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Oulton K, Gibson F, Kenten C, Russell J, Carr L, Hassiotis A, Kelly P, Kerry S, Tuffrey-Wijne I, Whiting M, Wray J. Being a child with intellectual disabilities in hospital: The need for an individualised approach to care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13153. [PMID: 37792824 DOI: 10.1111/jar.13153] [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: 11/10/2022] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There is limited qualitative research focussed specifically on what it is like for children and young people with intellectual disabilities coming into hospital, with much of the evidence-base being about those with Autism Spectrum Condition or adults with intellectual disabilities. AIM To share rich detail of the emotional and physical impact on children and young people with intellectual disabilities of attending hospital, from their own and their parent's perspective. METHODS Talking Mats interviews, sticker survey and photography with children and young people with intellectual disabilities, and in-depth interviews, hospital diaries and photography with their parents. RESULTS AND CONCLUSIONS The multiple and compounding layers of complexity surrounding hospital care of children and young people with intellectual disabilities resulted in challenges associated with loss of familiarity and routine, undergoing procedures, managing sensory overload, managing pain and having a lack of safety awareness. An individualised approach to their care is needed.
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Affiliation(s)
- Kate Oulton
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Charlotte Kenten
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jessica Russell
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucinda Carr
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angela Hassiotis
- UCL Division of Psychiatry, University College London, London, UK
| | - Paula Kelly
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sam Kerry
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Mark Whiting
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Ong N, Lucien A, Long J, Weise J, Burgess A, Walton M. What do parents think about the quality and safety of care provided by hospitals to children and young people with an intellectual disability? A qualitative study using thematic analysis. Health Expect 2023; 27:e13925. [PMID: 38014873 PMCID: PMC10768875 DOI: 10.1111/hex.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Children with intellectual disability experience patient safety issues resulting in poor care experiences and health outcomes. This study sought to identify patient safety issues that pertain to children aged 0-16 years with intellectual disability admitted to two tertiary state-wide children's hospitals and a children's palliative care centre; to describe and understand these factors to modify the Australian Patient Safety Education Framework to meet the particular needs for children and young people with intellectual disability. DESIGN, SETTING AND PARTICIPANTS Parents of children with intellectual disability from two paediatric hospitals and a palliative care unit participated in semi-structured interviews to elicit their experiences of their child's care in the context of patient safety. Thirteen interviews were conducted with parents from various backgrounds with children with intellectual, developmental and medical diagnoses. RESULTS Eight themes about safety in hospital care for children and young people with intellectual disability emerged from thematic analyses: Safety is not only being safe but feeling safe; Negative dismissive attitudes compromise safety, quality and care experience; Parental roles as safety advocates involve being heard, included and empowered; Need for purposeful and planned communication and care coordination to build trust and improve care; Systems, processes and environments require adjustments to prevent patient safety events; Inequity in care due to lack of resources and skills, Need for training in disability-specific safety and quality issues and Core staff attributes: Kindness, Patience, Flexibility and Responsiveness. Parents highlighted the dilemma of being dismissed when raising concerns with staff and being required to provide care with little support. Parents also reported a lack of comprehensive care coordination services. They noted limitations within the healthcare system in accommodating reasonable adjustments for a family and child-centred context. CONCLUSIONS The development of an adapted Patient Safety Education Framework for children with intellectual disability should consider ways for staff to transform attitudes and reduce bias which leads to adaptations for safer and better care. In addition, issues that apply to quality and safety for these children can be generalised to all children in the hospital. PATIENT AND PUBLIC CONTRIBUTION Parent advocates in the project advisory team were shown the questions to determine their appropriateness for the interviews.
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Affiliation(s)
- Natalie Ong
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Child Development UnitChildren's Hospital at Westmead, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia
| | - Abbie Lucien
- UNSW MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW MedicineUniversity of New South WalesRandwickNew South WalesAustralia
| | - Annette Burgess
- Medical Education, Education Office, Sydney Medical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
| | - Merrilyn Walton
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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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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Armitage L, Walter F. Nurses' perception of what makes a good care experience for children and young people with intellectual disabilities align with parents' perceptions. Evid Based Nurs 2023; 26:119. [PMID: 36854610 DOI: 10.1136/ebnurs-2022-103571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Leah Armitage
- Department of Biomolecular Science, University of Manchester Institute of Science and Technology, Manchester, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mimmo L, Hodgins M, Samir N, Travaglia J, Woolfenden S, Harrison R. 'Smiles and laughter and all those really great things': Nurses' perceptions of good experiences of care for inpatient children and young people with intellectual disability. J Adv Nurs 2022; 78:2933-2948. [PMID: 35451515 PMCID: PMC9544709 DOI: 10.1111/jan.15256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/11/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
AIM To understand what constitutes a good experience of care for inpatient children and young people with intellectual disability as perceived by nursing staff. DESIGN Interpretive qualitative study. METHODS Focus groups with clinical nursing staff from speciality neurological/neurosurgical and adolescent medicine wards across two specialist tertiary children's hospitals in Australia were conducted between March and May 2021. Data analysis followed interpretative analysis methods to develop themes and codes which were mapped to a conceptual model of safe care. RESULTS Six focus groups with 29 nurses of varying experience levels were conducted over 3 months. Themes and codes were mapped to the six themes of the conceptual model: use rapport, know the child, negotiate roles, shared learning, build trust and relationships, and past experiences. The analysis revealed two new themes that extended the conceptual model to include; the unique role of a paediatric nurse, and joy and job satisfaction, with a third contextual theme, impacts of COVID-19 pandemic restrictions. With the perspectives of paediatric nurses incorporated into the model we have enhanced our model of safe care specifically for inpatient paediatric nursing care of children and young people with intellectual disability. CONCLUSION Including perceptions of paediatric nurses confirmed the position of the child with intellectual disability being at the centre of safe care, where care is delivered as a partnership between nursing staff, child or young person and their parents/family and the hospital systems and processes. IMPACT The enhanced model offers a specialized framework for clinical staff and health managers to optimize the delivery of safe care for children and young people with intellectual disability in hospital.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance UnitThe Sydney Children's Hospitals NetworkSydneyNSWAustralia
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Michael Hodgins
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Nora Samir
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Joanne Travaglia
- Centre for Health Services ManagementFaculty of HealthUniversity of Technology SydneySydneyNSWAustralia
| | - Susan Woolfenden
- Population Child Health Research GroupSchool of Women's and Children's HealthFaculty of MedicineUniversity of New South WalesSydneyNSWAustralia
| | - Reema Harrison
- Centre for Health Systems and Safety ResearchAustralian Institute of Health InnovationFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNSWAustralia
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Ong N, Long JC, Weise J, Walton M. Responding to safe care: Healthcare staff experiences caring for a child with intellectual disability in hospital. Implications for practice and training. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:675-690. [DOI: 10.1111/jar.12978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/07/2021] [Accepted: 01/09/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital Westmead Clinical School University of Sydney Sydney New South Wales Australia
| | - Janet C. Long
- Australian Institute of Health Innovation Macquarie University Sydney New South Wales Australia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry University of New South Wales Sydney New South Wales Australia
| | - Merrilyn Walton
- Department of Public Health, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
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Vanderlee E, Aston M, Turner K, McGrath P, Lach L. Patient-oriented research: A qualitative study of research involvement of parents of children with neurodevelopmental disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:567-582. [PMID: 32729369 DOI: 10.1177/1744629520942015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient-oriented research engages patients and caregivers as partners contributing to all phases of the research process. This was the goal of the Strongest Families Institute Neurodevelopmental research, in Halifax, Nova Scotia, when they included a parent advisory committee, made up of parents and caregivers of children and adolescents with a neurodevelopmental condition, to complete their research project. The purpose of this qualitative research was to examine the experiences of researchers and parents of children with a neurodevelopmental condition who participated on a research study advisory committee for the Strongest Families Neurodevelopment research project. From interviews with both parents/caregivers and researchers that played a role on the advisory committee, four major themes emerged on how to negotiate and navigate their time on the committee and what worked well and what did not. This led to recommendations for future researchers and patients who may create or be a part of an advisory committee.
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Aston M, Sweet K, McAfee E, Price S, Sheriko J, Monaghan J, Filliter J, Walls C, McGrath P, Vanderlee E, Bye A. Snap shot: Achieving better care through a one-page personal health profile. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:230-241. [PMID: 31544589 DOI: 10.1177/1744629519873503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Children with intellectual disabilities (IDs) can have complex health conditions that require intense and ongoing care management by multiple healthcare professionals (HCPs). Families often experience frustrations and challenges sharing necessary information about their children's unique emotional and communicative needs with HCPs. In turn, these needs are often poorly documented and shared with other HCPs. This contributes to compromised care and frustrations for families and HCPs. We conducted a qualitative study using focus groups to examine how 10 parents and 3 HCPs experienced provision of care for children with ID, as well as their suggestions for developing a one-page personal health profile (PHP) to improve communication. Parents suggested including behavioural descriptors rather than diagnoses. All participants believed a one-page PHP that was child and parent led would be very helpful and would improve communication between HCPs, parents and children leading to effective and supportive care.
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Clifford A, Standen PJ. Patient and Family-Centred Care (PFCC) as an evidence-based framework for optimising the acute healthcare experiences of families of young people with autism. Evid Based Nurs 2020; 24:133. [PMID: 33004421 DOI: 10.1136/ebnurs-2020-103309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Adam Clifford
- Specialist Services Directorate, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, Nottinghamshire, UK
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Shin HD, Price S, Aston M. A poststructural analysis: Current practices for suicide prevention by nurses in the emergency department and areas of improvement. J Clin Nurs 2020; 30:287-297. [PMID: 32956549 DOI: 10.1111/jocn.15502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention. BACKGROUND Emergency departments have been historically constructed as places for treating life-threatening physical crises, thereby constructing other "nonurgent" health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide-related thoughts and behaviours, negatively impacting the quality of care that certain groups of patients receive. DESIGN A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analysed using a poststructuralist framework. METHODS Relevant literature on the topic of emergency nursing related to suicide prevention was analysed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (see Supporting Information). DISCUSSION The emergency department is a critical point of intervention for patients with urgent and life-threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life-threatening physical crises in order to become inclusive of psychological crises such as suicide-related thoughts and behaviours. RELEVANCE TO CLINICAL PRACTICE How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the "taken-for-granted" emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.
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Affiliation(s)
| | - Sheri Price
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
| | - Megan Aston
- Dalhousie University School of Nursing, Halifax, NS, Canada.,IWK Health Centre, Halifax, NS, Canada
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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Partnerships for safe care: A meta-narrative of the experience for the parent of a child with Intellectual Disability in hospital. Health Expect 2019; 22:1199-1212. [PMID: 31560839 PMCID: PMC6882263 DOI: 10.1111/hex.12968] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/18/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To systematically identify and synthesize peer-reviewed qualitative evidence of the parental experience of hospitalization with a child with Intellectual Disability. SEARCH STRATEGY Key words, synonyms and MeSH subject headings that related to the three key concepts of parental experience, children with Intellectual Disability and hospital settings were applied to six electronic databases: Medline, CINAHL, Embase, PsycINFO, Scopus and Web of Science. Titles and abstracts of publications between January 2000 and February 2019 were screened for relevance. INCLUSION CRITERIA Empirical qualitative research involved participants aged 0-18 years, involved children with Intellectual Disability, involved participants hospitalized as an in-patient and involved participants focused on parent perspective. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesized using a meta-narrative approach. RESULTS Eleven publications met the inclusion criteria. Data synthesis revealed three research traditions contributing to this meta-narrative: Paediatric Nursing Practice, Intellectual Disability Healthcare and Patient Experience. A total of five themes were identified: (a) being more than a parent, (b) importance of role negotiation, (c) building trust and relationships, (d) the cumulative effect of previous experiences of hospitalization and (e) knowing the child as an individual. DISCUSSION AND CONCLUSION This review presents a working model for professional-parent partnership for the safe care of children with Intellectual Disability in hospital. Shifting paediatric healthcare to whole of hospital/multidisciplinary models of care that centre on the child will necessitate partnerships with the parent to identify and manage the needs of the child with Intellectual Disability, in order to achieve safe and equitable care for these children.
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Affiliation(s)
- Laurel Mimmo
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Community Child HealthSydney Children's HospitalSydneyNew South WalesAustralia
- Faculty of MedicineSchool of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Travaglia
- Faculty of HealthCentre for Health Services ManagementUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Faculty of MedicineSchool of Public Health and Community MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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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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13
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Affiliation(s)
- Claire R. Chang
- Independent scholar and clinician, Melbourne, Victoria, Australia
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14
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Kpobi L, Swartz L. Ghanaian traditional and faith healers' explanatory models of intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:43-50. [PMID: 29993171 DOI: 10.1111/jar.12500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of traditional/alternative medicine for health care in Africa has been examined for various conditions. However, there is limited research about traditional/alternative health care for intellectual disability. The present authors explored the explanatory models (EMs) of intellectual disability held by traditional/faith healers in Ghana. METHODS Using a case vignette, the present authors conducted semi-structured interviews with 36 traditional/faith healers in Accra, Ghana. Using the EMs of illness framework as a guide, participants were asked questions to examine their beliefs about the nature, causes, course and recommended treatment of intellectual disability. RESULTS The healers' causal explanations included maternal negligence during pregnancy and spiritual factors. They also believed that intellectual disability was a congenital, lifelong condition which could not be cured. CONCLUSIONS Unlike other conditions which traditional healers claimed to cure, participants admitted that intellectual disability was not curable. The present authors suggest that the findings highlight opportunities that exist for collaboration between biomedicine and traditional medicine.
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Affiliation(s)
- Lily Kpobi
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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15
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Breau LM, Aston M, MacLeod E. Education creates comfort and challenges stigma towards children with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2018; 22:18-32. [PMID: 27645205 DOI: 10.1177/1744629516667892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Children with intellectual disabilities (IDs) are frequent users of the healthcare system, yet nurses report they receive little education regarding specialized medical, social and relational needs of this population. Therefore, parents take on a greater burden of care while their child is in hospital than do parents of typically developing children. This article reports findings from a qualitative study that used feminist poststructuralism to examine the hospital experiences of eight children with IDs, 17 mothers and 12 nurses. Nurses and mothers reported a lack of knowledge and education regarding the healthcare of children with ID and identified a need for more education. Participants noted that physical care of children with ID was prioritized as more important than communication and relationships. This unintentional prioritization was socially and institutionally constructed through stigma and stereotypes about people with IDs. Nurses and parents offered suggestions to access and increase ID education for healthcare professionals.
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Mimmo L, Harrison R, Hinchcliff R. Patient safety vulnerabilities for children with intellectual disability in hospital: a systematic review and narrative synthesis. BMJ Paediatr Open 2018; 2:e000201. [PMID: 29637187 PMCID: PMC5843001 DOI: 10.1136/bmjpo-2017-000201] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 01/06/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Adults and children with intellectual disability (ID) are vulnerable to preventable morbidity and mortality due to poor quality healthcare. While poor quality care has been commonly identified among children with ID, evidence of the patient safety outcomes for this group is lacking and therefore explored in this review. DATA SOURCES Systematic searches of six electronic bibliographic research databases were undertaken from January 2000 to October 2017, in addition to hand searching. STUDY SELECTION Keywords, subject headings and MeSH terms relating to the experience of iatrogenic harm during hospitalisation for children with ID were used. Potentially relevant articles were screened against the eligibility criteria. Non-English language papers were excluded. DATA EXTRACTION Data regarding: author(s), publication year, country, sample, health service setting, study design, primary focus and main findings related to measures of quality and safety performance were extracted. RESULTS OF DATA SYNTHESIS Sixteen studies met the inclusion criteria, with three themes emerging: the impact of the assumptions of healthcare workers (HCWs) about the child with ID on care quality and associated safety outcomes; reliance on parental presence during hospitalisation as a protective factor; and the need for HCWs to possess comprehensive understanding of the IDs experienced by children in their care, to scientifically deduce how hospitalisation may compromise their safety, care quality and treatment outcomes. CONCLUSION When HCWs understand and are responsive to children's individual needs and their ID, they are better placed to adjust care delivery processes to improve care quality and safety during hospitalisation for children with ID.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance Unit, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, Faculty of Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- Centre for Health Services Research, University of Technology Sydney, Ultimo, New South Wales, Australia
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Lewis P, Gaffney RJ, Wilson NJ. A narrative review of acute care nurses’ experiences nursing patients with intellectual disability: underprepared, communication barriers and ambiguity about the role of caregivers. J Clin Nurs 2017; 26:1473-1484. [DOI: 10.1111/jocn.13512] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Lewis
- School of Nursing and Midwifery; Western Sydney University; Richmond NSW Australia
| | - Ryan J Gaffney
- School of Nursing and Midwifery; Western Sydney University; Richmond NSW Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery; Ingham Institute for Applied Medical Research; Western Sydney University; Richmond NSW Australia
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