Intellectual Disability Nurses Research Articles

Exploring decision making in intellectual disability nursing practice: a qualitative study

Due to the dearth of relevant research, intellectual disability nurses may have difficulty identifying sources of evidence on which they can base their clinical decisions. The aim of the present research was to explore how intellectual disability nurses make decisions and how their decisions are influenced by evidence. The method was guided by interpretative phenomenology and the analysis adopted an idiographic approach. Twelve National Health Service intellectual disability nurses in Wales participated in semi-structured interviews. Four key themes were identified: getting to know the person; working as a team; evidence to support decision making; and understanding of evidence-based practice. In the context of the myriad of other professionals involved in caregiving, the nurses conveyed a commitment towards ensuring that the person with intellectual disability is at the centre of decision making. Although using empirical evidence to support practice was acknowledged, these nurses considered person centred decision making to be paramount.

An international evaluation of networks and networking in learning disability nursing

This article presents the findings of a study of the networking activities of 665 learning disability and intellectual disability nurses in the UK and the Republic of Ireland. Participants were emailed a descriptive survey questionnaire, which they completed online. Key findings from this study include an agreed definition of networking and evidence about professional networking activities within the profession

A challenge to nursing: an historical review of intellectual disability nursing in the UK and Ireland

The aim of this paper is to provide an account of the early development of what was originally known as 'mental deficiency' nursing in the UK and Ireland. After a brief review of research literature, it analyses key issues behind the development of a workforce positioned on the margins of nursing in the two jurisdictions through a comparative discussion of similarities and differences. The paper draws on two doctoral studies that examined the development of intellectual disability nursing using an historiographical design. Primary sources consulted included records of nursing regulatory bodies, national archives, Royal College of Psychiatrists, archives, nursing journals, individual institutional records in both jurisdictions. In both countries, psychiatrists established early training programmes for nurses, although a nursing model was adopted to meet service needs in the 1950s. However, the way in which this branch of nursing developed laid the foundation for tensions as to whether it is appropriately located within the discipline of nursing. Ireland's colonial past and postcolonial position, the role of the church, welfare systems and diverse socio-political drivers for change represent key differences between the two jurisdictions. What eventually became known as learning or intellectual disability nursing poses a continued challenge for the profession as a whole in regard to its breadth, role and focus in working with marginalised groups in society. The paper considers the risks for UK and Irish intellectual disability nurses for marginalisation in nursing should they forge closer links to other disciplines concerned with common threads of disability, education or social care.

Diagnoses and Interventions Pertinent to Intellectual Disability Nursing*

The field of intellectual disability care in Ireland has been undergoing significant change, and this has called into question the role of specialist intellectual disability nursing. This review aims to identify the diagnoses and interventions that are employed by intellectual disability nurses. Exploration of the relevant professional literature, drawing on a broad scope of sources, was completed. Examination and discussion within the taxonomic structure of the Nursing Interventions Classification. Initial data set of diagnoses and interventions identified as a basis and justification for further systematic examination of specialist intellectual disability nursing practice. Explication and elaboration of the contribution of specialist nursing within intellectual disability care settings.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterColin Hemmings M.B.B.S., M.R.C.Psych.Lisa Underwood B.Sc.Nick Bouras Ph.D., F.R.C.Psych.Colin Hemmings M.B.B.S., M.R.C.Psych.Search for more papers by this authorLisa Underwood B.Sc.Search for more papers by this authorNick Bouras Ph.D., F.R.C.Psych.Search for more papers by this authorPublished Online:1 Aug 2008https://doi.org/10.1176/ps.2008.59.8.936AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail ACT for People With Intellectual Disabilities and Mental Health ProblemsTo the Editor: There is no consensus on whether assertive community treatment (ACT) for people with intellectual disabilities who also have mental health problems should be identical to ACT for people with mental illnesses. Two studies have evaluated ACT for people with intellectual disabilities and coexisting mental health problems ( 1 , 2 ). However, they used versions that were significantly different from each other and from the original ACT model ( 3 ). To evaluate the suitability of this model for this population, characteristics of ACT that are necessary for people with intellectual disabilities need to be identified. We therefore report the results of a study that explored the opinions of specialist health staff. The participants were 21 staff from four sites in the United Kingdom that deliver ACT-type services to people with intellectual disabilities. Participants included psychiatrists, psychologists, intellectual disability nurses, support workers, and occupational therapists. In-depth structured interviews were carried out in 2006 by two experienced clinicians. Participants were asked to express their opinion about each of 26 statements about ACT derived from the Dartmouth Assertive Treatment Scale ( 4 ). After complete description of the study, written informed consent was obtained from all participants. Ethical approval was obtained from Guy's Research Ethics Committee. In general, participants' opinions were similar, although some disagreement was noted. Participants believed that ACT for people with intellectual disabilities should include most of the structural and human resource features of the original model, including a shared caseload, regular team meetings, a practicing team leader, continuity of staff, and a vocational specialist on staff. They also thought that there should be more than one psychiatrist and more than two nurses per 100 service users. In regard to organizational boundaries, they believed that there should be explicit admission criteria, but having a low intake rate, 24-hour coverage, and a rule about not closing any cases were seen as unnecessary, unrealistic, or inappropriate for this population. Participants indicated that hospital admissions and discharge planning should involve personnel from the ACT service, but it was not agreed whether these personnel should take responsibility for such planning.There was disagreement about whether the ACT service should have full responsibility for treatment services, particularly housing support, employment, and rehabilitation. Participants agreed that the nature of the ACT service should be similar to that of the original model, including community delivery of services, involvement of service users' support networks, and a stagewise treatment model for those who misuse substances. There was disagreement on whether a no-dropout policy or high levels of service time and contacts were realistic or necessary. Participants did not support direct service provision by service users and family caregivers but agreed that their involvement in service development, support roles, and provision of feedback was essential. [Three tables that provide more details about participants' responses are available as an online supplement to this letter at ps.psychiatryonline.org.]The main limitation of this study was that participants did not share the same level of understanding about the original ACT model. In addition, they were typically serving persons with a wider range of mental health problems than those for whom ACT was originally intended. A focus on patients with more severe mental health problems—for example, by restricting future research on ACT among persons with intellectual disabilities to those who also have psychotic disorders—would better complement research on ACT among persons with mental illnesses.We thus hope that the findings reported here are useful for generating further discussion about ACT for persons with intellectual disabilities. It remains difficult to adequately determine whether service users with intellectual disabilities and mental health problems might benefit from ACT because of ongoing problems with the definition and implementation of the model for this service user group as well the lack of specialist professionals working with people with intellectual disabilities and mental health problems who have close knowledge and experience of ACT. Hence studies such as this one will be similarly limited. In our opinion, therefore, it may be more fruitful at present to explore the effectiveness of broader models of specialist community-based services for people with intellectual disabilities and coexisting mental health problems.Acknowledgments and disclosuresThe authors acknowledge the contributions of Stephen Higgins, M.Sc., Geraldine Holt, F.R.C.Psych., Dimitrios Paschos, M.R.C. Psych., Elias Tsakanikos, Ph.D., and Steve Wright, M.Sc.The authors report no competing in interests.Dr. Hemmings, Ms. Underwood, and Professor Bouras are affiliated with the Estia Centre, Institute of Psychiatry, King's College London.

Observing Communication Skills in Staff Interacting with Adults Suffering from Intellectual Disability, Autism and Schizophrenia

Background:Related to nursing, co-morbidity of intellectual disability (ID), autism and mental health problems, generate a need for integrated knowledge from both intellectual disability nursing and psychiatric nursing. Aim:The aim of the current paper is to examine the reliability of an instrument designed for observing communication skills in professionals caring for patients with intellectual disability, autism and schizophrenia. Procedure:A naturalistic prospective observational design was chosen. Scoring categories were developed, staff and patient communications were video-recorded and then scored. Reliability was estimated by inter-rater agreement. Results:Across 370 sequences of interaction, all categories except one were observed. Inter-rater agreement on the observational categories was high. Conclusion:The instrument worked as expected according to both observer agreement and presence of staff communication skills.

Intellectual disability nurses’ interest in undertaking postgraduate education

intellectual disability nurses’ interest in undertaking postgraduate education

Identifying the Foci of Interest to Nurses in Irish Intellectual Disability Services

The role of nursing in intellectual disability services has not been constructively debated in the Republic of Ireland. The single report on such nursing in recent years retained a biomedical bias and was prepared within the context of staffing shortages. Intellectual disability nursing in Ireland is at a crucial juncture, with various forces seeking to relegate it to a postgraduate specialist subject. The specific input of intellectual disability nursing to the broader profession may be lost, and may be subsumed within an illness model unrepresentative of the reality of care. The purpose of this study was to explore this specific input and to identify foci for nursing intervention within residential intellectual disability care. This was achieved through a Delphi study; three focus groups held among Irish intellectual disability nurses working in three service settings; and personal interviews held with residential service/nurse managers.

NANDA and NIC: Mediators to Describe Irish Intellectual Disability Nursing

PURPOSETo identify the foci of interest specific to nursing interventions within residential, intellectual disability nursing through the use of the terms and meanings presented in NANDA and NIC.METHODSData were collected using a Delphi approach involving a purposive sample of 8 individuals with relevant expertise, followed up by the conduct of three focus groups held with a total sample of 17 intellectual disability nurses working in three Irish service settings: traditional residential, community residential, and nurse education. Data were examined for contextual meaning as well as consensus of perceptions.FINDINGSMany potential interventions and diagnoses were identified for the field of residential learning disability nursing. Interventions that elicited a >50% consensus among participants across groups were examined for contextual meaning, based on the taped and noted responses, and potentially related NIC interventional labels were then applied. These led, through a reverse NIC‐NANDA linkage exercise, to the identification of 8 potentially related interventions. The contextual aspect directed the analysis process to identify the nursing diagnoses associated with the interventions to be used, and 21 resultant diagnoses were identified.DISCUSSIONFurther analysis and study are needed to verify the relevance of these diagnoses and interventions to residential learning disability. A quick comparison of the results with those of studies carried out in other countries demonstrates that certain diagnoses have been identified by one or more authors in their studies.CONCLUSIONSThis study identified a number of foci that have achieved various levels of consensus among the study participants. The ongoing study plan will further examine nurses' and managers' perceptions while also looking at these within the context of current service philosophy.