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Nursing
Physical
Disabilities
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"What
Makes a Nurse?"
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 change…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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