Case Study – Nursing and Motor / Manual Dexterity Difficulties

Case Study 1 – Source: Can’t do Nursing with one Hand! – Nikki Heazell Proves Everyone Wrong. (2003). Disability Rights Commission.

Nikki Heazell, who had her left arm amputated below the elbow when she was a baby, qualified as a staff nurse last July and now works at Birmingham City Hospital. Since childhood, Nikki, now 24 years old, has always wanted to be a nurse, yet she has had to overcome careers advisor’s ignorance, blatant discrimination and many people’s preconceptions of her ability to fulfil her dream.

Why did you always want to be a nurse?

When I was a teenager, I dislocated my elbow, but because of my amputation, it took a long time for the doctors to detect it. Because of this, I was always in and out of hospital, and as I was always placed in the children’s ward, I helped the nurses to look after the babies and younger children. It was because of this that I decided that I wanted to become a nurse.

What were people’s attitudes when you first said that you wanted to go into nursing?

Careers advisors always told me I couldn’t do nursing, as it needed dexterity, something that I didn’t have. Outwardly I said, “OK then”, but inwardly I was saying to myself “well sod you”. Careers advisors always tried to deter me from nursing by advising that I go into health related subjects like health science or health studies. I saw one particular careers advisor three times, who always said “but you can’t go into nursing”. To me, this wasn’t a justified answer – in fact nobody could ever give me a justified answer.

From September 2002, if a disabled person is discriminated against in their education due to their disability, they may be able to challenge this under the DDA as amended by the Special Education Needs and Disability Act (SENDA). Did you face any discrimination when you first applied to do a nursing degree?

I applied to do my degree at a few universities throughout the country. Following my initial applications, I received a letter from one particular university saying that I had to be rejected from the course as I was termed as unfit, due to my only having one hand and the physical dexterity that the job entailed. They hadn’t even seen me or seen what I could do!

Regarding the other universities, my acceptance on the courses was subject to assessments by occupational health doctors, which to my knowledge – no other nurses had to go through. The occupational health doctors often asked me how I would cope with only one hand, and I always used to answer saying, “I don’t know any different. How do you cope with two hands?” With hindsight, I often wonder if occupational health doctors are the right people to assess if disabled people who want to go into nursing can do the job.

How did these experiences make you feel?

I had never really thought of myself as having a disability, however my rejection and blatant discrimination from that one university kind of changed my thinking. I was more annoyed that they assumed that I couldn’t do nursing before they had even seen me or seen what I could do. The rejection was not justified and I thought that if the university was going to be that narrow-minded, then I didn’t want to attend it anyway.

Did you ever experience any discrimination during your degree, or since you’ve qualified as a nurse?

I have a false arm, yet it is more comfortable for me not to wear it. However, during my training, one ward manager made me wear it as she said that my scar was quite unsightly. I told her that is was more dangerous for me to work with my arm on than it was without it. In contrast, my current ward manager didn’t even notice my disability until I had been working on the ward for three days.

Instead of being a hindrance, do you think that your disability is beneficial to your work?

Yes, I do believe that my disability benefits my work. For example, I am able to show patients who have had a stroke and can only use one arm how to do things with one hand. Also, I find that I put a lot of mums at ease whose children have had a limb amputated, in particular their daughters. For example a lot of mums ask me how their daughters will put their bras on or shave under their arms.

I haven’t seen any other nurses with disabilities, yet I believe that disabled nurses should be actively recruited, as these would be more benefit to patients.

Were you ever discriminated throughout your school years?

The matron at the school I attended always used to try and force me to wear my false arm. Also the PE teacher used to make me wear the arm when playing sports, which I didn’t like to do as I felt that if I was ever to fall, I was more likely to injure myself. I was once modelling at a fashion show at the school, and the head mistress came up to me and said “I hope that you are gong to wear your prosthetic arm”. I had to wear my false arm to keep up appearances. In the end, my occupational therapies (who has been working with me since I was seven years old) came into the school and spoke to the school staff to sort any problems out.

Do you consider yourself as a role model for disabled people?

No, I don’t consider myself as a role model as I’ve never made my disability an issue. However, on one occasion, I was treating a teenage girl who had recently had her arm amputated. She later on told another member of staff that I had inspired her. I didn’t realise that I had helped her in any way, as she was just coming out of anaesthetic and was quite groggy, and I was just getting on with my nursing. Yet I am quite keen to say to anyone in a similar position as me that they can do what they want – even when they are told that they can’t!

Case Study 2 – Source: Brunt, J. (2004). Nurse Overcame Others’ Blocks.

It was Nathan Lee Zinnerman’s first bath. His nurse, Susanne Fleming, held his head gently under the sink for a shampoo, and after changing his diapers, giving him his first shot and wiping his body, she wrapped him like a mummy in warmed blankets.

“They’ve got a personality already,” Fleming said, noting Nathan’s relative calm. Fleming’s ease in her role was noticeable. Her silicone hand wasn’t.

Fleming was born without a left hand, but that didn’t stop her from pursuing a career in nursing, even after she was told she couldn’t.

Last week, the mother of four was presented with the 2004 Cherokee Inspired Comfort Award for her passion for the field and her advocacy for nurses who have disabilities. The prize comes with a cruise to the Cayman Islands, a crystal trophy and $1,000 worth of Cherokee health care uniforms.

“I’ve had patients comment on her ability to do things with one hand and make it look so effortless,” said Sandi Maddy, who works with Fleming at Deaconess Medical Center. “She’s a wonderful nurse, always in a good mood, always cheerful and helpful.”

Fleming first became passionate about nursing when she worked in her midteens as a nursing assistant at a care center for people with severe disabilities. But when Fleming first tried to enter nursing school in California in the mid-1970s, she was turned down. Officials there told her that she would endanger her patients and even expressed concern that she wouldn’t be able to give bilateral back rubs, Fleming said.

So she went to a different school, the Los Angeles County School of Nursing. There, she was elected president of her class, and she discovered that she could perform all the duties of a nurse. (While she can’t give a bilateral back rub, a rub with two hands, she has found that using one hand is just as effective.)

The only time she asks for assistance from another nurse is when catheterizing patients, a function she could perform on her own but prefers to do with help. It’s not something she often has to do, anyway.

Fleming says she tried to make herself available to other nurses who might need her help to lift patients or assist in other ways. It’s just part of being a team. After school in Los Angeles, Fleming worked at a veterans hospital in Seattle and at medical centers in Hawaii, Texas and Germany when her husband was in the Army. Nine years ago, she and her family moved to Chewelah, where she still works at St. Joseph’s Hospital.

For the past year and a half, Fleming also has worked with moms and their newborns at the mother-baby unit at Deaconess Medical Center.

She earned her bachelor’s degree in nursing in May from Washington State University Intercollegiate College of Nursing, where an adviser persuaded her to become more vocal about nurses with disabilities. Fleming has since become a board member of, which advocates for the inclusion of more people with disabilities in nursing.

Her disability sometimes helps her help patients. She has counselled mothers of newborns who have disabilities, and believes that she might better understand some patients because of the challenges she’s faced.

“Most patients are in a disabled condition,” Fleming said of hospital patients. “I hope I’m extra sensitive.”

Fleming is now pursuing her master’s degree in nursing from the University of Washington, completing most of her work online.

To get where she is now, Fleming said she had to dismiss the many depressing and pitiful images she saw in her childhood of people with disabilities. She remembers one particular time how she felt after seeing such a picture on TV.

“My mom came home from work and I asked her, “Am I a handicap?” and she said, “Only if you want to be,” I felt relieved. It set me free.”

Despite her award, Fleming said the credit really belongs to the hospitals and schools that have welcomed her.

“I’m appreciative of all the people who allow me to work because it wasn’t like that 20 years ago,” Fleming said. “These are the people who are doing things. I’m just being myself.”

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