Identifying the Need for Respite Care for People with Learning Disabilities in Northern Ireland

The present paper describes the methods employed to investigate the range and models of respite care services provided for people with learning disabilities and their carers in Northern Ireland. A total of 1786 carers (representing 1917 persons with learning disabilities) were surveyed to determine their perceptions and levels of satisfaction regarding the range of services provided for them. In addition 101 local respite care services were examined and interviews conducted with commissioners, providers and professional support staff to assess the perceptions of individuals involved in the planning, commissioning and provision of respite care services. The study confirmed that regional variations existed throughout the Province and that the current range of services often failed to meet the significant (and often complex) needs of users. Epidemiological data was obtained regarding the presenting needs of users. Specific recommendations were made requesting that the availability of comprehensive information about respite care should be readily accessible to users and carers. The need to extend the range of services and to provide more inclusive services for groups such as children and adults with autistic spectrum disorder, people with behavioural and complex medical conditions was also identified. Whilst the study was conducted in Northern Ireland it is considered that many of the findings will be equally applicable to elsewhere in the UK and the Republic of Ireland.

Independent travel and people with learning disabilities: the views of a sample of service providers on whether this nee is being met

This paper describes part of a larger study that involved interviewing clients, carers and service providers to investigate barriers to independent travel for people with severe learning disabilities. The initial part of the study, reported here, involved interviewing service providers. A purposive sample of 2I service providers involved in promotion of independent travel for people with learning disabilities in the South East of one of the major cities in Northern Ireland were interviewed. Aims were to identify the number of clients on travel programmes, perceived barriers and suggestions to promote independent travel. Analysis involved mainly quantitative methods, with a small qualitative input. Findings indicated that although independent travel was viewed as a valuable skill for people with learning disabilities to possess, there were relatively few who practised this. In a population of 890 people, 187 (21 %) were reported as being able to travel independently. In the remaining 703 people, 65 (9%) were involved in programmes to promote independent travel. This data was obtained from the respondents who collated the figures from notes and records in the establishments in which they were based. The most significant obstacles to independent travel were suggested to be clients' cognitive abilities, and the wishes of carers, who according to the study, often did not wish the client to be involved due to perceived risks. Recommendations are made regarding practices to promote independent travel.

An investigation into the aspirations and experiences of newly appointed dual diagnosis workers

This qualitative, exploratory study was designed to explore a sample of eight recently appointed dual diagnosis workers' (DDWs) perceptions of their new role and function in Northern Ireland (NI). A semi-structured interview was used and respondents were assured that their anonymity/rights would be protected. All of the narratives were shown to the respondents for their approval prior to going to press. The transcripts were analysed by using a tried and tested analytical framework. Seven key categories emerged from the findings relating to the DDWs perceptions of their: (1)understanding of the term dual diagnosis; (2) hopes; (3) fears; (4) support in their new role; (5) key clinical issues; (6) the positioning of the service; and (7) their overall role and function. This is a new and important area of work in NI. However, to date, no research has been carried out on the topic in the province. Consequently, the findings from this small study could go some way towards helping to shape the future direction of, and bring about some universality to the provision of the dual diagnosis service within different National Health Service Trusts in NI. Further research is required on this new and growing service as well as on the service users' perceptions of the care provided by DDWs. The study will be followed up on an annual basis for 3 years to provide longitudinal data. Generalization of findings requires caution because of the small sample size.

Early life experiences and their impact on our understanding of depression

This paper presents part of a larger Grounded Theory study, which was designed to capture a sample of people's perceptions of living with or, caring for, individuals with depression. Data were collected from a focus group consisting of people with depression (n = 7). In-depth one-to-one interviews were undertaken with eight further respondents (n = 8). Purposeful sampling was used initially. Thereafter, in keeping with one of the key tenets of grounded theory, theoretical sampling was used. The emergent concepts were pursued until saturation occurred. The constant comparative approach was used to analyse the data together with the NVivo qualitative analysis software package. This paper focuses on the respondents' perceptions of the pre-diagnosis, depression encounter. The key category that emerged was 'the pre-diagnosis phase of depression and the now experience'. Five key themes surfaced within this category: (1) negative impact significant life events; (2) self-blame; (3) personal characteristics; (4) pre-diagnosis, depression unknowingness; and (5) pre-help seeking. The findings suggest that those in the field of human services need to better understand the lived experience of people with depression, in order to provide holistic treatment and care.

The Response of Retrobulbar Vasculature to Hypercapnia in Primary Open-Angle Glaucoma and Ocular Hypertension

PURPOSE

To evaluate the physiological effects of hypercapnia on the retrobulbar vasculature in ocular hypertension (OH) and open-angle glaucoma (OAG).

METHODS

Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of the ophthalmic (OA) and central retinal arteries (CRA) were evaluated in 12 eyes with OH and 8 eyes with OAG using color Doppler imaging. Measurements were taken before and during hypercapnia.

RESULTS

Patients with OAG were found to have increased EDV (p < 0.035) of the CRA, and decreased PSV (p < 0.097) and EDV (p < 0.098) of the OA, during hypercapnia. Patients with OH had increased PSV (p < 0.062) and EDV (p < 0.072) of the CRA during hypercapnia. Patients with OH also demonstrated a greater percent change in the calculated RI (p < 0.065) of the CRA in response to hypercapnia when compared to OAG. The mean RI of the CRA decreased during hypercapnia.

DISCUSSION

Patients with OH were found to have a normal vasodilatory response within the retrobulbar vasculature during hypercapnia resulting in increased volumetric blood flow to the retina while patients with OAG did not, suggesting there is vasospasm at or downstream from the CRA resulting in decreased volumetric blood flow to the retina.

Naming of depression: nursing, social and personal descriptors

This paper explores descriptors of depression and begins by exploring nursing descriptors including the nature of assessment and nursing diagnosis and progresses to underpin these major processes by considering social descriptors such as cultural and spiritual constructs. The role and influence of stigma is discussed and an examination of gender influences and experiences is undertaken. The paper concludes by examining personal descriptors in the literature. The overall aim of the paper is (1) to add to nursing knowledge by depicting the grounded realities of the experience of depression and (2) stimulate discussion on the need to provide holistic care pathways that are responsive to the uniqueness of this lived experience and finally to (3) encourage further research on key psycho-social factors associated with depression and the concurring advancement of nursing care. This paper has been completed in the context of an ongoing study into the grounded experience of 'Depression' and the development of a psychiatric nursing theory of connectivity.

The legal and ethical status of children in health care in the UK

Ethical issues about children's rights in respect of matters concerning resource allocation or treatment opportunities are now a matter for public consumption and concern. Alongside this exists a long-frustrated desire by children's nurses to promote children's health. Long-held assumptions about the legal and moral status of children within the health care system in this country are now rightly scrutinized and challenged. Those of us who claim to represent children now possess an opportunity to exploit public attention for the benefit of these children. This article will explore selected major relevant legal and moral concepts that relate to children with the aim of making transparent some of the important and often confusing information available. It is anticipated that debates about the legal and ethical status of children may be stimulated and fuelled from the following discussion. It is strongly recommended that entering into dialogue with families and children about their perceived needs will go a long way towards advancing thoughtful nursing care of individual children, their families and the general population.

Future directions for learning disability nursing

Over the past decade learning disability nurses have had to make many changes in the way they practice. Changes in attitude towards the way in which people with learning disabilities are cared for has meant that nurses have had to adjust their practice to address different expectations in the way these services are delivered. Nursing now provides opportunities for people with learning disabilities to express themselves and become involved in decision-making that affects their lives. For nurses this is a totally new way of working with this client group. Learning disability nurses have risen to the challenge that has resulted from moving into community care and forming links with primary healthcare teams.

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate-non-graduate status, a comparative study

A review of the literature suggests people with learning disabilities are viewed negatively by others in society. Such negative views have also been found among many health care professionals, including nurses. This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n = 31) towards people with learning disabilities. The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire. Two comparisons between subjects in the study were undertaken-a comparison of the attitudes of graduate nurses and those who were non-graduates; a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities. From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified. Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession. The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses. Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities.

The development of the generalist nurse within pre-registration nurse education in the UK: some points for consideration

A major difference between pre-registration nurse education in the UK as distinct from most other European countries is the existence of discrete branches of nursing. The package of four specialty areas of adult nursing, children's nursing, learning disability, and mental health nursing do not exist at pre-registration level in the majority of other European countries. The Republic of Ireland offers pre-registration education in general, mental health and learning disability nursing, and not children's nursing. Intergovernmental support was given to the idea of a generalist nurse in 1988. Such a change in nurse education in the UK would have major implications for patients, nurses and the nursing profession, and requires careful consideration by all nurses in education and practice. This paper presents some of the key arguments for and against the adoption of a generalist approach to pre-registration nurse education in the UK.

Empowering consumers: the caring challenge

This article considers current issues relating to power relationships that exist between learning disability nurses and their clients. It examines the changing role of learning disability nurses and considers their influence on enhancing the quality of life for people with learning disabilities, whose autonomy and right to decision making has been consistently challenged throughout society.

Impaired autonomy--the challenge of caring

The aim of this paper is to present an informed argument in favour of changing power relationships between learning disability nurses and their clients and to do so through an examination of the influence that they have on quality of life issues for people whose autonomy is impaired. The challenge of empowerment and enhanced autonomy is considered to be at the 'cutting edge' of the learning-disability agenda with its increasing focus on the provision of supported living opportunities for clients in the community. Features related to institutional methods of care delivery continue to exist in some services and as a result clients may still be expected to conform to the dominant themes of time, order, control and regimentation. The application of social and environmental engineering techniques to the field of learning disability care is prerequisite for the development of more positive alternatives to the mental-handicap hospital as a focus for care provision. The main requirement for persons whose autonomy is impaired will be the promotion of equal power sharing between clients and carer. This process will involve a number of transactional considerations such as advocacy, risk taking and shared action planning. The emergence of a new paradigm for nursing practice will result in the solution for shifting the balance of power in the emergent world of consumerism for clients whose autonomy is impaired.

The arrogance of power: a reflection on contemporary mental health nursing practice

This paper explores the role of contemporary mental health nursing and challenges practitioners to acknowledge the influence that power relationships have on therapeutic practice and client outcomes. It is argued that empowerment and advocacy remain central concepts for nursing and that the art of accurate empathy is a pre-requisite for contemporary mental health care.

Nursing people with learning disabilities: new directions

Since the suggestion that the mental handicap branch of nursing be disbanded 21 years ago, these nurses have refocused their vision and emerged as a new and exciting specialism. This article relates their experiences to the key issues now confronting nursing in general, in a changing social and political context.

Specialist practitioners for people with learning disabilities

Recent developments occurring within the nursing profession have signalled the need for an introspective review of the role and function of nursing practice in each speciality. Learning disabilities is no exception.

Meeting consumer needs: the future role of the mental handicap nurse

As mental handicap care moves out into the community, the nurse's role is changing. As part of the multidisciplinary team it offers specific skills to help support individual clients.