Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: a literature review

Understanding the contribution of intellectual disability nurses. Paper 2 of 4 - Survey

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.

Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals

Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.

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

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.

Appreciating the work of nurses caring for adults with intellectual disability and mental health issues

This paper presents findings from a study exploring the nurses' experience of caring for adults with intellectual disability and mental health issues in inpatient settings. Semi structured interviews were undertaken with 13 nurses from various regions of New Zealand. Methods suggested by an Appreciative Inquiry methodology were used to explore the nurses' positive experiences of their role. Interviews were transcribed and analysed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around 'Contextualising behaviour', 'Communication', 'Confidence to care' and 'Time'. Participants reflected upon their experiences offering personal interpretations in identifying the aspects of nursing that mattered and that worked. What is shown is that nurses were able to describe a range of creative and adaptive ways of nursing in responding to numerous complex factors they faced in their roles. This suggests a strong foundation on which to advance nursing care in this field.

The Use of Validation in Mental Health Nursing for Adults with Intellectual Disabilities and Mental Illness: A Descriptive Study

Mental health nursing for adults with intellectual disabilities and mental illness is understudied. The aim of this study was to investigate the use of validation in mental health nursing for patients with intellectual disabilities and additional mental illness in a specialised psychiatric inpatient setting. Ten nurses/social educators and four individual therapists described the use of validation; each provided three vignettes with clinical examples. The clinical examples support the view that interventions developed for patients in the general population are feasible also for patients with intellectual disabilities. Clinical implications relate to the use of validation as an important factor in mental health nursing for adults with intellectual disabilities. Skills required include being capable of interpreting behavioural equivalents of mental illness symptoms, responding adequately to unusual utterances, and occasionally communicating in a predominantly non-verbal way.

Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities - a cross-sectional study

PURPOSE/DESIGN

This cross-sectional descriptive study describes staff experiences of appreciative management.

METHODS

Data were collected by way of e-survey from staff (n = 87) working in the institutional care of people with intellectual and developmental disabilities. The Appreciative Management Scale (AMS 1.0) was used and data were analysed by statistical methods.

FINDINGS

Overall, respondents experienced appreciative management as being well implemented, with equality as the best implemented dimension and systematic management the worst. The promotion of well-being at work was associated with age. Appreciation staff received from management had a positive correlation with systematic management, equality, appreciation of know-how and the promotion of well-being at work.

CONCLUSIONS

The knowledge of weak systematic management in this study may be utilised in developing management strategies. The managers should use the concept of appreciative management to help young and less experienced nurses to increase their competency and willingness to work in this field.

Diagnostic Masking and Overshadowing in Intellectual Disability-How Structured Evaluation Helps

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.

Mental Health Nursing of Adults With Intellectual Disabilities and Mental Illness: A Review of Empirical Studies 1994-2013

Mental health nursing for adults with intellectual disabilities and mental illness is underresearched. The aim of this review is to summarize empirical mental health nursing studies including adults with intellectual disabilities and additional mental illness. Out of 137 hits, 16 articles were reviewed in full text. Thirteen of the articles presented modified nursing interventions. Three articles discussed training and education. The main finding is that mental health nursing interventions in patients with intellectual disabilities and additional mental illness are in line with mental health nursing for the general population. There are still not many publications on empirical studies concerning mental health nursing for adults with intellectual disabilities. Clinical implications are primarily related to the need for facilitated nurse-patient communication adjusted to the patients' cognitive levels. Insights drawn from this review illuminate the importance of mental health nursing interventions adjusting to the particular patients' symptoms, instead of targeting behavior change. The findings underpin factors found to have a positive impact on patients with mental illness in the general population as relevant topics for future research.

Intellectual Disability: A Critical Concept Analysis

Over the last number of years, the emergence of new scientific and social constructions of intellectual disability has contributed to many terminological, conceptual, and structural changes. As a result, the expression "mental retardation" has gradually been abandoned in favor of "intellectual disability" for classification and diagnosis. In addition to helping redefine intellectual disability, the implementation of new deinstitutionalized mechanisms of governmentality required the adoption of different clinical models. Concrete applications of those models have yet to be studied in nursing practice. The main objective of this article is to analyze the concept of intellectual disability in light of recent developments to clarify its philosophical bases, influence, and relevance for clinical practice. This concept analysis was realized following a literature review of scientific articles and monographs addressing topics related to intellectual disability. Inspired by a poststructuralist approach, we will discuss about the ambiguity of nurses' role regarding people labeled as having an intellectual disability. Lastly, we will address the clinical implications of our analysis and we will propose an actualized understanding of the nursing practice in such context.

Mental health inpatient experiences of adults with intellectual disability

This paper presents findings from a study exploring the mental health inpatient care of people with a dual disability of intellectual disability and mental health issues from the perspective of those people with the dual disability. A mixture of semi-structured interviews and focus group interviews were carried out with nine participants who had been admitted to an inpatient unit for mental health care exploring their experience of care. Interviews were transcribed and analyzed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around 'Therapeutic and Meaningful Activity', 'Emotion Focussed Care', and 'Feeling Safe?' Participants were able to identify the aspects of inpatient care that worked for them in terms of coping with time in hospital. This research suggests that there are several factors that should be considered in providing effective mental health inpatient care for people with dual disability. A number of strategies and recommendations for responding to their needs are identified and discussed.

A literature review exploring the preparation of mental health nurses for working with people with learning disability and mental illness

The aim of this literature review is to explore whether mental health nurses are being appropriately prepared to care for learning disabled patients who also suffer from mental ill health. A systematic approach was adopted in order to identify relevant literature for review on the topic. Five electronic databases were searched; CINAHL, Medline, ERIC, PubMed and Scopus. Searches were limited to the years 2001-2013. A total of 13 articles were identified as relevant to the topic area for review. Three main themes were identified relating to (a) attitudes (b) practice and (c) education. There appears to be a lack of research that directly addresses this issue and the existing literature suggests that there are considerable deficits in the ability of mental health nurses to be able to provide appropriate care for those with both a learning disability and mental ill health. The findings of this review would suggest that this topic area is in urgent need of further investigation and research. Further research into this area of practice could possibly help to inform education regarding this subject at pre-registration and post qualifying levels, which could therefore in turn, improve the delivery of mental health nursing care to this particular client group.

Research participation by people with intellectual disability and mental health issues: an examination of the processes of consent

Balancing the demands of research and ethics is always challenging, and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health-care services. Research in the field of intellectual disability presents particular challenges in regards to consenting processes. This paper is a reflective overview and analysis of the complex processes undertaken, and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information, and voluntariness is presented, with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilized are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.