B.

P KOIRALA INSTITUTE OF HEALTH SCIENCES

COLLEGE OF NURSING
DHARAN, SUNSARI.

LESSON PLAN ON
“CARE OF HANDICAPPED IN COMMUNITY”

SUBMITTED TO:
SUMBITTED BY:
Mrs. Deva Rijal
Sugam Pokhrel

Assistant Prof.
B.Sc Nursing 4th year

Dept. of Community Health Nursing

Batch 2018

College of Nursing
Roll no: 23

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 classroom teaching, B.Sc Nursing 2nd year students
will be able to describe about care of handicapped in community.

SPECIFIC OBJECTIVES
At the end of this classroom teaching, 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.
S.N. SPECIFIC CONTENTS TIME METHOD MEDIA EVALUATION
OBJECTIVES

Self- Brain White board

Storming and marker Do you have any idea
Introduction
5min + regarding handicap?
Topic PowerPoint
Presentation
Introduction
Objectives of
session
Pretest

At the end of
this session,
participants
will be able to:

define Definition of Interactive

1. handicap handicap discussion PowerPoint What do you understand
5min Presentation by handicap?

2. explain about Magnitude of 2min Discussion What do you know

magnitude of disability PowerPoint about the magnitude of
disability Presentation disability?

3 describe the Classification 10mi Interactive PowerPoint What are the

classification of disability in n discussion Presentation classifications of
of disability in Nepal disability in Nepal?
Nepal

4 list out the Causes of 4min Interactive What are the causes of
causes of disability and discussion PowerPoint disability and handicap?
disability and handicap Presentation
handicap

describe about Prevention of How can we prevent

5 prevention of disability and Interactive PowerPoint disability and handicap
disability and handicap 10mi discussion Presentation condition?
condition n
handicap
condition

6 explain about Role of CHN in 5min Interactive What are the roles of
role of care of discussion CHN in care of disabled
PowerPoint
Community disabled and and handicapped people
handicapped Presentation
health nurse in in community?
in community
care of
disabled and
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

Magnitude of disability
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%

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:
(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 fourth row of the Snellen chart (3/60), 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: The inability to behave in accordance with age and
situation and delay in intellectual learning due to problems in performing intellectual
activities like problems arising in the brain and mental parts and awareness, orientation,
alertness, memory, language, and calculation.
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:

(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.

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.
• Physiotherapy and exercise to improve physical conditions.
• Occupational therapy according to the child's ability and that should be provided with music,
painting, weaving, woodwork, pottery.
• 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.
• 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
• 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
• Nepal Netra Jyoti Sangh
• Nepal National Federation of Deaf and Hard of Hearing
• Nepal Ear Foundation
• KOSHISH Nepal
• Asha Bal Kendra
• Karuna Foundation Nepal

POST TEST

MCQS
1. Which of the following is most logical sequence?
a) Disease-Handicap-Impairment-Disability
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

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)

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