CHAPTER ONE      

                                         INTRODUCTION

• Background of the study.

         The world health organization [WHO] emphasizes the importance of inclusive health care for individuals with disabilities, highlighting that health care professional must be adequately trained to meet the needs of this population. In many regions including Bamenda, there is a growing recognition of the need for health care systems to be more inclusive. However, the effectiveness of nursing education in preparing student nurses to care for individuals with disabilities remains underexplored. This study aims to fill the gap by assessing the current state of knowledge, attitudes and practices among nursing students in this context .Today, intellectually, physically or emotionally disabled individuals comprises Significant portion of the world’s population (Sen and Yurtsever 2017) of nearly 6.5 billion in 2004, 18.6 million (2.9%) were Severely disabled and another 19.7 million (12.4%) had moderate long term disability. Disability prevalence rise strongly with age (W.H.O 2014). The average global Prevalence of moderate and severe disability ranges from 5% in children aged 0-14 years, to 15% in adults aged 15-59 years and 46% in adults aged 60 years and older. At all ages both moderate and severe levels of disability are higher in low and middle income countries than in higher income countries. They are also higher in Africa than in other low and middle income countries. Older people make up a greater Proportion of the population in the high income countries but have lower levels of disability in their counter parts in low and middle income cities. Disability is also more common among children in the low and middle-income cities. Survey conducted in all EU members states have shown that about 16% of the population aged 16-64 has a long standing health Problem or disability and that 3.4% 11 has severe health Problem (United states, Agency for international Development 2019) Biritwum et al (2021) also reported that prevalence of disabilities is poor

          According to the American with disabilities Act (2019) disability is “defined as a physical or mental impairment that substantially limits a major life activity” W.H.O has a functional division between impairment, disability and handicap Johnson. W.H.O defines an impairment as “the objective pathology or psychological difficulty”, disability as “the effects that the impairment has on everyday activity” and lastly handicap as “the effect of the impairment on social and occupational roles”. A single impairment leads to varying degree of handicap depending on the amount of the person’s social and occupational exclusion or involvement.

        The prevalence of disability is significant with the world health organization estimating that approximately 15% of the global population lives with some form of disability. This demographic encompasses a wide range of physical, sensory, intellectual and mental health challenges, necessitating tailored healthcare approaches. Unfortunately, individuals with disabilities often encounter various barriers to accessing healthcare services, including physical accessibility issues systemic biases and lack of understanding among healthcare providers regarding their specific needs. These disparities highlight the critical importance of comprehensive training in disability awareness and sensitivity of healthcare professionals. A lack of knowledge can leads to miscommunication, inadequate care and the perpetuation of stigma, ultimately affecting patient outcomes [Sahin and Akyol2019. The context of student nurses, the educational preparation they receive can vary significantly across nursing programs curricula may not adequately cover disability related topics leaving nurses ill- prepared to provide appropriate care for individuals with disabilities. Researches indicate that nurses may hold preconceived notions or biases about this population which can influence their willingness to engage and the quality of care they provide. For instance, a study by Miles [2022] found that nurses’ attitudes significantly impact the quality of healthcare provided to patients with disabilities. Positive attitudes and strong knowledge base are crucial for effective nursing practice; student nurses who possess a better understanding of disability are more likely to demonstrate empathy and provide high quality care. Furthermore, practical exposure to individuals with disabilities during clinical rotations can significantly impact their attitudes leading to improved care practices. Addressing the knowledge gaps and biases of student nurse regarding PWD is essential for promoting equitable healthcare. By fostering positive attitudes and incorporating comprehensive training into nursing education, the profession can better meet the needs of all patients, particularly those with disabilities. This approach not only enhances the quality of care provided but also contributes to more inclusive healthcare environment benefiting both patients and healthcare providers alike.  In conclusion, integrating disability awareness into nursing education is vital for preparing future healthcare professionals to provide compassionate and competent care to PWD which will not only lead to improved healthcare but also foster a more inclusive health

        The common man view of disability is as a tragedy, disgrace, the result of sins and God’s punishment. People with disabilities are seen as a burden to others, to their families, to themselves and the society. In English they are described as being invalid (not a valid person) as being handicapped (implying a beggar with cap) or as being disabled (not able). Do these views carry over to the way people in the helping profession relate with people with disabilities? That is the interesting question (Pfeiffer et al 2024). Heath was defined in the WHO “constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Recently, the concept has been extended to include health related quality of life. Today the international classification of impairments, disabilities and handicaps (ICIDH) provides indicators that allow a more structured approach to health disorders (Barbttle 2021).

There are many definitions of disabling and types of conditions. The W.H.O define disability as a limitation in a person’s abilities (example mobility, personal care, communication  behavior)  impairment as an  alteration in body system (example neurological, respiratory, Urologic) and handicap as disadvantages experienced people in their environment (example Workplace and independence) (Lollar and Crews 2023) In 2021 WHO revised its definition to change the focus from a classification system based on consequences of disease to one that is focused on components of health. Disability can be classified according to American with disability Act.

1. Physical disability example mobility visual and hearing impairment
2. Mental disability example learning disability schizophrenia, Phobia, neurosis.
3. Developmental disability example  Dyslexia Syndrome, ADHD, autism
4. Other disabilities example substance abuse Sanity.

Care system.

          Today, numerous laws and norms are in place to ensure equal treatment of people with disabilities. As consequence of living in a society that takes pride in its tolerance and open enmity or dislike towards people are physically different is no longer socially desirable and accepted (Krahe and Altheasser 2016)

       Attitude is complex, different researchers have define it in different way (Hsu -2012) defines attitude in psychology as “a psychological tendency is expressed by evaluating a particular entity with some degree of favor and disfavor. Trevo, Palmer and Redinius (2024) states that  attitudes are learned disposition directing feelings, thoughts and actions Longoria and Marini (2016) define attitude as “any belief or opinion that Includes a positive or negative evaluation to some target ( on object, person or event) and that predisposes us to act in a certain way toward the target. Many research (Hsu 2012) for instance said there is significant relationship between attitude and behavior Allpert 2018 stated that “an attitude characteristically provokes behavior that is acquisitive or generous, favorable or unfavorable, affirmative or negative towards the object or class of objects with which it is related. Attitude comprises of three Components; affective, behavior and cognitive (Mishra 2016). Affective is shown by positive or negative emotional expression towards people, events or objects. Behavioral is the tendency to behave in a particular way towards people, events actions and cognitive refers to our beliefs formed about objects or person (Mishra 2016).

1.2. Statement of the Problem

          Globally, approximately 1 billion people live with disabilities, representing about 15 % of the world’s population. These demographic faces significant barrier in accessing healthcare, often exacerbated by healthcare professionals’ lack of knowledge and understanding of their needs. In Africa, the situation is practically dire, with an estimated 80% of persons with disabilities living in low income settings, facing higher rates of discrimination and inadequate healthcare services.in Cameroon, the challenges are pronounced with a disability prevalence of approximately 4.5% according to 2020 census. Despite national policies promoting inclusively healthcare providers often lack the training and awareness necessary to provide effective care to persons with disabilities. A study indicated that only 30% of healthcare workers in Cameroon feel adequate trained to address the needs of this population, revealing a critical gap in knowledge and practice. Within this study area of RHB, this deficiency leads to suboptimal care for PWD resulting in poor health outcomes, increased healthcare costs, and prolonged hospital stays. Many nurses report discomfort and uncertainty in managing patients with disabilities, which further complicates their care. The implication of this problem extend beyond individual patients affecting the overall healthcare system and contributing to inequities in care delivery, while also exacerbating social stigma surrounding disabilities. Furthermore, to improve the knowledge, attitudes, and practices of nurses towards persons with disabilities could perpetuate a cycle of neglect and discrimination leading to increased morbidity and mortality rates among this vulnerable population. Not addressing this problem risks undermining the broader goals of public health which include reducing health disparities and promoting inclusive practices. Ultimately, fostering an inclusive healthcare environment that upholds the rights and dignity of all patients is essential for achieving better health outcomes and enhancing the quality of care in healthcare system.  

• Research questions.

1.3.1 Main research question

What is the level of knowledge, attitude and practice of s nurses towards persons with disabilities at the RHB?

• specific research question

1. What level of awareness do nurses have about the various disabilities?
2. What attitude do nurses have towards persons with disabilities?
3. What is the level of practice of nurses towards persons with disabilities at the RHB?

1.3 Objectives of the Study

The purpose of this study is to determine the attitudes of nurses toward people with disabilities.

1.3. General objectives

To assess the knowledge attitudes and practices of nurses towards persons with disabilities at the RHB

• specific objectives

1. To evaluate the awareness level nurses about various disabilities
2. To investigate the attitude of nurses towards persons with disabilities
3. To evaluate the practice of nurses towards persons with disabilities at the regional hospital Bamenda