Neglect of people with intellectual disabilities: a failure to act?

Preventing abuse in accommodation services: from procedural response to protective cultures

This article reviews current approaches of disability accommodation services to addressing the abuse and neglect of people with intellectual disability who live in them. We review international literature and provide practice examples from accommodation services for people with intellectual disability in Australia to develop a framework of current research, policy and practice in this area. The results of this review show that dominant policy and practice approaches do not give adequate consideration to the prevention and protection of people from harm, focusing primarily on responding to individual instances of maltreatment. Managerial, compliance-based systems may be deflecting attention from recognizing and responding more effectively to abuse and neglect at individual, systemic and structural levels. The current dominant approach fails to develop a culture of prevention and protection for people with intellectual disability. Further, some systemic and structural preconditions are set which make abuse and neglect less likely to be prevented.

Models of disability: their influence in nursing and potential role in challenging discrimination

AIM

This paper presents a discussion of medical and social models of disability associated with experiences of disabled people as citizens and patients.

BACKGROUND

Disability is fairly universally a negative concept. Disabled people have frequent contact with health services, however much of this experience is viewed as discriminatory.

DATA SOURCES

Literature was obtained using the Psych-INFO, Medline and CINAHL databases for the years 1989-2009, using derivatives of the concept 'disability' and associated 'models', and then these terms combined with 'nursing'.

DISCUSSION

Nursing as a profession embraces the need to avoid discrimination, yet disability as an equal opportunity issue is relatively neglected in nursing. Nursing has a moral, professional and, in some countries, a legal responsibility to promote disability equality in the provision of nursing services. Insights offered by the social model of disability may be instrumental in empowering nurses to respond to this obligation. While some groups may not be well-represented in this model and there is risk in embracing the social model of exposing a policy-practice divide, it nevertheless represents a powerful tool for strengthening nurses' advocacy role. In particular, 'social advocacy' may be enhanced by a paradigm shift away from the medical model of disability.

IMPLICATIONS FOR NURSING

Nurses have an obligation to promote disability equality in relation to the provision of health care. Adoption of the social model of disability in nursing practice, education and research as a strategy to challenge discrimination should be seriously considered.

CONCLUSION

The utility value of the social model of disability in strengthening the social advocacy role of nurses should be investigated.

Patient satisfaction with a hepatitis B vaccination programme among persons with an intellectual disability

This article demonstrates that a patient satisfaction survey can be carried out to evaluate the acceptability of a hepatitis B vaccination programme among persons with an intellectual disability. In this exploratory study, involving six clients, 41 care staff and three managers of intellectual disability services, core themes were identified on the acceptability of the programme. The following recommendations are made: a respectful attitude should be shown to all clients by the healthcare providers; appropriate information about the programme should be provided that is tailored to the needs and receptive capability of all recipients and their carers; the intervention should be delivered in an environment, and by healthcare personnel, familiar to clients; carers should be attentive to the possibility of adverse effects; and explicit, ethically stringent policies should be in place on the use of physical restraint. The article makes suggestions regarding future work in assessing patient satisfaction among this client group.

Dimensionality of the Contact With Disabled Persons Scale

The purpose of this study was to examine the dimensionality of the Contact With Disabled Persons Scale (CDP). An exploratory factor analysis of the CDP yielded three factors: General Interpersonal Contacts, Positive Contact Experiences, and Negative Contact Experiences. A confirmatory factor analysis provided further evidence for the stability and generalizability of this three-factor solution. The CDP factors were also analyzed in the predicted directions, with several attitude measures, other psychosocial instruments, and a set of demographic variables. A discussion of how this scale can be used in attitudes toward disability research is provided.

Examining a community model of epilepsy care for people with learning disabilities

PURPOSE

To assess the use of specialised medical epilepsy services by people with learning disabilities (LD) and epilepsy in a community healthcare setting, to compare medical epilepsy care in this group to current management guidelines, and to contrast important outcomes with those achieved in different healthcare settings.

METHODS

Postal survey with a carer completed questionnaire addressed to all adults with epilepsy registered on an LD register in Sheffield, UK (n=442).

RESULTS

An analysis based on 225 returned questionnaires revealed that 22.7% of individuals with LD and epilepsy had been free of seizures for over 1 year. 95.1% were taking antiepileptic drugs (AEDs), 46.2% had had an EEG, and 41.3% a brain scan. 53.3% of diagnoses had been made by epilepsy experts, 38.7% of individuals with LD and epilepsy were under specialist review. Although patients with more severe epilepsy were more likely to be under specialist care, 60.6% of patients with ongoing seizures, 57.9% with major seizures and 68.7% of individuals taken to hospital with prolonged had no access to specialist advice.

CONCLUSION

The proportion of people with LD who achieved seizure-control in the described population was lower than in all previously reported studies of LD patient groups. The poor outcome in terms of seizure-control, the lack of access to the epilepsy specialist service, and the apparent under-utilisation of investigations indicate that there are grounds for serious concern about this community model of medical epilepsy care for people with LD.