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Case Study – Nursing and Mobility Difficulties

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Source: What Makes a Nurse? http://www.healthsciencefaculty.org/profile_gallery/Perduata.html

Sonya Perduata-Fulginiti had to consider this question after she woke up on a striker frame in a hospital in Germany. She had been working as a registered nurse on a medical unit in the United States, and was just about to start a new job in the challenging cardiac care unit when she took a month off to vacation around Europe. On her vacation, she was involved in a car accident and suffered a spinal cord injury that left her with T-12 level paraplegia. On her way back to the states for rehabilitation, she wondered if she still possessed the necessary skills to go back to her nursing career.

A head nurse at her rehabilitation hospital helped her answer that question by offering to hire her as a nurse as soon as she was discharged from the hospital. After taking two weeks at home, Perduata-Fulginiti continued her career as a nurse. At this time during the 1970’s, hospitals and other public buildings were not required to be accessible to a person with a disability. Perduata-Fulginiti found that rehabilitation units were more accessible to her, since they were designed to be more spacious and accessible for the patients.

She also found that she could really contribute to patient care by using her own experiences as a person who had spent time as a patient in rehabilitation and who had a disability. She decided to go back to school and get her Bachelor of Science in Nursing with an emphasis in rehabilitation medicine. She applied at her state school, and was told by the nursing school administrator that she could never be a nurse because there was no way she could empty a bedpan.

Again, Perduata-Fulginiti had to ask herself, “What makes a nurse?” “[The administrator’s comments] kind of burst my bubble,” she said. “It was a really hard blow, especially coming from this person who had worked as a clinical psychiatric nurse. She probably hadn’t emptied a bedpan in twenty years.” Perduata-Fulginiti had to go home and think through some logistical obstacles to her disability. Could she empty a full bedpan, and if she couldn’t, did this end her nursing career? She decided to figure it out by just going ahead with her plans and applying to other nursing programs. She was accepted into Fitchberg State College. “They had a completely opposite approach. Once they saw my references, what my skills were, that I was well knowledgeable, that I could do things, could practice in the nursing field, they were eager to try. They asked me what they could do to accommodate me.”

At Fitchberg State College, and later when she attended graduate school at the University of California at San Francisco, she faced architectural barriers when attending her classes. Most of her classes at Fitchberg had to be moved to the Library, since it was the only accessible building on campus. Some professors did not like having to move away from their usual building to teach one class. Perduata-Fulginiti says that there was some grumbling about this, but she never felt that they penalized her in their grading of her work.

She says that accessibility problems in college were always something she had to plan for and they sometimes isolated her. She often had to drive to campus in the early hours of the morning in order to get a disabled access parking space. Then she had to plan extra time to take long, roundabout routes to her classes on accessible paths, since the most direct route was inaccessible. “I would have to sometimes go up to a quarter mile to get to a class that other students would just go up three steps and up an elevator to get to,” she remembered. “Many times, I would be isolated in the back of an auditorium and was not able to sit next to my classmates. The professor might not even see me if I raised my hand.” She felt that these accessibility problems really limited her ability to network and socialize with her classmates and teachers. She could not chat after class or on a walk across campus because she always had to leave immediately to take her longer route to get to the next class on time. One semester, she was only able to get into a class by waiting outside at the bottom of a flight of steps and depending on her classmates to carry her and her wheelchair up to class. After that semester, she made a decision to not allow herself to be carried anymore. “It was a safety issue for me as well as for the students who carried me. I didn’t like being dependent and it put me in the position where I had no choice but to be in a dependent and pitied role.”

She also had some architectural accessibility problems in her clinical work and in her positions in rehabilitation units. Once, she worked in a newly remodeled rehabilitation unit, yet the staff bathrooms were not made accessible. She had to take the elevator down to the bottom floor in order to use the bathroom. This took several extra minutes out of her busy day. “People just didn’t expect that there would ever be a staff member who might need an accessible bathroom. Meanwhile, they were supposed to be advocating for their rehab patients to go out and get jobs. It was kind of hypocritical.”

Sometimes, patients and staff members who weren’t familiar with Perduata-Fulginiti thought that she was just playing around in a hospital wheelchair. “They would say things like, “Put that wheelchair back. It’s for the patients,” or “when are you going to quit playing around in that thing and do some work.” It never occurred to them that a person in a wheelchair might actually be a nurse.”

There were some things that Perduata-Fulginiti could not find an alternative for in patient care, such as lift a quadriplegic patient. However, there was a broad range of work that she found accommodations for. She was able to empty bedpans by covering her lap with several chux (linen savers) and maneuvering slowly with the bedpan on her lap. She was able to maintain sterile or clean technique by making sure she always has extra latex gloves in her pockets. She then sets up her supplies, washes her hands and gloves up, wheels over to the patient, removes her gloves and re-gloves without touching her wheelchair again. Using advanced preparation and placing the bed at a specific height, she is able to do sterile wound care, catheterization, and IV procedures. She hangs an infusion bag on an IV pole by making sure that she always used a pole that is height adjustable. She uses a seatbelt to secure herself to her wheelchair and positions a patient using a transfer sheet. She found that her co-workers were always quite surprised at what she could do. She worked around the things she couldn’t do by herself in a number of ways. By only taking patients that she could treat safely, she eliminated the need to ask for assistance very often. She also bartered jobs with other nurses and nursing assistants.

Despite the fact that she had to work around some physical procedures that she was not able to do, she feels that she made up for it in other ways. She is able to show patients how to function in a wheelchair, rather than just telling them. She was able to push her patients to work harder on rehabilitating themselves because many of them wanted to do the things she could do as well as her. “Some of the patients were competitive, especially the men,” She says, “They always wanted to learn to do something better or faster than I could do it.” She often met in the hallway for casual conversations with her patients. They would start a conversation with small talk, but then they would get into some of the logistical and psychological issues of disability. “Once a doctor told me that I was wasting time talking to the patients. I told him that this is where I do some of my best work.”

Perduata-Fulginiti also thinks that the medical profession needs more individuals with disabilities like her to be practicing alongside non-disabled staff to help educate them about disability issues. “Doctors hold a lot of myths regarding individuals with disabilities. They really come from that dated medical model where if you have a disability, you are sick and need to be fixed, and that you are ignorant and can’t make decision about your life.” Once, Perduata-Fulginiti went to the emergency room when she suspected that severe pain she was experiencing was appendicitis. A doctor told her that she could not possibly be having any pain because she was paralyzed. “These inaccurate ideas can really affect medical care. As it stands now, and hopefully this will changeā€¦but now doctors have a lot of power over disabled people. I have to get a prescription for a wheelchair. Someone else makes a decision about the type and options on the most important thing I use in my life. I have to ask for a prescription for bladder supplies, adaptive equipment, and a doctor must even approve my driver’s license. They have way too much control over the lives of disabled people, and sometimes without really understanding the issues well enough, or listening and respecting the patient’s decision well enough to make those decisions.” Perduata-Fulginiti has been able to speak formally at conferences and lectures about these issues, and also in her every day work and by example.

Although she has had to work around a few issues, Perduata-Fulginiti has proved to herself and others that she has the essential criteria of what makes a nurse: skill, knowledge, the ability to communicate, and compassion for the well-being and rights of her patients.

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