatment of particular disability condition by medical or surgical management e.g., Cataract, otitis
media, leprosy, accidental injury, rickets, congenital anomalies
• Correction of deformity. E.g., Visual or hearing problems by spectacles or hearing aids.
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 • Physiotherapy and exercise to improve physical conditions.
• Speech therapy to improve communication ability.
• Prosthetics e.g., provision of artificial limb in a child with amputated leg.
• Special care for mentally handicapped children with love, warmth, patience, tolerance, discipline,
and avoidance of criticism.
• Counseling and guidance to the parents and family members for continuation of care of the children
with emotional, educational, and social support.
• Referral for services for assistance of aids and appliances, for special training and education,
rehabilitation and support services like pension, scholarship, special allowances.

C) TERTIARY PREVENTION

Tertiary prevention includes rehabilitation measures. The process of rehabilitation should involve the
following aspects:

• Medical rehabilitation includes restoration of functions by prosthesis, artificial limbs, etc.

• Social rehabilitation includes restoration of family and social relationship by replacement in the
family
• Educational rehabilitation includes specialized training and educational facilities e.g., Braille for
blind, sign language for deaf and dumb.
• Psychological rehabilitation includes restoration of personal dignity and confidence during the period
of growth and development and in adult life.
• Vocational rehabilitation includes restoration of the capacity to earn a livelihood. This can be
achieved by community participation and social legislation for the handicapped individual.
• The community needs to offer employment opportunities in shops, factories and other business
establishment (according to their capacity) to the handicaps.
• The handicapped person needs to be trained for and independent living with special training and
education.
• These include day care centers, special school (for blind, deaf and dumb), vocational training centers,
special hospitals for crippled children.

Role of CHN in Care of disabled and handicapped in community

For many people with disabilities and those who care for them, daily life may not be easy. Disabilities affect
the entire family. Meeting the complex needs of a person with a disability can put families under a great deal
of stress — emotional, financial, and sometimes even physical. The support of family, friends and
community services is important.

• Nurses can serve as educators who provide clients at any level with sufficient knowledge to enable
them to care for their own needs.

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 • Nurses may serve as advocates for individuals and families or groups in need, assess their level of
negotiating skills and capacity and help as needed but don’t make them dependent on you.
• As referral agents, nurses maintain current information about agencies whose services are of
potential use to those who are disabled.
• In the coordinator role, nurses assist clients and families by recognizing and integrating the resources
of other agencies or care providers to meet clients’ needs most efficiently.
• As health care provider with the goal of making basic care universally accessible, nurses are
positioned well to ensure that the full range of prevention and information about the health
promotion are made available to individual with disabilities.

Specific plans and programs for people with disability in Nepal

EDUCATION
• Educational scholarship for basic level students
• Free school/higher education
• 5% of all quotas in Government organizations that provide vocational training should be reserved for
disabled people
• Additional times in examination
• Scholarships for technical education and vocational training

HEALTH
• Free medicines
• Free medical treatment in government health centers or hospitals
• Hospital beds reservation (2 beds reservation for >50 bedded governmental hospital)

EMPLOYMENT, INCOME GENERATION AND TRAINING

• 5% reservation in the civil service
• It is prohibited to discriminate against disabled people in relation to their employment. Individual
business employing more than 25 people should give 5% of their jobs to disabled people
• Tax exemption up to 50% for the people with disability in their taxable income
• There should be income tax exemption for employers who employ disabled people
• Special Provisions for Acquired Disability During Job
• Self-employment programs
• Launch a special package (skill-based training, interest-free loan) program for income generation,
self-employment, social security for poverty alleviation and empowerment.
• Free vocational training

MOBILITY AND PHYSICAL ACCESIBILITY

• Discount in public road transportation (50%)
• Seat reservation in public road transportation
• 50% discount on airfares
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 • No custom taxes in special types of 4-wheeler scooter
• While constructing and rebuilding physical structures of public importance, create structures that are
easily accessible (Disabled Friendly) to people with disabilities according to the standards.

COMMUNICATION

• Daily news will be broadcast on television in sign language, and it will also be written (Caption)
when the news is broadcast.

• Provision of interpreters in major places of public importance for deaf and slow hearing, provision of
information of public importance in Braille to the visually impaired.

• To train persons with disabilities in information and modern technology.

• Tax exemption on information technology materials used by persons with disabilities

REHABILITATION, EMPOWERMENT AND SOCIAL SECURITY

• No custom charges for assistive devices
• Establishment of orphanage and center for persons with intellectual disability
• Disability pensions
• Provision for disability allowance
 Red - complete disability----- Rs. 3990/month
 Blue - severe disability-------Rs. 2128/month
 Yellow – moderate disability
 White – mild disability

SPORTS AND ENTERTAINMENT

• Paralympic sports

LEGAL SUPPORT

• Free legal services

Various organizations working for disabled and handicapped

• Community Based Rehabilitation Centre

• National Federation of Disabled Nepal
• Nepal Disabled Association
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 • Nepal Netra Jyoti Sangh
• Nepal National Federation of Deaf and Hard of Hearing
• Nepal Ear Foundation
• KOSHISH Nepal
• Asha Bal Kendra
• Karuna Foundation Nepal

SUMMARY

REFERENCES
Park K. Park’s Textbook of preventive and social Medicine: 24th edition. Jabalpur: Banarsidas
Bhanot Publishers; 2017. P.48-49
S Kamalam. Essentials in community health nursing practice. 3 rd edition. New Delhi: Jaypee
Brothers Medical Publishers; 2017.P.603-610
Stanhope M. Jeanette L. Community health nursing: process and practice for promoting health. 3rd
edition. Page no:537-539
National Federation of the Disabled – Nepal – Nothing about us, without us (nfdn.org.np) Retrieved
on: 2023/1/10
The Act Relating to Rights of Persons with Disabilities, 2074 (2017) – Nepal Law Commission
Retrieved on: 2023/1/10
How To Apply Social Security Allowance in Nepal 2022 (nepalinerd.com) Retrieved on: 2023/1/10
Status of Disability in Nepal: Apangata Sarokar अपाङ्गता सरोकार: Create media space for
disability Retrieved on: 2023/1/10
Disability (who.int) Retrieved on: 2023/1/10
Interactive map of disabled population in Nepal | Code for Nepal Retrieved on: 2023/1/11

POST TEST

MCQS (5*1=5)
1. Which of the following is most logical sequence?
a) Disease-Handicap-Impairment-Disability
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 b) Impairment-Disease-Disability-Handicap
c) Disease-Impairment-Disability-Handicap
d) Disease-Impairment-Handicap-Disability
Ans: c
2. When a person ‘lost’ his hands and is unable to do routine work called as:
a) Handicap
b) Impairment
c) Disability
d) Disease
Ans: c
3. Speech Therapy to improve communication ability comes under………...prevention?
a) Primary
b) Secondary
c) Tertiary
d) Primordial
Ans: b
4. Prosthesis falls under…………. rehabilitation?
a) Medical
b) Vocational
c) Social
d) Psychological
Ans: a
5. Inability to perform daily individual or social activities without the help of others is
known as:
a) Profound disability
b) Mild disability
c) Moderate disability
d) Severe disability
Ans: d

ASSIGNMENTS

SAQ (5*5=25)

a) State the difference between impairment, disability, and handicap with example. (5)
b) Explain about prevention of disability and handicap condition. (5)
c) List out the plans and programs for people with disability in Nepal. (5)
d) Explain the roles of community health nurse in care of disabled and handicapped in community. (5)

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