ACE.D Teaching Strategies
The teaching strategies offered in this section are guidelines for faculty to develop encounters with persons with disabilities and incorporate all or some of the ACE.D Knowledge Domains and ACE.D Essential Nursing Actions into student learning experiences.
Persons with Disabilities Teaching Strategies
While more than 60 million people in the US are living with some type of disability, there remains very little in the way of education about this population in schools of nursing. Health care providers are faced with a complex environment in which to care for patients. This series of teaching strategies is designed to help students become more proficient in understanding disability as well as caring for persons with disabilities, across the lifespan and in varied settings.
Effective communication and interpersonal skills are essential in conducting any patient assessment; this includes making eye contact with the interviewee and being at the patient’s eye level. For a patient with a disability, this often requires sitting down to ensure that you are at the patient’s eye level, so that the patient is not required to look up to communicate with you. If he or she is in a wheelchair or sitting in a chair or on a motorized scooter, this is especially important.
People with disability often report that health care professionals treat them differently or do not communicate with them about their disability. Some may be uncomfortable discussing it, while others may think that since the disability is “old” or not the primary problem, it is not relevant to the care of the person. The communication module is designed to promote effective communication of nursing students who will interact with persons with disability during the course of their clinical experience(s). The module is a teaching strategy that addresses overarching issues related to communication with persons with disability during any and all clinical settings and situations. It is designed to be used by nursing faculty in a classroom setting at any point during the nursing curriculum. Since effective communication skills are usually introduced early in the nursing curriculum, use of the module and integration with other communication teaching strategies is recommended.
Autism spectrum disorder (ASD) is an intellectual developmental disorder characterized by a range of disabilities in communication, social interaction, language, and abstract concepts. Persons with ASD have difficulty verbalizing their needs and often express themselves with behaviors that are not understood.
Malocclusions, such as tooth crowding, open bite, poor tongue coordination, and a tendency to pouch food inside the mouth instead of swallowing, are common and can lead to poor oral health. Persons with ASD often have negative oral habits like nocturnal bruxism, lip biting, and tongue thrusting. In addition, they are often sensitive to the taste of toothpaste and have a lack of coordination for brushing.
Cerebral palsy (CP) is a neuromuscular disorder often accompanied by disturbances in movement, sensation, communication, and behavior. These problems can include changes in orofacial structure, problems with eating and swallowing, and oral self-care. Children and adults with CP have increased incidence of periodontal disease, dental caries, malocclusion, tongue thrust, drooling, gastrointestinal reflux, bruxism, hyperactive bite and gag reflex. Maintaining oral hygiene and accessing appropriate dental care, all of which affect oral health, can represent a health equity challenge.
Stroke significantly impacts a person’s ability to maintain self-care and increases reliance on others to support activities of daily living, including oral hygiene. Normal daily activities that affect oral hygiene such as eating, drinking, and tooth brushing can be severely disrupted. Motor dysfunction, a typical feature of stroke, can contribute to dysphagia, which increases risk for aspiration of food and development of pneumonia, which can be fatal.
This teaching strategy offers guidelines for faculty to prevent non-ventilator-associated hospital-acquired pneumonia (NVHAP) by integrating oral health into the care of veterans and persons with disabilities.
Teaching Strategies on Disability from Other ACE Programs
This teaching strategy will increase students’ awareness of the link between oral health and behavioral health. It will provide interventions to assist the student to help patients understand the importance of oral health to overall health and to increase oral health self-care behaviors in patients with mental health problems.
This case study is about an aging woman experiencing Down’s Syndrome (DS) and dementia. People with Down’s Syndrome are living longer than ever before. Since the 1980s their life expectancy has doubled and many now live into their 60s, most likely because of advances in medical treatment and improved living conditions.