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Hayward BA. A job analysis of mental health nursing in a school for students with intellectual and developmental disabilities. Int J Ment Health Nurs 2024; 33:957-966. [PMID: 38291653 DOI: 10.1111/inm.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self-reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant-participator in a single-case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health.
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Affiliation(s)
- Brent A Hayward
- Department of Education, East Melbourne, Victoria, Australia
- Department of Education, School of Social and Political Sciences, Faculty of Arts, University of Melbourne, Parkville, Victoria, Australia
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Rozani V, Zur-Peled S, Aharon AA. Caring for people with intellectual disabilities: Insights from a cross-sectional study among nursing students. NURSE EDUCATION TODAY 2024; 138:106187. [PMID: 38574546 DOI: 10.1016/j.nedt.2024.106187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Caring for people with intellectual disabilities poses substantial challenges. Nursing students' emotions, thoughts, and behaviors during their education in the context of people with intellectual disabilities, remain relatively unexplored. OBJECTIVES To examine nursing students' emotions, thoughts, competence, and expected professional behaviors in care provision for people with intellectual disabilities, as well as to identify factors associated with their expected professional behaviors with this population. DESIGN A cross-sectional study using a closed self-report questionnaire and one open-ended question. SETTING The largest academic nursing department in Israel. PARTICIPANTS Of 245 sophomore nursing students, 177 agreed to participate (71.4 % response rate). METHODS The study measured feelings, thoughts, competence, and expected professional behaviors in care provision for people with intellectual disabilities based on the Multidimensional Attitudes Scale. One open-ended question addressed how students believe their competence in caring for people with intellectual disabilities could be improved during their nursing studies. A hierarchical linear regression analysis was performed to investigate the contribution of emotions, thoughts, and competence to explaining expected behaviors in care provision. The significance of the model and the R2 were calculated. The open-ended question was analyzed by the constant comparative method. RESULTS Negative emotions and thoughts (β = -0.37, 95 % CI -0.47; -0.15 and β = -0.33, 95 % CI -0.39; -0.13, respectively), along with positive emotions (β = 0.25, 95 % CI 0.07;0.33), showed significant associations with expected professional behaviors. Qualitative analysis revealed three key themes: communication concern, knowledge gap, and curiosity. The findings of the open-ended question corroborate the quantitative findings. CONCLUSION It is important to realize that in order to develop quality professional skills for caring for people with intellectual disability, nursing educators must adopt a deep discussion of negative emotions and thoughts with their students regarding people with intellectual disabilities. Ignoring these negative emotions and thoughts can exacerbate the neglect of people with intellectual disabilities' health needs.
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Affiliation(s)
- Violetta Rozani
- Department of Nursing, Steyer School of Health Professions, Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 69978, Israel.
| | - Sharona Zur-Peled
- Department of Nursing, Steyer School of Health Professions, Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 69978, Israel; Dina Academic School of Nursing, Rabin Medical Center, Petah Tikva, Israel.
| | - Anat Amit Aharon
- Department of Nursing, Steyer School of Health Professions, Faculty of Medical and Health Science, Tel Aviv University, Tel Aviv 69978, Israel.
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Jojo N, Wilson RL. Enhancing Disability Nursing Practice in Australia: Addressing Educational Preparedness. Int J Ment Health Nurs 2024. [PMID: 38873821 DOI: 10.1111/inm.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/08/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
People with intellectual disabilities (IDs) face significant health challenges, including poor outcomes, limited access to health care, and a 26-year life expectancy gap compared with the general population. This highlights the need for improved public health and social policies to enhance the quality of care in hospital and community settings. An integrated literature review was conducted to examine the state of disability nursing practice in Australia following the implementation of the National Disability Insurance Support (NDIS) scheme. The review included English-language studies published from 2010 to 2023. Systematic searches in five databases resulted in a final sample of 28 studies. The data were then thematically analysed, and the following three themes emerged: Workforce development and professional standards, hospital experience and support needs of individuals with IDs, and nursing curriculum and ID. Study findings suggest that nurses lack preparation for effective health communication with individuals with IDs and their families. Evidence is insufficient to guide nursing practice and policies in ID care. Varying understandings of practice standards exist among nurses. Nursing curriculums in Australia fail to adequately prepare students to manage the unique needs of individuals with IDs, perpetuating the high mortality rates in this population. Specialised nursing practice areas are vital for meeting the complex needs of individuals with IDs. Reintroducing a disability nursing specialty and integrating dedicated study units and clinical placements in undergraduate programmes are recommended steps to improve care outcomes and support the overall well-being of this population.
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Affiliation(s)
- Natasha Jojo
- School of Nursing and Midwifery, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Rhonda L Wilson
- Mental Health Nursing, RMIT University, Melbourne, Victoria, Australia
- Central Coast Local Health District, NSW Health, Gosford, New South Wales, Australia
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Ailey SH, Molly B, Tichá R, Abery B, Khuu BK, Angel L. Health professionals' education related to people with intellectual and developmental disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13208. [PMID: 38382496 DOI: 10.1111/jar.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system. METHODS Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population. RESULTS Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning. CONCLUSION We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population.
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Affiliation(s)
- Sarah H Ailey
- Department of Community, Systems, and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois, USA
| | - Bathje Molly
- Occupational Therapy Program, DePaul University, College of Science and Health, Chicago, Illinois, USA
| | - Renáta Tichá
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian Abery
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Belle K Khuu
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa Angel
- Department of Community, Systems, and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois, USA
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Caltabiano P, Bailie J, Laycock A, Shea B, Dykgraaf SH, Lennox N, Ekanayake K, Bailie R. Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review. Implement Sci Commun 2024; 5:39. [PMID: 38627849 PMCID: PMC11020327 DOI: 10.1186/s43058-024-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. METHODS This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. RESULTS The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. CONCLUSION Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
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Affiliation(s)
- Paul Caltabiano
- School of Rural Health, The University of Sydney, Dubbo, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Bradley Shea
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, ACT, Canberra, Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Kanchana Ekanayake
- University of Sydney Library, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- School of Public Health, The University of Sydney, Camperdown, Australia
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Cashin A, Pracilio A, Buckley T, Trollor JN, Wilson NJ. Filling the Gaps: Evaluation of an Online Continuing Professional Development Program for Australian Registered Nurses to Build Capacity to Care for People With Developmental Disability. J Contin Educ Nurs 2023; 54:554-560. [PMID: 37855824 DOI: 10.3928/00220124-20231013-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND People with autism spectrum disorder and/or intellectual disability have some of the worst health outcomes of any population group. Internationally, it has been identified that RNs are not adequately prepared to provide care to these groups through mainstream health care services. METHOD A cross-sectional online evaluation survey of participants who completed learning to build the capacity of RNs to care for people with autism spectrum disorder and/or intellectual disability was conducted. RESULTS The learning site was found to be easily accessible and engaging, and it facilitated knowledge construction. A statistically significant increase in self-reported comfort, confidence, and preparedness compared with the sample of RNs in a national survey conducted before the site launch was identified. CONCLUSION This online continuing professional development program facilitated RNs' perceived comfort, confidence, and preparedness to care for people with autism spectrum disorder and/or intellectual disability. Findings suggest the merit of high-quality online continuing professional development programs to fill this educational gap. [J Contin Educ Nurs. 2023;54(12):554-560.].
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Mafuba K, Kiernan J, Kudita C, Chapman HM, Kupara D, Chester R. Understanding the contribution of intellectual disabilities nurses: Paper 3 of 4 - evaluation. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231196588. [PMID: 37611566 DOI: 10.1177/17446295231196588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The overall objective of this research was to identify intellectual disability nursing interventions and their impact on the health and healthcare of people with intellectual disability. This is part 3 of a 4-part series. In this paper we report the findings from quantitative questions from an online survey of intellectual disability nurses. The objective of this part of the study was to a evaluate intellectual disability nurses' confidence in their understanding of the interventions they undertook. Quantitative data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants from 7 countries. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. The evaluation data suggest and demonstrate a lack of clarity among intellectual disability nurses of the interventions they can effectively undertake. There appears to be correlations between lack of role clarity and the types of employer organisations and countries. Further work need to be undertaken by nurse leaders ascertain and address this lack of clarity.
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Affiliation(s)
| | - Joann Kiernan
- Edge Hill Universityand Alder Hey Children's Hospital, UK
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Ong N, Lucien A, Long JC, Weise J, Walton M, Burgess A. What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis. BMJ Open 2023; 13:e071494. [PMID: 37491102 PMCID: PMC10373726 DOI: 10.1136/bmjopen-2022-071494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital. DESIGN Qualitative study. SETTING We conducted semi-structured interviews and focus groups of staff of tertiary children's hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis. PARTICIPANTS There were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff. INTERVENTION Questions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital. RESULTS Key themes elicited include Definition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk. CONCLUSIONS Staff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Affiliation(s)
- Natalie Ong
- Children's Hospital Westmead Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Child Development Unit, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Abbie Lucien
- Faculty of Medicine, School of Psychiatry, UNSW, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Merrilyn Walton
- Office of Teaching and Learning in Medicine, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Annette Burgess
- Medical Education, Education Office, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Sandberg M, Axmon A, Ahlström G, Kristensson J. Predictors of specialist somatic healthcare utilization among older people with intellectual disability and their age-peers in the general population: a national register study. BMJ Open 2023; 13:e072679. [PMID: 37407048 DOI: 10.1136/bmjopen-2023-072679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to identify predictors for somatic healthcare usage among older people with ID. PARTICIPANTS Equally sized cohorts, one with people with ID and one referent cohort, one-to-one-matched by sex and year of birth, were created. Each cohort comprised 7936 people aged 55+ years at the end of 2012. DESIGN Retrospective register-based study. SETTING All specialist inpatient and outpatient healthcare clinics in Sweden. OUTCOME MEASURES Data regarding planned/unplanned and inpatient/outpatient specialist healthcare were collected from the Swedish National Patient Register for 2002-2012. Diagnoses, previous healthcare usage, sex, age and cohort affiliation was used to investigate potential impact on healthcare usage. RESULTS Compared with the referent cohort, the ID cohort were more likely to have unplanned inpatient and outpatient care but less likely to have planned outpatient care. Within the ID cohort, sex, age and previous use of healthcare predicted healthcare usage. CONCLUSIONS Older people with ID seem to have lower risks of planned outpatient care compared with the general population that could not be explained by diagnoses. Potential explanations are that people with ID suffer from communication difficulties and experience the healthcare environment as unfriendly. Moreover, healthcare staff lack knowledge about the particular needs of people with ID. Altogether, this may lead to people with ID being exposed to discrimination. Although these problems are known, few interventions have been evaluated, especially related to planned outpatient care.
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Affiliation(s)
- Magnus Sandberg
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Anna Axmon
- EPI@LUND (Epidemiology, Population studies and Infrastructures at Lund University), Division of Occupational and Environmental Medicine, Lunds University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
| | - Jimmie Kristensson
- Department of Health Sciences, Lunds Universitet, Lund, Sweden
- Institute for Palliative Care, Lund University, Region Skåne, Lund, Sweden
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Edwards AP, Nash AJ. Transformative care for people with disabilities: Empowering senior nursing students with competency based clinical education-A qualitative study of the impact. NURSE EDUCATION TODAY 2023; 126:105822. [PMID: 37182275 DOI: 10.1016/j.nedt.2023.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND People with disabilities (PWD) constitute 26 % of the U.S. population yet no nursing schools have compulsory clinical education specific to PWD. Inadequate education and negative attitudes lead to lack of preparedness for working with PWD. To meet the needs of this highly underserved population, nursing students need training and experience in the care of PWD. OBJECTIVE The objective of this paper is to report three themes from the qualitative evaluation of two immersive clinical experiences with PWD for undergraduate nursing students designed to evaluate competencies for working with PWD. DESIGN Curriculum evaluation using qualitative methods. METHODOLOGY During and after the clinical experience, qualitative data (reflection papers, debriefing responses, and group interviews) were collected with a volunteer sample of senior nursing student participants of the clinical experiences with PWD. Thematic analysis was used to identify changes in students' attitudes, perceived competence, and motivation for working with PWD. FINDINGS Three major themes are reported in this paper: A positive shift in perspective of PWD (attitudes), impact of the experience on students' practice with PWD (comfort, confidence, awareness and motivation), and revelations from the experience (attitudes and resource awareness). CONCLUSIONS A comprehensive immersive clinical experience caring for PWD provides a real-world laboratory with important experiential learning activities that help students acquire and apply knowledge about the healthcare needs of PWD. Reflection activities facilitate synthesis of that knowledge. Results from this study suggest that this clinical experience can transform students' attitudes toward PWD, enhance their clinical skills, and motivate them to consider a nursing career with this highly under-served population.
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Affiliation(s)
- Allison P Edwards
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center Houston, 6901 Bertner Ave., Ste. 716, Houston, TX 77030, United States of America.
| | - Angela J Nash
- Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center Houston, 6901 Bertner Ave., Ste. 630, Houston, TX 77030, United States of America.
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Salomon C, Bellamy J, Evans E, Reid R, Hsu M, Teasdale S, Trollor J. 'Get Healthy!' physical activity and healthy eating intervention for adults with intellectual disability: results from the feasibility pilot. Pilot Feasibility Stud 2023; 9:48. [PMID: 36949532 PMCID: PMC10032022 DOI: 10.1186/s40814-023-01267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND People with intellectual disabilities (ID) experience high rates of lifestyle related morbidities, in part due to lack of access to tailored health promotion programmes. This study aimed to assess the feasibility and preliminary efficacy of a tailored healthy lifestyle intervention, Get Healthy! METHODS Get Healthy! is a 12-week physical activity and healthy eating programme designed to address lifestyle-related risks for adults with mild-moderate ID. The feasibility pilot was designed to assess subjective participant experience and programme feasibility across: recruitment and screening, retention, session attendance and engagement, adverse events, and practicality and reliability of outcome procedures. Exploratory programme efficacy was assessed across the following measures: anthropometry (body mass index, weight, waist circumference), cardiovascular fitness, physical strength, dietary intake, healthy literacy, and quality of life. RESULTS Six participants with moderate ID and two carer participants completed the feasibility trial, representing a 100% retention rate. Qualitative data indicated the programme was well received. Participants with ID attended 75% of sessions offered and displayed a high level of engagement in sessions attended (91% mean engagement score). While most data collection procedures were feasible to implement, several measures were either not feasible for our participants, or required a higher level of support to implement than was provided in the existing trial protocol. Participants with ID displayed decreases in mean waist circumference between baseline and endpoint (95% CI: - 3.20, - 0.17 cm) and some improvements in measures of cardiovascular fitness and physical strength. No changes in weight, body mass index, or objectively measured knowledge of nutrition and exercise or quality of life were detected from baseline to programme endpoint. Dietary intake results were mixed. DISCUSSION The Get Healthy! programme was feasible to implement and well received by participants with moderate ID and their carers. Exploratory efficacy data indicates the programme has potential to positively impact important cardiometabolic risk factors such as waist circumference, cardiovascular fitness, and physical strength. Several of the proposed data collection instruments will require modification or replacement prior to use in a sufficiently powered efficacy trial. TRIAL REGISTRATION ACTRN: ACTRN12618000349246. Registered March 8th 2018-retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374497 UTN: U1111-1209-3132.
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Affiliation(s)
- Carmela Salomon
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
| | - Jessica Bellamy
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
- School of Medical, Indigenous & Health Sciences, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, 2522, Australia
| | - Elizabeth Evans
- Council for Intellectual Disability, 418A Elizabeth St, Surry Hills, NSW, 2010, Australia
| | - Renae Reid
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
| | - Michelle Hsu
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, 2006, Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 26 Llandaff Street Bondi Junction, Sydney, 2022, Australia
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Kensington, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Sydney, Room 241, Level 2, Biolink Building E25, Sydney, NSW, 2052, Australia.
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Are They the Same for All People? Nurses' Knowledge about the Basic Human Needs of People with Disabilities. Behav Sci (Basel) 2023; 13:bs13010068. [PMID: 36661640 PMCID: PMC9854844 DOI: 10.3390/bs13010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
Nursing care involves a continuous interaction between nurses and people with disabilities. This has created a need for assessment tools that measure nurses' knowledge about the basic human needs of people with disabilities. The aim of this cross-sectional study was to develop a Knowledge of Basic Human Needs Scale and investigate nurses' levels of knowledge about the basic human needs of people with disabilities and their association with nurses' education. Data were analyzed using principal component analysis to test the construct validity and to identify factors using principal varimax rotation. The reliability estimate was based on Cronbach's alpha coefficient. Linear regression models were used to assess the association between knowledge about basic human needs and predictors. Factor analysis extracted eight factors, explaining 66.3% of the total variance. The sampling adequacy, criterion validity, and internal consistency were satisfactory. The nurses' levels of education was associated with their knowledge about the basic human needs of people with disabilities. The questionnaire constitutes a valuable contribution to improving nurses' knowledge and practice, as well as the quality of healthcare, and it provides a contribution to improving the quality of life for people with disabilities.
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Currie J, Thompson C, Grootemaat P, Andersen P, Finnegan A, Carter M, Halcomb E. A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries. J Clin Nurs 2023; 32:283-297. [PMID: 35146817 PMCID: PMC10078692 DOI: 10.1111/jocn.16239] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/14/2022]
Abstract
AIM The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice. BACKGROUND Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future. DESIGN A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines. RESULTS One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation. CONCLUSION There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.
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Affiliation(s)
- Jane Currie
- Queensland University of Technology, Kelvin Grove Campus, Brisbane, Queensland, Australia.,Susan Wakil School of Nursing & Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Thompson
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, New South Wales, Australia
| | - Pam Grootemaat
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, New South Wales, Australia
| | - Patrea Andersen
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia.,School of Nursing, Midwifery and Social Science, CQ University, Queensland, Australia
| | - Alan Finnegan
- University of Chester, Riverside Campus, Chester, UK
| | - Michael Carter
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Appelgren M, Persson K, Bahtsevani C, Borglin G. Swedish registered nurses' perceptions of caring for patients with intellectual and developmental disability: A qualitative descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1064-1076. [PMID: 34009687 DOI: 10.1111/hsc.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.
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Affiliation(s)
- Marie Appelgren
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- City of Malmö, Borough Administration Operation Support Management, Malmö, Sweden
| | - Karin Persson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Christel Bahtsevani
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
- Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Norway
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Comparative effects of disability education on attitudes, knowledge and skills of baccalaureate nursing students. Nurse Educ Pract 2022; 61:103330. [DOI: 10.1016/j.nepr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
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Doody O, Hennessy T, Moloney M, Lyons R, Bright AM. The value and contribution of intellectual disability nurses/nurses caring for people with intellectual disability in intellectual disability settings: A scoping review. J Clin Nurs 2022; 32:1993-2040. [PMID: 35301775 DOI: 10.1111/jocn.16289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disability experience poorer health and healthcare access issues. As a leading role in healthcare provision for people with intellectual disability nurses are key to supporting person-centred care and health outcomes. However, little is known about specialist intellectual disability nursing and their contribution to care provision for people with intellectual disability. METHODS A systematic scoping review. Searches of seven academic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO, Embase, Scopus and Web of Science were conducted to identify relevant literature. Literature addressing intellectual disability nursing or nursing care for people with intellectual disability in intellectual disability centres/units/care homes were reviewed and reported as per PRISMA-ScR checklist and PRISMA flow diagram. RESULTS The published literature (n = 68) is extensive and describes the value and contribution of intellectual disability nursing across all domains of professional practice and supports a biopsychosocial-educational approach to addressing the physical, mental and social needs of clients with intellectual disability across the care continuum of health management, health promotion and health education. CONCLUSIONS Despite the importance of the review question and the large volume of publication evidence detailing wide-ranging professional nursing roles and responsibilities, there remains limited literature on the assessment and intervention strategies employed by intellectual disability nurses that highlight their specialist knowledge and skill. Future research should focus on making the role of the nurse more visible and presenting their unique contributions to client care, service delivery, policy and ultimately to the art and science of nursing.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mairead Moloney
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Rosemary Lyons
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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17
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Desroches ML, Howie VA, Wilson NJ, Lewis P. Nurses' attitudes and emotions toward caring for adults with intellectual disability: An international replication study. J Nurs Scholarsh 2021; 54:117-124. [PMID: 34741386 DOI: 10.1111/jnu.12713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Negative nurse attitudes and emotions toward caring for adults with intellectual disability have been implicated as a contributing factor to the cascade of health disparities faced by this population. The purpose of this study was to identify influencing factors of nurses' attitudes and emotions toward caring for adults with intellectual disability that transcend national borders and differing systems of care. METHODS This cross-sectional correlational predictive replication study used an online electronic survey with a snowball sample of 115 Australian nurses, from March to August 2020. RESULTS Nurses' attitudes toward adults with intellectual disability were significantly less positive compared to adults without intellectual disability, and nurses' beliefs about the quality of life of adults with intellectual disability predicted nurses' attitudes, replicating findings of the USA study. The frequency of both the professional and personal contact was associated with positive and negative emotions in both countries, however no consistent predictive pattern was evident. CONCLUSIONS Our findings suggest that worldwide, there is room for improvement in nurses' attitudes and emotions toward this underserved group. Future research should investigate the role of nurses' beliefs about quality of life of adults with intellectual disability for potential interventions to improve nurses' attitudes toward care. CLINICAL RELEVANCE Assisting nurses to identify misconceptions about the quality of life of adults with intellectual disability is suggested as an intervention to improve nurses' attitudes toward caring for adults with intellectual disability.
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Affiliation(s)
- Melissa L Desroches
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, USA
| | - Virginia A Howie
- School of Nursing, Midwifery, and Social Sciences, CQUniversity, Nth Rockhampton, Queensland, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Lewis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Edwards AP, Hekel BE. Appraisal of disability attitudes and curriculum of nursing students: a literature review. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2021-0029. [PMID: 34260832 DOI: 10.1515/ijnes-2021-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
Worldwide, more than one billion people live with a disability (World Health Organization. (2011). World report on disability. Retrieved from https://www.who.int/disabilities/world_report/2011/report/en/). People with a disability (PWD) have unmet needs with the delivery of health care, secondary to nursing student's negative attitudes, knowledge, and skill deficits. This integrative literature review evaluated nursing student's education and attitudes towards PWD. Deficient education, attitudes, knowledge, and skills are addressed. Combined search terms utilized included: healthcare students; healthcare education; nursing students; clinical experience; clinical rotation; attitude of health care students; and exposure to PWD. Thirty articles were analyzed with common themes identified. Educational methods that produced improved attitudes, knowledge and skills included standardized patients with disabilities; phenomenological approaches; curriculum enhancement; empathy exercises and clinical experiences (Anderson, E. S., Ford, J., & Thorpe, L. (2011). Learning to listen: Improving students' communication with disabled people. Medical Teacher, 33(1), 44-52. doi: 10.3109/0142159X.2010.498491; Castro, S. S., Rowe, M., Andrade, L. F., & Cyrino, E. G. (2018). Developing competencies among health professions students related to the care of people with disabilities: A pilot study. Interface: Comunicacao, Saude, Educacao, 22(65), 551-563. doi: 10.1590/1807-57622016.0684; Hensel, D., Malinowski, C., & Watts, P. A. (2015). Implementing a pediatric camp clinical for pre-licensure education. Nursing Education Perspectives, 36(1), 60-61. doi: 10.5480/12-871.1; Levett-Jones, T., Lapkin, S., Govind, N., Pich, J., Hoffman, K., Jeong, S. Y., . . . Everson, N. (2017). Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the comprehensive state empathy scale. Nurse Education Today, 59, 75-81. doi: 10.1016/j.nedt.2017.09.007; Smith, P., Ooms, A., & Marks-Maran, D. (2016). Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses: Students' perspectives. Nurse Education in Practice, 16(1), 111-118. doi: 10.1016/j.nepr.2015.09.010). Nursing schools must incorporate disability education to fully realize its impact and eliminate barriers to transform care.
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Affiliation(s)
- Allison P Edwards
- Department of Undergraduate Studies, Cizik School of Nursing at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Barbara E Hekel
- Department of Undergraduate Studies, Cizik School of Nursing at The University of Texas Health Science Center at Houston, Houston, TX, USA
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Costa LSD, Pereira LCDS, Sá GGDM, Silva OWL, Barros LM, Caetano JÁ, Galindo Neto NM. Brazilian Sign Language teaching in undergraduate nursing courses. Rev Bras Enferm 2021; 74:e20200709. [PMID: 34037134 DOI: 10.1590/0034-7167-2020-0709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to characterize the Brazilian Sign Language teaching in undergraduate nursing courses. METHOD a cross-sectional study, carried out on the curriculum matrices of 553 higher education nursing courses. Data collection took place through access to the websites of the Ministry of Education and educational institutions. RESULTS the nursing courses that offered Libras were located predominantly in the Southeast (36%), coming from private institutions (87.2%). Most Libras courses (82%) were offered on a mandatory basis in the second half of the course (46.7%). The semester in which the offer was most frequent was the eighth (15.9%). There was an association (p <0.001) between the offer of course and the variable "public or private category". CONCLUSIONS there was a predominance of Libras course in private institutions, in the Southeast region, with a 40-hour workload, offered in the second half of the course.
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Affiliation(s)
- Leonardo Silva da Costa
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco. Pesqueira, Pernambuco, Brazil
| | | | | | | | - Lívia Moreira Barros
- Universidade da Integração Internacional da Lusofonia Afro-brasileira. Redenção, Ceará, Brazil
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20
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Endocrine pharmacotherapy education in United States colleges and schools of pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Howie VA, Welch AJ, Horton ES, Wirihana LA. The quandary of registered nurses untrained in adult intellectual disability nursing when caring for this diverse patient group in acute care settings: An integrated literature review. J Clin Nurs 2021; 30:1542-1555. [PMID: 33462921 DOI: 10.1111/jocn.15663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To critically appraise relevant literature on the lived experiences of registered nurses caring for adults with intellectual disability in the acute care setting in Australia to determine current knowledge and gaps in the literature. BACKGROUND People with intellectual disability have the right to the highest attainable health care the same as everyone else. However, inequities still exist in the delivery of health care across the globe, including Australia that result in poorer health outcomes for this population group. Part of the problem is a lack of understanding of the complexities of ID care due to an absence of ID specific content in undergraduate curricula. DESIGN Integrative literature review. METHODS Electronic databases were searched for relevant empirical and theoretical literature. Additional articles were found by reviewing reference lists of selected articles resulting in ten articles for review. Selected articles were critically appraised using JBI critical appraisal tools. Data were analysed using comparative thematic analysis. PRISMA checklist completed the review. RESULTS Two main themes emerged from the data that informed the gap in knowledge: (a) Defining nursing practice; and (b) Confidence to practice. CONCLUSIONS There was limited qualitative research published on the topic. International studies revealed that a lack of understanding of the ID condition due to inadequate education left registered nurses feeling underprepared, unsupported and struggling to provide optimal care. No studies were located on the phenomenon within the Australian context. A study exploring the lived experiences of RNs in Australia is needed to offer a deeper understanding of the phenomenon that will help inform practice. RELEVANCE TO PRACTICE Including ID care in national undergraduate and postgraduate nursing curricula must become a nursing educational and professional priority to support nurses more fully in their practice to ensure patients with ID receive the highest attainable standard of nursing care.
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Affiliation(s)
- Virginia Anne Howie
- School of Nursing, Midwifery & Social Sciences, CQ University Australia, North Rockhampton, QLD, Australia
| | - Anthony Joseph Welch
- School of Nursing, Midwifery & Social Sciences, CQ University Australia, North Rockhampton, QLD, Australia
| | - Eleanor Sandra Horton
- School of Nursing and Midwifery, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Lisa Anne Wirihana
- School of Nursing, Midwifery & Social Sciences, CQ University Australia, North Rockhampton, QLD, Australia
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22
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Bur J, Missen K, Cooper S. The impact of intellectual disability nurse specialists in the United Kingdom and Eire Ireland: An integrative review. Nurs Open 2020; 8:2018-2024. [PMID: 34388861 PMCID: PMC8363355 DOI: 10.1002/nop2.690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
AIM To identify and evaluate the impact of Intellectual Disability Nurse Specialists person-centred care for people with intellectual disability. DESIGN An Integrative review of the literature was performed between January 2007-December 2017. METHODS Searching the PubMed Library of Medicine, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline Ovid, PsychINFO, Health Source: Nursing/Academic edition. A total of eight articles were selected for the final study example, including four mixed methods studies and four qualitative studies. RESULTS Three Intellectual Disability Nurse Specialist models were evaluated, and three main themes emerged: person-centred care, organizational and practice development. CONCLUSION The Intellectual Disability Nurse Specialist expert knowledge and skills contribute to the development of effective systems and processes. The results highlighted the complex nature of the Intellectual Disability Nurse Specialist role and the importance of ongoing development, promotion and evaluation and their contribution to care in the healthcare setting.
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Affiliation(s)
- Jennifer Bur
- School of Nursing and Health Professionals, Federation University, Churchill, Vic, Australia
| | - Karen Missen
- School of Nursing and Health Professions, Federation University, Churchill, Vic, Australia
| | - Simon Cooper
- School of Nursing and Health Professions, Federation University, Churchill, Vic, Australia
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Colbert A, Kronk R. Equity Access: Online Nursing Education on Care for People With Disabilities. J Nurs Educ 2020; 59:349-351. [DOI: 10.3928/01484834-20200520-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
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Bowen CN, Havercamp SM, Karpiak Bowen S, Nye G. A call to action: Preparing a disability-competent health care workforce. Disabil Health J 2020; 13:100941. [PMID: 32467076 DOI: 10.1016/j.dhjo.2020.100941] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
People with disabilities make up the largest minority population in the country, yet our health care workforce is unprepared to meet their needs. Two initiatives - and the Alliance for Disability in Health Care Education's Disability Competencies and the Resources for Integrated Care Disability-Competent Care model-provide essential tools to build a health care workforce prepared to meet the health needs of people with disabilities. We note gaps in health education and continuing education curricula, document barriers to progress, and demonstrate how the two initiatives offer a clear roadmap to effect systemic change. Finally, we issue a call to action for health care education, practice, and research to ensure a health care workforce prepared to provide quality health care to people with disabilities.
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Affiliation(s)
| | - Susan M Havercamp
- Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, USA.
| | - Sonya Karpiak Bowen
- Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, USA
| | - Gretchen Nye
- Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services, USA
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Spassiani NA, Abou Chacra MS, Selick A, Durbin J, Lunsky Y. Emergency department nurses’ knowledge, skills, and comfort related to caring for patients with intellectual disabilities. Int Emerg Nurs 2020; 50:100851. [DOI: 10.1016/j.ienj.2020.100851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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Tengelin E, Dahlborg E, Berndtsson I, Bülow PH. From political correctness to reflexivity: A norm‐critical perspective on nursing education. Nurs Inq 2020; 27:e12344. [PMID: 32009272 DOI: 10.1111/nin.12344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Ellinor Tengelin
- Department of Health Sciences University West Trollhättan Sweden
| | | | - Ina Berndtsson
- Department of Health Sciences University West Trollhättan Sweden
| | - Pia H. Bülow
- Department of Social Work School of Health and Welfare Jönköping University Jönköping Sweden
- Department of Social Work University of the Free State Bloemfontein South Africa
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Lewis P, Wilson NJ, Jaques H, O'Reilly K, Wiese M. A qualitative study of nurses' perspectives of caring for children with intellectual disability and their families in a paediatric acute care setting. J Child Health Care 2019; 23:639-651. [PMID: 31359791 DOI: 10.1177/1367493519867234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Children with intellectual disability (ID) experience chronic and pervasive limitations across intellectual and adaptive functioning. They are also at risk of developing co-morbidities. They are likely to be hospitalised more frequently and for longer periods of time than other children. The purpose of this study was to understand the experiences of nurses when caring for children and teenagers with ID in an acute paediatric hospital setting. The aim of the research was to inform future directions for the delivery of equitable and effective care for this vulnerable population. This study used a qualitative thematic analysis of individual interviews conducted with eight registered and enrolled nurses who provided care to children and adolescents with ID in an Australian paediatric acute hospital setting. Themes which emerged from this analysis were (1) Recognising similarities and managing differences; (2) Nurse-parent relationships; and (3) Caring for children with ID requires additional time. This study highlights that navigating care delivery and relationships when working with young people with ID and their caregivers in an acute care setting is complex. Nursing children with ID in hospital requires sophisticated skills. To ensure quality healthcare for patients with ID, a range of strategies are proposed.
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Affiliation(s)
- Peter Lewis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Hayden Jaques
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Kate O'Reilly
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Michele Wiese
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
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Doody O, Murphy F, Lyons R, Gallen A, Ryan J, Downey J, Sezgin D. Development of nursing quality care process metrics and indicators for intellectual disability services: a literature review and modified Delphi consensus study. BMC Health Serv Res 2019; 19:909. [PMID: 31783758 PMCID: PMC6883715 DOI: 10.1186/s12913-019-4749-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Nursing process quality care metrics and indicators are quantifiable measures of the nursing care delivered to clients. They can be used to identify and support nurses’ contribution to high quality, safe, client care and are lacking in specialist intellectual disability nursing. In a national Nursing Quality Care-Metrics project for Irish intellectual disability services, a set of nursing quality care process metrics and associated indicators were established for intellectual disability services. Methods A two-stage design approach was undertaken; a broad scoping review of the literature and a modified Delphi consensus process. The Delphi included a four round e-Delphi survey and a consensus meeting. Four hundred one intellectual disability nurses working in Ireland were recruited for the surveys and 20 stakeholders attended the consensus meeting. Results From the review, 20 existing and 16 potential intellectual disability nursing metrics were identified for nurses to prioritise in the e-surveys. After the four survey rounds, 12 intellectual disability nursing metrics and 84 associated indicators were identified. Following the consensus meeting, these were reduced to 12 metrics and 79 indicators. Conclusions This first set of intellectual disability nursing process metrics and associated indicators has been identified for implementation in practice. These metrics while developed in Ireland have international relevance and their application and appropriateness in practice needs to be evaluated.
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Affiliation(s)
- Owen Doody
- Health Research Institute and Senior Lecturer, Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland.
| | - Fiona Murphy
- Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland
| | - Rosemary Lyons
- Lecturer, Faculty of Education and Health Sciences, Department of Nursing and Midwifery, University of Limerick, Castletroy, Limerick, Ireland
| | - Anne Gallen
- Director of Nursing and Midwifery Planning Development Unit, National Lead for Nursing and Midwifery Quality Care Metrics Project, Health Services Executive Ireland North West, Bishop Street, Ballyshannon, Donegal, Ireland
| | - Judy Ryan
- Director of Nursing and Midwifery Planning Development Unit, Intellectual Disability Services Work-stream Chairperson, Health Services Executive Ireland South East, Kilkenny, Ireland
| | - Johanna Downey
- Quality Care Metrics Project Officer, National Lead for Intellectual Disability Services Workstream, Health Services Executive, Ireland South, Cork, Ireland
| | - Duygu Sezgin
- Postdoctoral Researcher, College of Medicine, Nursing & Health Sciences, Clinical Sciences Institute, National University of Ireland Galway, Costello Road, Galway, Ireland
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Ailey SH, Johnson TJ, Cabrera A. Evaluation of Factors Related to Prolonged Lengths of Stay for Patients With Autism With or Without Intellectual Disability. J Psychosoc Nurs Ment Health Serv 2019; 57:17-22. [PMID: 30753733 DOI: 10.3928/02793695-20190205-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Patients with autism spectrum disorder and/or intellectual disability (ASD/ID) face unique health care challenges. In addition to hospital experiences characterized by fear and insufficient staff training, these patients have 1.5-times longer lengths of stay (LOS) than patients without ASD/ID, and 3.4% of patients with ASD/ID have prolonged LOS (i.e., ≥30 days). Little research exists on factors related to prolonged LOS of patients with ASD/ID, hindering efforts to develop and implement evidence-based practices to improve care and reduce prolonged LOS. The purpose of the current study was to describe factors related to prolonged LOS of adult patients with ASD/ID in acute care settings using a retrospective chart review of 10 patients discharged from one academic medical center. Findings indicate that health care institutions should evaluate performance with this patient population and identify evidence-based strategies to provide a safe environment for care and reduce LOS that is due to non-health care needs. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 17-22.].
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Reframing the role, identity and standards for practice for registered nurses working in the specialty area of intellectual and developmental disability in Australia: The NDIS and beyond. Collegian 2019. [DOI: 10.1016/j.colegn.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wilson NJ, Wiese M, Lewis P, Jaques H, O'Reilly K. Nurses working in intellectual disability‐specific settings talk about the uniqueness of their role: A qualitative study. J Adv Nurs 2019; 75:812-822. [DOI: 10.1111/jan.13898] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Nathan J. Wilson
- School of Nursing and Midwifery Western Sydney University Penrith NSW Australia
| | - Michele Wiese
- School of Social Sciences and Psychology Western Sydney University Penrith NSW Australia
| | - Peter Lewis
- School of Nursing and Midwifery Western Sydney University Penrith NSW Australia
| | - Hayden Jaques
- School of Nursing and Midwifery Western Sydney University Penrith NSW Australia
| | - Kate O'Reilly
- School of Nursing and Midwifery Western Sydney University Penrith NSW Australia
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Cvejic RC, Trollor JN. Transition to adult mental health services for young people with an intellectual disability. J Paediatr Child Health 2018; 54:1127-1130. [PMID: 30294982 DOI: 10.1111/jpc.14197] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 02/05/2023]
Abstract
People with intellectual disabilities (ID) experience high rates of mental health problems, particularly during the period of transition to adulthood. It is therefore important that the transition from child- to adult-oriented health services for people with ID is well managed to ensure appropriate orientation to ongoing adult mental health care. The purpose of this paper is to summarise the impact and experience of transition to adult mental health care for people with ID and those who support them, as well as issues related to current policy and practice in this area. Several opportunities for improvement are identified in the broad areas of policy, service structure and organisation, research and workforce capacity. Enhancements in these areas will lead to improved outcomes for young people with ID transitioning from child- to adult-oriented mental health care.
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Affiliation(s)
- Rachael C Cvejic
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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O'Reilly K, Lewis P, Wiese M, Goddard L, Trip H, Conder J, Charnock D, Lin Z, Jaques H, Wilson NJ. An exploration of the practice, policy and legislative issues of the specialist area of nursing people with intellectual disability: A scoping review. Nurs Inq 2018; 25:e12258. [PMID: 30066979 DOI: 10.1111/nin.12258] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/14/2018] [Accepted: 06/17/2018] [Indexed: 11/26/2022]
Abstract
The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability Insurance Scheme offers an apt moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability.
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Affiliation(s)
- Kate O'Reilly
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, NSW, Australia
| | - Peter Lewis
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, NSW, Australia
| | - Michele Wiese
- School of Social Science and Psychology, Western Sydney University, Penrith South DC, NSW, Australia
| | - Linda Goddard
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Albury, NSW, Australia
| | - Henrietta Trip
- Centre for Postgraduate Nursing Studies, the University of Otago, Christchurch, New Zealand
| | - Jenny Conder
- Centre for Postgraduate Nursing Studies, the University of Otago, Christchurch, New Zealand
| | - David Charnock
- Faculty of Medicine and Health Sciences, the University of Nottingham, Nottingham, UK
| | - Zhen Lin
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, NSW, Australia
| | - Hayden Jaques
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, NSW, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith South DC, NSW, Australia
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Northway R, Todd S, Hunt K, Hopes P, Morgan R, Shearn J, Worth R, Bernal J. Nursing care at end of life: a UK-based survey of the deaths of people living in care settings for people with intellectual disability. J Res Nurs 2018; 24:366-382. [PMID: 34394550 DOI: 10.1177/1744987118780919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background People with intellectual disability are believed to be at risk of receiving poor end-of-life care. Nurses, given their advocacy role and duty to provide compassionate end-of-life care, have the potential to change this situation but research regarding this aspect of their role is limited. Aims This paper thus seeks to answer the question 'How and when are nurses involved in providing care at end of life for people with intellectual disability?' Methods A total of 38 intellectual disability care providers in the UK providing support to 13,568 people with intellectual disability were surveyed. Data regarding 247 deaths within this population were gathered in two stages and subsequently entered into SPSSX for analysis. Results Findings revealed that the majority of deaths occurred between the ages of 50 and 69 years, the most commonly reported cause of death being respiratory problems. Both community and hospital-based nurses were involved in supporting individuals during their final 3 months of life, and sometimes more than one type of nurse provided support to individuals. Generally nursing care was rated positively, although room for improvement was also identified. Conclusions Nurses are involved in supporting people with intellectual disability at end of life and appropriate education is required to undertake this role. This may require change in curricula and subsequent research to determine the impact of such change on nursing support to this population.
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Affiliation(s)
- Ruth Northway
- Professor in Learning Disability Nursing, University of South Wales, UK
| | - Stuart Todd
- Reader in Intellectual Disability Research, University of South Wales, UK
| | | | - Paula Hopes
- Senior Lecturer, University of South Wales, UK
| | | | - Julia Shearn
- Research Assistant, University of South Wales, UK
| | - Rhian Worth
- Research Assistant, University of South Wales, Uk
| | - Jane Bernal
- Honorary Fellow, University of South Wales, UK
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Wallace RA. National Disability Insurance Scheme, health, hospitals and adults with intellectual disability. Intern Med J 2018; 48:351-359. [PMID: 29512328 DOI: 10.1111/imj.13671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
Preventable poor health outcomes for adults with intellectual disability in health settings have been known about for years. Subsequent analysis and the sorts of reasonable adjustments required in health and disability support settings to address these health gaps are well described, but have not really been embedded in practice in any significant way in either setting. As far as health is concerned, implementation of the National Disability Insurance Scheme (NDIS, the Scheme) affords an opportunity to recognise individual needs of people with intellectual disability to provide reasonable and necessary functional support for access to mainstream health services, to build capacity of mainstream health providers to supply services and to increase individual capacity to access services. Together these strands have potential to transform health outcomes. Success of the Scheme, however, rests on as yet incompletely defined operational interaction between NDIS and mainstream health services and inherently involves the disability sector. This interaction is especially relevant for adults with intellectual disability, known high users of hospitals and for whom hospital outcomes are particularly poor and preventable. Keys to better hospital outcomes are first, the receiving of quality person-centred healthcare from physicians and hospitals taking into account significance of intellectual disability and second, formulation of organised quality functional supports during hospitalisation. Achieving these require sophisticated engagement between consumers, the National Disability Insurance Agency, Commonwealth, State and Territory government leaders, senior hospital and disability administrators, NDIS service providers and clinicians and involves cross fertilisation of values, sharing of operational policies and procedures, determination of boundaries of fiscal responsibility for functional supports in hospital.
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Affiliation(s)
- Robyn A Wallace
- Calvary Health Care Tasmania, Hobart, Tasmania, Australia.,St Helen's Private Hospital, Hobart, Tasmania, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
AIM As educators strongly influence the attitudes of their students, the purpose of this study was to determine nurse educator attitudes toward people with disabilities. BACKGROUND Inadequate education of health professionals is a known barrier to care for people with disability. Continuing calls for improved education of health professionals compel an assessment of nurse educator attitudes. METHOD This was a cross-sectional, correlational web-based survey of nurse educators (n = 126). Nurse educator attitudes were analyzed using descriptive statistics, analysis of variance, and multiple regression analysis. RESULTS Nurse educators held discriminatory attitudes toward people with disabilities, though most preferred a biopsychosocial model of disability. Forty-four percent lacked knowledge of disability-related aims, objectives, or outcomes within the curriculum. CONCLUSION To advance equity in health care, nurse educators must confront personal bias and teach competent care of people with disabilities.
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Affiliation(s)
- Lori Lyon
- About the Authors Lori Lyon, EdD, RN, is a professor, Capstone College of Nursing, University of Alabama, Tuscaloosa, Alabama. Rick Houser, PhD, is a professor, College of Education, University of Alabama. The authors are grateful to the nurse educators who participated in this survey and to Robert Findlay for his constructive comments. For more information, contact Dr. Lyon at
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Northway R. Perspectives: The health of people with intellectual disabilities: realising the future potential of all nurses and nursing to reduce health disparities. J Res Nurs 2017. [DOI: 10.1177/1744987117742041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ruth Northway
- Professor of Learning Disability Nursing, University of South Wales, UK
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CitySCaPE: Moving beyond indifference in education for pre-registration nurses about learning disability. Nurse Educ Pract 2017; 26:82-88. [PMID: 28772114 DOI: 10.1016/j.nepr.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 05/04/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022]
Abstract
People with learning disabilities and Autism continue to suffer from the delivery of ineffective and inadequate care from health services CitySCaPE (City Simulated Community and Practice Environment) is a multi media resource delivering a simulation of situations student nurses may encounter in relation to service users with learning disabilities. The resource is applicable to adult, mental health and children's nursing. It is delivered in a blended approach to students in the first part of their programme as part of their simulated practice. Following the implementation of the resource an evaluation of student experience was undertaken using a mixed methods approach. 146 responses were obtained to a questionnaire containing quantitative and qualitative data. The findings indicate that this is a pedagogy that suits a variety of learning styles, is deemed to be realistic and improves the understanding of nursing students about the care of people with learning disabilities in generic practice areas. It is anticipated that CitySCaPE can be used as a model for delivery of practice based learning in areas that are often challenging to teach and demonstrate using a service user and person centred approach.
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Chang CK, Chen CY, Broadbent M, Stewart R, O'Hara J. Hospital admissions for respiratory system diseases in adults with intellectual disabilities in Southeast London: a register-based cohort study. BMJ Open 2017; 7:e014846. [PMID: 28360254 PMCID: PMC5372120 DOI: 10.1136/bmjopen-2016-014846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/17/2017] [Accepted: 03/01/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intellectual disability (ID) carries a high impact on need for care, health status and premature mortality. Respiratory system diseases contribute a major part of mortality among people with ID, but remain underinvestigated as consequent morbidities. METHODS Anonymised electronic mental health records from the South London and Maudsley Trust (SLaM) were linked to national acute medical care data. Using retrospective cohort and matched case-control study designs, adults with ID receiving SLaM care between 1 January 2008 and 31 March 2013 were identified and compared with local catchment residents for respiratory system disease admissions. Standardised admission ratios (SARs) were first calculated, followed by a comparison of duration of hospitalisation with respiratory system disease between people with ID and age-matched and gender-matched random counterparts modelled using linear regression. Finally, the risk of readmission for respiratory system disease was analysed using the Cox models. RESULTS For the 3138 adults with ID identified in SLaM, the SAR for respiratory system disease admissions was 4.02 (95% CI 3.79 to 4.26). Compared with adults without ID, duration of hospitalisation was significantly longer by 2.34 days (95% CI 0.03 to 4.64) and respiratory system disease readmission was significantly elevated (HR=1.35; 95% CI 1.17 to 1.56) after confounding adjustment. CONCLUSIONS Respiratory system disease admissions in adults with ID are more frequent, of longer duration and have a higher likelihood of recurring. Development and evaluation of potential interventions to the preventable causes of respiratory diseases should be prioritised.
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Affiliation(s)
- Chin-Kuo Chang
- Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Chih-Yin Chen
- Nursing Department, Chang Jung Christian University, Tainan City, Taiwan
| | - Mathew Broadbent
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology, and Neuroscience), London, UK
- South London and Maudsley National Health Service (NHS) Foundation Trust, London, UK
| | - Jean O'Hara
- King's Health Partners, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience, London, UK
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Manohar H, Subramanian K, Kandasamy P, Penchilaiya V, Arun A. Diagnostic Masking and Overshadowing in Intellectual Disability-How Structured Evaluation Helps. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:171-176. [PMID: 27901303 DOI: 10.1111/jcap.12160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 11/28/2022]
Abstract
PROBLEM Comorbid psychiatric diagnoses tend to be underdiagnosed in patients with intellectual disability. Diagnosing anxiety disorders in such patients can pose challenges, in particular with regard to obsessive and compulsive disorder (OCD). METHODS We present the case of an adolescent diagnosed with intellectual disability with poor expressive language skills who presented with nonspecific mood and behavioral symptoms, not improving with routine clinical evaluations and treatment. A structured assessment was done to decipher the psychopathology. FINDINGS The structured evaluation was able to diagnose OCD, and the treatment response was accentuated, bringing about a significant reduction in patient and caregiver distress. Psychosocial interventions through nurses played a significant role. CONCLUSIONS The case highlights the need for a systematic assessment of patients with intellectual disability to arrive at reliable diagnoses and to plan appropriate treatment strategies.
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Affiliation(s)
- Harshini Manohar
- Harshini Manohar, MBBS, is a Junior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Karthick Subramanian
- Karthick Subramanian, MD, is a Senior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Preeti Kandasamy
- Preeti Kandasamy, DM (Child & Adolescent Psychiatry), is an Assistant Professor, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkatalakshmi Penchilaiya
- Venkatalakshmi Penchilaiya, MBBS, is a Junior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandbabu Arun
- Anandbabu Arun, MD, is a Senior Resident, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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