1
|
Mafuba K, Kiernan J, Chapman HM, Kupara D, Kudita C, Chester R. Understanding the contribution of intellectual disability nurses. Paper 2 of 4 - Survey. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231213434. [PMID: 37956695 DOI: 10.1177/17446295231213434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The objective was to identify ID nursing interventions and their impact on the health and healthcare of people with IDs. Data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. We identified 878 interventions that could be undertaken by ID nurses from 7 countries. We categorised the interventions into five themes: effectuating nursing procedures, enhancing impact of ID services, enhancing impact of mainstream services, enhancing quality of life, and enhancing ID nursing practice. Findings demonstrate that ID nurses play important roles in improving the health and healthcare experiences of people with IDs.
Collapse
Affiliation(s)
| | - Joann Kiernan
- Edge Hill University and Alder Hey Children's Hospital, UK
| | | | | | | | | |
Collapse
|
2
|
Kouroupa A, Hassiotis A, Hamza L, Courtenay K, Hall I, Langdon PE, Taggart L, Crossey V, Lloyd-Evans B, Morant N. Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1101-1112. [PMID: 37271584 DOI: 10.1111/jar.13129] [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: 05/26/2022] [Revised: 03/06/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. METHOD Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). RESULTS Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. CONCLUSIONS ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community.
Collapse
Affiliation(s)
| | | | - Leila Hamza
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health, NHS Trust, London, UK
| | - Ken Courtenay
- Assessment and Intervention Team, Barnet, Enfield and Haringey Mental Health, NHS Trust, London, UK
| | - Ian Hall
- East London NHS Foundation Trust, Hackney Integrated Learning Disability Service, London, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Laurence Taggart
- Institute of Nursing and Health Research, University of Ulster, Antrim, UK
| | - Vicky Crossey
- South West Community Learning Disability Team & Mental Health Intensive Support and Treatment Team, NHS Lothian, Edinburgh, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
| | - Joann Kiernan
- Edge Hill Universityand Alder Hey Children's Hospital, UK
| | | | | | | | | |
Collapse
|
4
|
Zarotti N, Hudson C, Human H, Muratori G, Fisher P. 'It's working together with what you've got': Healthcare professionals' experiences of working with people with combined intellectual disability and personality disorder diagnoses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1317-1326. [PMID: 35725900 PMCID: PMC9796244 DOI: 10.1111/jar.13020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis. METHODS Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis. FINDINGS Four overarching themes were identified: (a) diagnostic issues and the need for person-centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access. CONCLUSIONS The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed.
Collapse
Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
| | - Clive Hudson
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Hannah‐Rose Human
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Greco Muratori
- Adult Community Mental Health ServiceNorfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Paul Fisher
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
| |
Collapse
|
5
|
Ee J, Stenfert Kroese B, Rose J. Experiences of mental health professionals providing services to adults with intellectual disabilities and mental health problems: A systematic review and meta-synthesis of qualitative research studies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:758-781. [PMID: 34165022 PMCID: PMC9442780 DOI: 10.1177/17446295211016182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mental health professionals play an important role in providing care and treatment for adults with intellectual disabilities. A number of studies use qualitative methods to explore the experiences of these professionals and their perspectives regarding the mental health services for this population. A systematic review using meta-ethnographic approach was undertaken to summarise this research. METHOD A systematic search found 14 relevant studies which were critically appraised. Key themes from these studies were extracted and synthesised. RESULTS Three main themes were identified: 1) Understanding the person, 2) Relational interaction and 3) Organisational factors. CONCLUSIONS The findings of this review identified the issues mental health professionals raised in relation to their work. They described the complex presenting problems as intense yet fulfilling therapeutic relationships with their clients and their wish to improve their knowledge and skills. They identified organisational issues that need to be addressed to improve staff morale and efficiency.
Collapse
Affiliation(s)
| | | | - John Rose
- John Rose, Centre for Applied Psychology,
School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15
2TT, UK.
| |
Collapse
|
6
|
Scheffers F, Moonen X, van Vugt E. External sources promoting resilience in adults with intellectual disabilities: A systematic literature review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:227-243. [PMID: 32985320 PMCID: PMC9016661 DOI: 10.1177/1744629520961942] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Persons with an intellectual disability are at increased risk of experiencing adversities. The current study aims at providing an overview of the research on how resilience in adults with intellectual disabilities, in the face of adversity, is supported by sources in their social network. METHOD A literature review was conducted in the databases Psycinfo and Web of Science. To evaluate the quality of the included studies, the Mixed Method Appraisal Tool (MMAT) was used. RESULTS The themes: "positive emotions," "network acceptance," "sense of coherence" and "network support," were identified as sources of resilience in the social network of the adults with intellectual disabilities. CONCLUSION The current review showed that research addressing sources of resilience among persons with intellectual disabilities is scarce. In this first overview, four sources of resilience in the social network of people with intellectual disabilities were identified that interact and possibly strengthen each other.
Collapse
Affiliation(s)
- Femke Scheffers
- Femke Scheffers, Department of Behavioral
Expertise, MEE ZHN, Rijnsburgersingel 60, 2316 XX Leiden, The Netherlands.
| | | | | |
Collapse
|
7
|
Hudson N, House R, Robson N, Rayner-Smith K. 'It's a good thing we're doing, we just need to be better at it'. Forensic intellectual disability nursing experiences of Transforming Care: A multi-perspectival interpretive phenomenological analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1066-1075. [PMID: 33432723 DOI: 10.1111/jar.12855] [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: 06/13/2020] [Revised: 11/17/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Concerns have been expressed regarding the impact of Transforming Care (TC) an English deinstitutionalisation mandate, on forensic services. With nursing staff positioned as significant in delivering TC; this research explored nursing experiences. METHOD Nine face-to-face semi-structured interviews were completed with nursing staff working in either inpatient or community forensic teams. Multi-perspectival interpretive phenomenological analysis was used to explore participants' experiences. Interviews were analysed independently, prior to a mini meta-synthesis. RESULTS Participants from the inpatient group experienced TC as a threat, which resulted in consistency of perspective and practice. Participants from the community group viewed TC as a worthwhile challenge, which presented opportunity. The community infrastructure was experienced as inadequate by both groups, with the needs of people in forensic services needing more consideration, leading to widespread frustration. CONCLUSIONS The blanket approach of TC may not be suitable for this population, with those leading TC perceived as naïve.
Collapse
Affiliation(s)
| | | | - Neil Robson
- Tees, Esk, and Wear Valleys NHS Foundation Trust, Forensic LD service, Darlington, UK
| | - Kelly Rayner-Smith
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
8
|
Pelleboer-Gunnink HA, van Oorsouw WMWJ, van Weeghel J, Embregts PJCM. Stigma research in the field of intellectual disabilities: a scoping review on the perspective of care providers. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 67:168-187. [PMID: 34188898 PMCID: PMC8211133 DOI: 10.1080/20473869.2019.1616990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/04/2019] [Accepted: 05/05/2019] [Indexed: 05/27/2023]
Abstract
Care providers are key agents in the lives of individuals with an intellectual disability (ID). The quality of their support can be affected by manifestations of stigma. This scoping review was conducted to explore studies that provide indications of care providers' stigmatization of people with ID. Methods: A structured search was made in four databases to identify relevant studies in English-language peer-reviewed journals. Records were systematically and independently screened by the researchers. Results: The 40 articles included in this review were mainly conducted in Western countries and used Likert-type self-report measures of explicit attitudes. Stigmatization seemed more distinct concerning people with high support needs. The few studies on public stigma preliminary suggest that staff may also stigmatize people with ID based on other social identities. Regarding the support of structural stigma, staff reported skepticism regarding community inclusion for people with high support needs, and tended to be ambivalent about the protection-or-empowerment balance in the support of people with ID. Possible indications of stigmatization regarding sexuality were found on specific issues, such as self-determination and privacy. Agreement of staff with certain rights did not necessarily lead to staff acting in accordance with such rights. Conclusion: Indications of stigmatization of people with ID by care providers were found. Stigmatizing attitudes might affect the quality of care providers' support. Potential leads for future interventions concern creating awareness, sharing power, addressing diagnostic overshadowing, and providing explicit policy translations. Directions for future research concern strengthening the methodology of studies and enriching the studied topics.
Collapse
Affiliation(s)
- Hannah A. Pelleboer-Gunnink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, TheNetherlands
- Dichterbij Innovation and Science, Gennep, The Netherlands
| | | | - Jaap van Weeghel
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, TheNetherlands
- Phrenos Centre of Expertise, Utrecht, The Netherlands
- Parnassia Group, Dijk en Duin Mental Health Centre, Castricum, The Netherlands
| | - Petri J. C. M. Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, TheNetherlands
| |
Collapse
|
9
|
Coates B, Jones T. A qualitative analysis of the experience of staff employed within the forensic disability sector in Victoria, Australia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:757-766. [PMID: 31066150 DOI: 10.1111/jar.12611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This paper explores the experience of staff employed within forensic disability across Victoria in an attempt to better understand service needs in this field. The complex needs of individuals with disabilities involved in the criminal justice system or presenting with offence-related behaviours suggest that there is a requirement to improve services directed towards forensic disability. METHODS Four semi-structured group interviews, determined by geographical location, were completed with employees (n = 14) within the Australian Community Support Organisation, with an average of 5 years of forensic disability experience. Data were analysed based on thematic analysis. RESULTS Five themes were revealed. Three pre-existing themes were emphasized that included client complexity; poor responses from external services; and funding, and two novel themes labelled as staff well-being and responses to risk. CONCLUSIONS Recommendations include multiagency collaboration, funding forensic disability services, development of best practice initiatives and advocacy.
Collapse
Affiliation(s)
| | - Tim Jones
- University of Worcester, Worcester, UK
| |
Collapse
|
10
|
Appelgren M, Bahtsevani C, Persson K, Borglin G. Nurses' experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach. BMC Nurs 2018; 17:51. [PMID: 30524202 PMCID: PMC6276187 DOI: 10.1186/s12912-018-0316-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs' experiences of nursing patients with IDD. METHOD We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations. RESULTS We included eighteen published studies from eight countries involving 190 RNs. The RNs' experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs' experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group. CONCLUSION Lack of awareness and knowledge are likely breeding grounds for the 'otherness' that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face. TRIAL REGISTRATION PROSPERO 2017: CRD42017077703.
Collapse
Affiliation(s)
- Marie Appelgren
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
- City of Malmö, Borough Administration Operation Support Management, SE-205 80 Malmö, Sweden
| | - Christel Bahtsevani
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Karin Persson
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Gunilla Borglin
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| |
Collapse
|
11
|
Jaques H, Lewis P, O'Reilly K, Wiese M, Wilson NJ. Understanding the contemporary role of the intellectual disability nurse: A review of the literature. J Clin Nurs 2018; 27:3858-3871. [PMID: 29893440 DOI: 10.1111/jocn.14555] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify the specialist role/s that nurses perform and the specialist skills that nurses use when caring for people with intellectual disability. METHODS Adhering to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," various subject headings were used to systematically search six electronic databases for articles published in English between 2000 and 2017. A total of 27 articles were reviewed. RESULTS The literature demonstrates that similarities exist between the physical care delivered to people with intellectual disability and that delivered to people without intellectual disability. However, skills in the areas of communication, advocacy and person-centred care differ between these two groups. DISCUSSION Our findings suggest that the skill set of the specialist intellectual disability nurse is not uniquely technical but it is uniquely relational that incorporate increased patience and resilience when developing relationships with the people they care for. CONCLUSION This review has provided insights into the main differences in the skills required when working with people with intellectual disability compared to working with those without. However, minimal literature was identified that adequately describes what is unique about the performance of the role of specialised intellectual disability nurses-especially in Australia. RELEVANCE TO CLINICAL PRACTICE Understanding the skills required of nurses caring for people with intellectual disability provides the opportunity for more nurses to develop these specialised relational skills and for this branch of nursing to attract professional recognition that is currently limited.
Collapse
Affiliation(s)
- Hayden Jaques
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Peter Lewis
- 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
| | - Michele Wiese
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| |
Collapse
|