PERSONS WITH

SPECIAL NEEDS
Anne N. Mbithi
BS(Medical Education)

1
• Module competence:
• To enable the learner apply knowledge, skills and attitude and manage
persons with special needs
• Module units:
1. concepts and processes for persons with special needs 2 hrs
2. Geriatric nursing 4 hours
3. Challenged persons4 hours
• Module Outcome: By the end of the module, the learner should be
able to identify and manage persons with special needs.
2
Module content
• Geriatrics: Aging process and the role of the nurse
• School health programmes: Concepts of school health, components
and activities of school health programmes, organization of school
health programmes, challenges of school health programmes,
monitoring and evaluation of school health programmes

3
• Regulations covering the care of minors, children and
young persons act, challenged persons, mentally ill, and
control of imprisoned patients, restrained and confined
persons and role of the nurse; community mental health
nursing, occupational health and the role of the nurse in
occupational health and safety

4
 Definition of Disability
• It’s a physical, emotional or mental injury or illness, that interferes
with an individual’s normal growth, development or ability to learn
or work.
• Impairment: In life anything that stops a part of your body from
functioning fully.
• Types of impairment; motor, sensory, and emotional or intellectual
impairment
• Most disabilities start at birth or in childhood.
• Those that start later in life are often as a result of accidental injury.
• NB; In many cases the loss of a function due to disability need not
make a person useless. 5
6
 Cont…..
• Often disabled people have other faculties which they can put into
good use and therefore can be able to earn a living for themselves
and their family.
E.g
• blind people can work as telephone operators;
• those with disabilities affecting the legs can do any work that
requires the use of their hands.
• In order to help them you need to identify their abilities and modify
the environment to avoid overtaxing them.
• You will also provide them with appliances and the appropriate
apparatus, in order to develop their potential ability and compensate
for the defect. 7
Types of common disabilities:
Physical Disabilities
• Motor defects due to congenital causes eg missing limbs,
trauma, cerebral palsy (spastics), paraplegia neurological
disorders, arthritis, spinal cord injuries, talipes etc.
• Chronic illness, for example, epilepsy.
• Services available
• Families
• Hospitals: physiotherapy dept, occupational health dept
• Institutions

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 Mental Disability
Due to mental deficiency
• These include: mongolism, birth injuries, meningitis and emotional problems,
mental retardation, cerebral palsy, personality disorders, eating disorders
• Problems/ needs of the mentally impaired
• Risk of sexual exploitation and harassment
• Basic needs; nutrition, shelter and clothing
• Stigma and discrimination
• Health care
• Parental/ family love
• Educational needs especially the mentally retarded
• Lack of concentration on the activities of daily living thus need someone to
take care of them.
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 Mental Disability cont…
Services available
• Family
• Community
• Rehabilitation centres/ Psychiatry units
• Spiritual centre
• Role of a nurse
• Counselling on elimination of stigma and discrimination
• Encourage safe hospital delivery to avoid head injuries/ asphyxia at
birth
• Teach the community on how to take care of the persons and involve
them in the community activities 10
Sensory defects eg blindness, hearing and deafness Impairments
Hearing impairment
• Hearing impairment is a disability that hinders successful processing of sound
waves through audition (i.e. the inability to hear or interpret/perceive sound
waves).
• Human contacts and relationships depend on communication by means of
speech.
• A person who has profound hearing impairment cannot converse with others
unless they can both use and understand sign language.
•.

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• Impairment in hearing may also cause changes in personality
and attitude, awareness of the surroundings and ability to
protect oneself.
• This calls for a great deal of patience and tolerance from
other people when dealing with the patient

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Cont….

• People with hearing impairment try to conceal their disability by

developing some defence mechanisms, eg
• withdrawing from contact with others
• displaying unreasonable irritability and aggressiveness.
• NB; It is therefore important for health workers to bear this in mind as
they help a person with hearing impairment.
• Sometimes the person may even reject the help required to facilitate
their hearing. E.g. they may refuse to wear hearing aids because they
feel it advertises their disability.
• It is therefore important to teach family members and the community
how to cope and live with a person who has hearing impairment.

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 Needs/ problems of the hearing
•impaired
Security needs
• Loneliness
• Risk of accidents
• Discrimination/ stigma
• Social burden
• Loss of self -esteem
• Special educational needs
• Communication need
• Suspiciousness- you think people are talking about you
• Lack of sense of belonging

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 Resources Available for the Hearing Impaired
• Community Teachers
In most communities it is possible to find people who have
hearing impairment and who can be requested to mentor
and train a child with hearing impairment.
• It is important to identify and use such persons because
they relate easily to the emotions and difficulties the
challenged persons may be going through.
• Some are trained which would be an added advantage.

15
 Resources Available for the Hearing Impaired
• Other Families with Hearing Impaired Members
Families with persons who have hearing impairment in the
same community can come together and form a support group
where they share experiences.
• This serves as group therapy and they learn very well as a
group.
• As a community nurse you can again motivate these families to
come together and support each other, provide them with
equipment and training, give them information and ideas about
prevention, and the different services available for their
challenged persons.
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 Cont…..
• Institutions for the Hearing Impaired & Special
Schools
Institutions where special education and programmes
for the persons with hearing loss take place.
• You can find these through the ministry of education
in our country and refer our patients to them.

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• Special Schools
Persons learn through special training offered in special
schools.
• In Kenya there are many schools for persons with hearing
impairment.
• They assist them to develop skills that make them feel
important and useful members of the community.
• Visiting these special schools helps us to understand and
appreciate their services to persons with hearing loss
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 Associations
In many countries, persons with hearing impairment have formed
associations to look after their needs and welfare.
• Some of them meet to discuss issues affecting them, and arrange for
short training courses in communication skills.
eg
• i) The Kenya National Association for the Deaf
ii) Kenya National Deaf HIV/AIDS Education Programme (NGO )
As a health worker it is important for you to know about these
associations so that you can refer your patients appropriately.
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 Management of Hearing Impairment

• The effective management of hearing impairment is based on early

detection.
• In most cases impairment starts in childhood.
• Therefore all under fives should are properly screened & managed in
order to prevent diseases that cause hearing impairment.eg proper
treatment of ear infections, or diseases such as otitis media.
• Routine screening on all the under fives to diagnose and assess if
impairment exists for early identification and treatment of hearing loss
or a hearing problem.
• proper drug prescriptions and client education on the possible drug
side effects some of which are sensory impairments.
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 Prevention of Hearing Impairment
• Improved prenatal labour and delivery services
• Pregnant mothers should be vaccinated against german measles
(rubella).
• The mother should also be advised to avoid taking drugs unless
prescribed by the doctor.
• Since deafness can also be caused by complications of labour and
delivery, it is very important that you identify early and manage
mothers who may present with labour complications.
• Early diagnosis in order to minimise chances of intracranial injury
to the newborn.

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• Early diagnosis and treatment of infections and trauma eg otitis
media, ear discharge or a foreign body in the ear, so as to prevent
complications which may lead to hearing impairment.
• The community should be educated on the importance of
identifying these signs and seeking prompt medical advice.
• Avoid drugs which may cause ototoxicity, or use them under
medical supervision.
• Avoid excessive noise, which may result to temporally or
permanent hearing loss

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 Visual Impairment
• Visual impairment is the lack or inability to see, which may be
caused by diseases or injuries to the eye.
The following are possible causes of visual impairment:
• Trachoma.
• Vitamin A deficiency.
• Allergy.
• Cataract.
• Macular degeneration.
• Some types of cancer such as retinoblastoma and pituitary gland
tumours.
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• Glaucoma.
• Childhood blindness, for example, congenital cataract and
corneal blindness.
• Diabetic retinopathy.
• Disorders of the nervous system such as multiple sclerosis
and stroke.
• Refractive errors.
• Ocular complications of HIV/AIDS.
• Accidents which cause injury to the eye. 24
 Services Available for the Visually Impaired

• At the Family Level

• Security
• Psychological support
• Specialized education
• Basic needs; food, shelter clothing
• Normally, activities of daily living such as feeding, socialising, playing,
verbal skills, and mobility are learnt at home.
• A normal child learns how to do every day activities by watching what
others are doing and imitating them.

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 Cont…..services at family level

• If a child is under five years of age and is visually impaired, then

they need special help from the family in order to learn these skills.

The family needs to train the child to recognise common domestic

objects by touching. They need to provide the child with toys to
play with in a room that does not put the child at risk from
accidents.
• Parents also need to be educated about the importance of
keeping the child’s articles and toys in their regular places, so
that they can find them easily

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Services Available for the Visually Impaired cont….
• Children who are visually impaired also need more body
contact, especially when talking to them to facilitate
communication.
• When the child is old enough to attend nursery school, the
family should recite nursery rhymes and songs with the child,
in order to prepare the child for integration into the
community, where they will identify with the learning
activities of other nursery school children.
• Encourage a person who is visually challenged to
have contacts for relatives and friends to be contacted when
the need arises.
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• The family needs to modify the environment to prevent accidents.
Encourage the person to participate in activities they can perform and
enjoy.

Nurse’s role: Your role is important in providing support and

encouragement to the family and availing them with information on
the available resources

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 Institutional Level

Education Institutions: eg Schools for the Blind

• special schools that provide special services to the visually impaired
• Owned and managed by the government, NGO’s and missions.
• The visually impaired are taught Braille, a system of reading specially
developed for blind people which uses small raised marks that they feel
with their fingers
• Afterwards they are able to pursue their studies and careers.
• are also taught survival skills and skills of daily living eg how to get
around from point A to B using a cane.
• Special schools play a very big role in increasing their participation in
the community and facilitating their integration.
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Cont…
• Educational Assessment and Resources Centres (EARCs)

These are centres which were created countrywide to offer assessment

and referral, as well as placement of children in schools which are
nearest to their homes.
• CBOs/NGOs/Collaborators

These are organisations which look after the interests of the visually
impaired.
• They provide assistance in the form of materials and equipment,
education, finances, and provision of guidance for the visually
impaired.

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 Institutions cont….
• Sight Savers International
• Is the sponsor of the integrated programmes through the Kenya Society for the
blind.
• The organisation provides resources and materials to help the visually impaired.
• Salvation Army
• This organisation collaborates with Thika School for the blind.
• Thika school for the blind offers primary and secondary school education for the
blind
• Low Vision Project

This project is based in Kikuyu pentecostal church of east Africa (PCEA) hospital,
and it provides services to people with low vision
• Other Organisations : Catholic church etc
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 Management and Prevention of Visual Impairment

• The management starts with proper assessment of the

condition followed by treatment, integration and
rehabilitation.
• Once the problem has been properly diagnosed, then the
treatment may include surgery or visual aids, such as the fitting
of eye glasses.
• If after assessment a person is found to be completely visually
impaired, they will need to be integrated and rehabilitated into
the community.
• The process of integration and rehabilitation starts at the family
level, and continues into the community through special schools
and other institutions for the visually impaired.
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 Prevention of Visual Impairment

Prenatal Stage
• Advise pregnant mothers to avoid taking any medicines
unless prescribed by the doctor.
• Educate pregnant mothers on the need for proper prenatal
care in order to prevent infections, early diagnosis and
management of conditions if they occur and their
complications

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• Administration of the following measures:
• All primary immunisations should be completed
• Application of tetracycline eye ointments to new-borns
at birth
• Giving vitamin A capsules to children suffering from
measles
• Control of diabetes and the blood pressure
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 Prevention of Visual Impairment cont….

• Nutrition
• The diet should be rich in Vitamin A and B to avoid changes in the
retina, conjunctiva and cornea
• Wearing Protective Devices : In activities that pose a danger of
injury to the eye from foreign objectives, for example, hairsprays,
ultraviolet rays and bright sun.
• Lighting
• Adequate and well placed lighting in the rooms to avoid straining
of the eyes, glares and flittering lighting.
• Personal Hygiene
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• Educating members of the community of the importance of
good personal hygiene, eg, a daily bath, keeping eyes clean
especially when they are infected, in order to avoid attracting
flies
• Early Diagnosis and Treatment

Prompt and correct treatment of all common eye infections

and especially trachoma.

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 3. Care of Children in Need

• A child in need is one who has been abandoned, orphaned, or one

whose parents are incapable of looking after them properly.
• Such a child needs the best possible alternative arrangements for their
care in the absence of the parents.

Needs of the Children

• Nutritional needs. Most of these children are malnourished.
• Parental love.
• Lack of education.

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• Lack of access to health care. Eg AIDS orphans who are themselves
infected.
• Security and protection from harmful practices like female genital
mutilation, child labour, forced marriage.
• Stigma and discrimination such as those orphaned by AIDS.
• Social burden such as care for the other children or for a terminally ill
parent.
• Poverty due to lack of a source of income to care for themselves and
the family.
• Inadequate or lack of shelter.
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 Services available for children in need in the community
• Children’s Homes

These homes are owned and run by individuals with the help of
donors and well wishers. They provide the children with their
basic needs and education.
• These homes are supervised by the department of children
under the ministry of social services.

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• Remand Homes/ Approved schools
• These are run by social services dept of the government. Approved
schools, e.g Kirigiti in Kiambu, Wamumu in Mwea and many others.
• Hospitals
• Most of the abandoned children are brought to the hospitals. Here they
are cared for and then handed over to the children’s department for
adoption, or are later taken to homes or institutions

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 Reduction of Children in Need

• Integration and Rehabilitation

• When these children grow and attend school or acquire some
skills they are able to be independent by getting employment or
by becoming self-employed, thus become useful members of the
community.
• You can reduce the number of children in need by:
• Strengthening family relationships so that such children are taken
care of by their immediate family members, especially orphans
thus providing a condusive environment for the child to grow in.

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Cont….
• Implementing safe motherhood initiatives in order to prevent
maternal deaths.
• Providing family planning services, so that families get the
number of children they can manage.
• Providing information to the community members on the
services available for adoption. This would help those
members in the community who have no children of their
own, as well as those with unwanted pregnancies
• Providing family life education to the youth on consequences
of pre-marital sex, as many of the abandoned children are as
a result of unwanted pregnancies.
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Care of the Elderly

• The ageing process is often defined in terms of physical changes that

negatively affect the body’s function and appearance. Old age is
associated with poor health, poverty and dependency.
• In the past, our traditional support systems were so effective that
they made the problems of the elderly insignificant.
• However, today these support systems have disintegrated due to
socio-economic changes in our society.
• The number of elderly citizens in this country has been on the
increase.
• This increase would not be of much concern if you already had
support structures in place to take care of them.
• This leaves them vulnerable to medical and social problems.
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 Problems of the Elderly
• Poverty
• Loneliness
• Poor nutrition
• Physical handicap
• Dental problem
• Mental problems
• Lack of energy to provide activities of daily living
• Inadequate housing
• Chronic illnesses
• Age related changes such as immobility, dementia and presbyopia
• Lack of care in sickness
• These problems are experienced by the elderly throughout the world, although
they vary depending on the kind of support available in the community. 44
 Available Services for the Elderly

• At the Family Level

In Kenya most elderly people live with their nucleus and extended family,
who care for them.
• As a community health nurse, it is your responsibility to encourage families
to care for their elderly persons. You need to educate them on the needs of
the elderly, equip them with the necessary knowledge, skills and attitudes to
provide effective care.
• You also need to educate members of the community on the importance of
planning for retirement. The aim for this preparation is to help the elderly
persons remain independent and comfortable in their own homes as long as
possible. There is need to discuss the payment of pensions and allowances
early for better planning
45
 Available Services for the Elderly cont……
• At the Community Level
• Elderly persons require community health services.
• It is your responsibility to identify them and make sure they are available
and accessible to the elderly persons. Encourage them to join recreation facilities
to improve their mobility and to join peer groups to help them psychologically.
• During home visiting you should be able to provide direct care to the elderly.
• Churches also provide spiritual support as well as material support to the elderly
persons.
• The women and youth groups visit them and alleviate their loneliness and improve their
nutrition status by providing them with meals.
• They also help them with cleaning, repair work and gardening.
• As a health worker, one of your important roles is to become their advocates. You
should let their needs be known by the community and motivate them, especially the
youth, to have a positive attitude towards care of the elderly, so that you add life into
their days 46
 Institutions for the Elderly

• In Kenya, there are few homes for the elderly and day care centres.

They provide the following services:

• Nutrition
• Activities of daily living such as personal hygiene
• Treatment of any sickness
• Recreational activities
• Safety and comfort
• The best care for the elderly is the one provided by the family

47
 Institutions for the Elderly

Hospitals
Geriatric hospitals are well established in developed countries.
• In Kenya the elderly do not have any special health services
targeting them.
• In some communities it is commonly believed that old age is a
cause of illness. This leads to delay in seeking health care for the
elderly.
• Another reason why the elderly may delay to seek health care is
that they live far from the health services.
• As a community health nurse, it is your responsibility to
sensitise and encourage community members to seek health
care for their elderly persons 48
 5. The Chronically Ill
• An illness is said to be chronic if it meets one or more of the
following criteria:
• Permanent
• Leaves a residual disability
• Caused by non-reversible pathological conditions
• Requires special rehabilitative training of the patient
• Requires long term supervision and care
eg:
• Diabetes mellitus ,Arthritis ,Hypertension, Sickle cell disease,
Renal disease, Heart disease, Terminal carcinoma and other
debilitating diseases, AIDS 49
 Available Services for the Chronically Ill

• A chronic condition does not only affect the patient, but also all the family
members who live with the affected person.
• This is because most chronic diseases bring about dependency and an extra
financial burden on the family.
services available;
• Family level
Often, chronically ill patients are taken care of at home by family members.
Through home-based care.
• In order for a family to care properly for a chronically ill patient, they need
to be prepared and educated on the requirements.
• It is your responsibility to provide them with the necessary information and
to follow up on the patient’s progress from time to time. This is important as
it helps the family and the patient to feel confident in the care at home.
50
 Available Services for the Chronically Ill

• Community
Community Health Workers (CHW), as well as Community Owned Resource
Persons (CORPS), can assist the family to care for a chronically ill person at
home.
• This can take the form of medical advice, material support and spiritual
support
• Institutions: include hospitals, hospices, and support groups depending on
the type of chronic illness.
• Hospices usually take care of terminally ill patients.
• They teach the patients and their caregivers all issues concerning care, and
also make follow up visits at home, where the patients are being cared for.

51
 Management of Chronically Ill Patients
• The management of chronically ill patients depends on the stage of
adaptation to the illness that the patient is in.
• In the first stage, they tend to be in denial and disbelief.
• During this stage you need to be actively involved in the care of
this patient even if they are being cared for at home.
• Educate the family members to listen to all the expressions of
feeling by the patient without criticising them.
• They should also be empathetic and listen to the arguments
without being judgmental.

52
Cont….

• Patients in the second stage of adaptation to their illness

commonly manifest with anger.
• During this stage the patient develops an awareness of the
chronic illness.
• You should educate the caregivers to exercise restraint and
self control.

53
Cont…..
• In the third stage the patient undergoes reorganisation and is
nourished by the concept of hope.
• You should therefore give hope generously within acceptable
limits.
• You should also provide the patient and family with suitable
and practical coping methods.
• Knowing the patient’s values, religion and beliefs will go a long
way in assisting you help the patient

(Ross Kubbler stages of death); denial, anger, bargaining,

depression and acceptance
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 Prevention of Chronic Illnesses
Primary Prevention
Provision of good prenatal, intrapartum and delivery care.
• Genetic counselling is done in cases where there is a genetic risk, for example, in diabetes
mellitus and sickle cell disease.
• Discouraging risky habits, eg smoking and over consumption of alcohol
• Regular exercises.
• A healthy diet low in calories and animal fat, to prevent obesity, heart and blood vessel
diseases
Secondary Prevention
• Regular medical check-ups.
• Screening measures, such as, Pap smear, self breast examination.
• Early diagnosis and treatment of the conditions.
Tertiary Prevention
• includes first aid, treatment and rehabilitation of diseases.
• It aims at preventing complications and disability 55
 6. Displaced Persons

• These are people who have been displaced from their communities or even
countries.
• most common causes; armed conflict, Natural disasters, famine, political
reasons and economic changes
• They can be divided into two categories:
• Internally displaced persons
• Externally displaced persons
Internally Displaced Persons
• people who have been displaced within their country, following ethnic
clashes or disasters such as floods and earthquakes.
• They get help from local organisations, churches and individuals. The
government has the main responsibility of settling internally displaced
persons. 56
Externally Displaced Persons
• These are people who have run away from their country as a
result of civil war or political persecution.
• also known as refugees.
• Eg in Kenya there are many refugees from neighbouring
countries such as Sudan and Somalia.

The government works closely with the United Nations High

Commission for Refugees (UNHCR) to settle all externally
displaced persons.

57
Problems encountered by displaced persons.

• The problems experienced by displaced persons include:

• Housing
• Sanitation
• Water supply
• Lack of inadequate nutrition which may result in malnutrition
• Security risk and human rights violation
• Overcrowding which may cause rapid spread of diseases
• Lack of education opportunities
• Lack of health services
• Emotional needs
• Poverty
• Psychological support 58
 Cont….
• Displaced persons tend to develop health problems due to poor living
conditions, as well as psychological and physical trauma caused by
displacement.
• Some displaced persons are separated from their families and relatives
and have lost homes, jobs and schools for their children.
• They need material as well as psychological care.
• Some may develop antisocial behaviour as a defence mechanism, as
they are unhappy with the displacement
• people who have been displaced may bring new diseases, such as
diarrhoeal diseases, typhoid, measles, meningitis, STIs and HIV/AIDS.
• Even their animals can bring in diseases (zoonotic infections) eg rabies,
anthrax, foot and mouth and brucellosis thus posing as a health risk to
the community where they settle
59
 Effects of Displacement of People
• Displacement often leads to dramatic changes in the family structure and gender
roles, relations and identities.
• In conflict situations, many women are suddenly thrust into the role of head of
the household because the men are recruited to combat, they stay behind to
maintain land, or migrate in search of work.
• There is also:
• Escalation in the level of poverty
• Reduction in the level of foreign aid
• Demographic consequences
• Religious effect
• Conflicts between the host community and the displaced group
• Political effect
60
 Services Available for displaced
persons
• The services available for displaced persons tend to be those provided by;
 relief agencies
 NGOs,
 the government through the national and county administration,
 the church, and
 institutions such as UNCHR which take care of external refugees.
• They provide them with shelter, medical care, food and clothing, and sometimes
rehabilitation in the form of teaching them new skills.
• Refugees have some sort of international protection. Their needs are catered for by
(united nation high commission for refugees) UNHCR and their rights are also
protected.
• The International Committee of the Red Cross (ICRC) protects the rights of internally
displaced people.
• It conducts protection and assistance programmes for these victims
61
Cont…on displaced persons

• Problems resulting from displacement are the government's

responsibility, the government also bears the primary responsibility
for internally displaced people. Aid is only a temporary measure, but
it is the government in question that must solve the problem.
• UNHCR is the watch dogs; ensures that states are aware of their
obligations in protecting refugees and those seeking asylum.
• Countries who attempt to forcibly return refugees to their country of
origin break international law, as refugees may face danger or
discrimination between groups of refugees.
• Internally displaced people can be forced to leave camps or
designated areas by their own national officials, and no aid
organisation or government has the authority to prevent this.

62
 Management of Displaced Persons
• Your role as a community health nurse will be to work with other health
workers as a team, in order to deal with the various problems of displaced
people.

The set up relief centres provide the following services:

• Screening and first aid to all new arrivals.
• Counselling and psychological care to the victims
• Food assistance, especially to infants and children, as food is a basic need. The
adults also need food for survival.
• Temporary shelter so that individuals can sleep and rest.
• Reproductive health services; antenatal, labour, delivery and post natal, family
planning services
63
• Medical care services, where curative care for common diseases and
injuries will be provided.
• Immunisation programmes for children and pregnant mothers.
• Health education and community mobilisation.
• Identification and the use of the community health workers in the
area is necessary
• Advise on ways of proper sanitation and waste disposal so as to
prevent communicable diseases
• As these emergency services are given, the families should be
encouraged to settle down, especially if the situation requires them to
stay there for a long period

64
7. Widows/Widowers

• The death of a spouse makes one to become a widow or widower and you
have many of them in your community. Some of the leading causes of death
today in Kenya include diseases and road traffic accidents.
• E.g. of diseases that are a major cause of morbidity and mortality in Kenya.
• HIV/AIDS.
• Malaria.
• Hypertension.
• Pneumonia
• Diabetes mellitus.
• Heart diseases.
• Diarrhoeal diseases.
• Obstetric complications

65
 widors/ widowers cont….
• When a spouse dies the effect of the loss affects the entire family.
• They not only lose the love and care from that parent or spouse, but
sometimes also the financial support.
• Therefore widows/widowers require a lot of support, empathy,
understanding, love and care.
• They need to surround themselves with people who they can trust and rely
on.
• This tends to be people who have been close, understanding and supportive
to the family.
• They help the family to cope with feelings of loss.
• As a community health nurse, your role is mainly to counsel the widow or
widower, and to support them as they go through the grieving process
66
 Needs of Widows
• Sex
• Psychological effects such as loneliness, and cultural practices not
allowing the widow to re-marry.
• Poverty, due to lose of the bread winner, not having the right to
inherit property or have their right enforced, being evicted from
their property, no support from family or relatives.
• Basic needs such as food and shelter cannot be met due to poverty,
resulting from unemployment and illiteracy.
• Support to care for the left children
• Vulnerable to violence, sexual abuse and rape.

67
Needs for widows/ widowers -cont….
• Exploitation at work place due to homelessness, illiteracy and poverty.
• Love and belonging; Some may be rejected by the family.
• Health needs for the whole family or the left spouse especially if the spouse was
sick, eg AIDS or if both were involved in an accident, which killed one and left the
other injured.
• Severely affected health and well-being because widowers are not able to care
for themselves since most of the care was provided by the wife.
• Immense feelings which may result in physical and psychological symptoms such
as sexual fear due to loss of a loved one, social isolation.

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 Services Available for Widows and Widowers
• In developed countries there are well established systems in place
for helping widows or widowers.
• However in Kenya there are a few formal systems e.g. monthly
stipend by the government , although within many communities
there are various support systems which can be mobilised to assist a
widow or widower
• The Extended Family Members
• In many communities, this is the support system for a widow or
widowers
• They support the widow during the grieving period and sometimes
take the responsibility of caring for the family, meet expenses such
as hospital bills or school fees for the children
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• Services Available for Widows and Widowers
• Spiritual services; churches, mosques etc
• Clan; In certain communities, clans play a
very big role in the care of a widow.
• The clan takes the responsibilities of the
children’s education, and may even assign
individual members of the family, the
responsibility over the children, in order to
ensure that the burden is well shared out.
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 Services Available for Widows and Widowers
• Support Groups
They come together to share their problems and help each other in solving them.
• They also contribute money, and sometimes look for donors to help them establish
income-generating activities.
e.g. Widows and Orphans of AIDS Kenya (WOFAK).
• As a community health nurse you should find out about these groups, so that you can
advice and encourage widows and widowers to join them for support
• Institutions

In Kenya there are no established institutions designed to take care of widow and
widowers.
• However, the government has established a system known as the widow and widowers
pension scheme (only covers those who are employed by the government)
• This scheme pays a pension to the widow or widower as well as allowances for the
children. 71
Questions??

All the best in your revision and exams

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