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Benson-Goldberg S, Geist L, Erickson K. Simplified COVID-19 guidance for adults with intellectual and developmental disabilities. J Appl Res Intellect Disabil 2024; 37:e13222. [PMID: 38494739 DOI: 10.1111/jar.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/22/2024] [Accepted: 02/23/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, the United States' Centers for Disease Control and Prevention (CDC) created guidance documents that were too complex to be read and understood by the majority of adults with intellectual and developmental disabilities who often read at or below a third-grade reading level. This study explored the extent to which these adults could read and understand CDC documents simplified using Minimised Text Complexity Guidelines. METHOD This study involved 20 participants, 18-48 years of age. Participants read texts and responded to multiple-choice items and open-ended questions to gather information about how they interacted with and understood the texts. RESULTS The results provide initial evidence that the Minimised Text Complexity Guidelines resulted in texts that participants could read and understand. CONCLUSION Implications for increasing the accessibility of public health information so that it can be read and understood by adults with extremely low literacy skills are discussed.
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Affiliation(s)
- Sofia Benson-Goldberg
- Center for Literacy and Disability Studies, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lori Geist
- Center for Literacy and Disability Studies, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Karen Erickson
- Center for Literacy and Disability Studies, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA
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2
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Furukawa S, Nawa N, Yamaoka Y, Fujiwara T. Concerns and needs of people with intellectual disabilities and their caregivers during the COVID-19 pandemic in Japan. J Intellect Disabil 2024; 28:137-156. [PMID: 36286242 PMCID: PMC9606640 DOI: 10.1177/17446295221135274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Background: People with intellectual disabilities (IDs) and their caregivers face difficulties during the COVID-19 pandemic. However, limited studies have comprehensively investigated their challenges, especially in Japan. We aimed to clarify the concerns and needs of people with IDs and their caregivers during the COVID-19 pandemic in Japan. Method: From March to August 2021, 27 in-depth interviews were conducted with principal caregivers of people with moderate to profound IDs in Japan. We then transcribed the interviews and conducted deductive coding using predetermined codes focused on their daily life difficulties. Inductive coding was used to ensure that no important themes were overlooked. Results: We found four concerns and four needs among people with IDs and their caregivers as significant themes. Conclusions: Our results provide useful information for supporting people with IDs and their caregivers, especially among those who need medical or social care in accordance with the infection control and social-distancing policies.
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Affiliation(s)
- Sawako Furukawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
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Ong N, Gee BL, Long JC, Zieba J, Tomsic G, Garg P, Lapointe C, Silove N, Eapen V. Patient safety and quality care for children with intellectual disability: An action research study. J Intellect Disabil 2023; 27:885-911. [PMID: 35657332 DOI: 10.1177/17446295221104619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Children with intellectual disability experience significant challenges in accessing and receiving high-quality healthcare leading to poorer health outcomes and negative patient experiences. Families of these children often report a need for healthcare staff to better understand, communicate, and collaborate for better care while staff acknowledge a lack of training. To address this, we utilised an action research framework with a pre- and post- survey to evaluate an integrated continuing professional development and quality improvement program combining strategies from education, behavioural psychology and quality improvement that was delivered in two departments within a tertiary children's Hospital in Metropolitan Sydney in 2019-2020. Parents reported noticeable changes in the clinical practice of staff, and staff acknowledged and attributed their shift in behaviour to raising awareness and discussions around necessary adaptations. The program demonstrates a novel method for knowledge translation to practice and systems improvements.
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Affiliation(s)
- Natalie Ong
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Brendan Loo Gee
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jerzy Zieba
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, NSW, Australia and Department of Psychology, University of Rzeszow, Poland
| | - Gail Tomsic
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Pankaj Garg
- Specialist Disability Health Team, Department of Community Paediatrics, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Caleb Lapointe
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
- The KidsSim Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Silove
- Child Development Unit, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), UNSW Sydney & Ingham Institute, Sydney, Australia
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4
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Limbu B, Deb SS. Support staff liaising effectively with professionals for the rational use of psychotropics for behaviours that challenge in adults with intellectual disabilities: Findings from a co-design event. Front Psychiatry 2022; 13:954522. [PMID: 36245886 PMCID: PMC9559865 DOI: 10.3389/fpsyt.2022.954522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Experience Based Co-Design (EBCD) and co-production are interdisciplinary collaborative approaches to improve health care services by involving all stakeholders. These approaches capture the experiences of all stakeholders who come in contact with services and use experiences as evidence to promote and implement service changes. The use of psychotropic medications for behaviours that challenge (BtC) in people with intellectual disabilities (ID) is a complex issue because of its off-licence use and use in combination with other medications for physical and psychiatric co-morbidities, which leads to overmedication of people with ID. As support staff plays a pivotal role in the prescribing for people with ID, we have developed a staff training programme, SPECTROM, to help reduce overmedication. A project team developed SPECTROM under the guidance of a Programme Development Group (PDG) consisting of 21 stakeholders. The PDG analysed data from a literature review, four focus groups and a co-design event day involving 26 stakeholders. In this paper, we have presented data based on the findings from the co-design event day, primarily on the issue of support staff effectively liaising with professionals such as doctors, nurses, and other community learning disability team members. In-depth information and recommendations were proposed at the co-design event, which helped develop the draft SPECTROM. The draft was finalised after receiving feedback from 56 stakeholders. Co-production and a modified EBCD can be successfully used to create training interventions and improve health care services. More research should utilise co-production and EBCD and use service users' experiences to develop interventions and improve health care services.
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Affiliation(s)
- Bharati Limbu
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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5
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Faissner M, Juckel G, Gather J. [Testimonial injustice against people with mental disorders in health care. A conceptual and ethical analysis]. Ethik Med 2021;:1-16. [PMID: 34803235 DOI: 10.1007/s00481-021-00666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
Menschen mit psychischer Erkrankung sterben statistisch gesehen früher als die Allgemeinbevölkerung. Ein Grund hierfür ist, dass sie eine schlechtere somatische Gesundheitsversorgung erhalten. Wir argumentieren, dass ableistische Netzwerke sozialer Bedeutung zu einer Abwertung der epistemischen Kompetenz von Menschen mit psychischer Erkrankung führen. Diese Abwertung kann mit dem Konzept der testimonialen Ungerechtigkeit erfasst werden. Testimoniale Ungerechtigkeit bezeichnet das ungerechtfertigte Herabstufen der Glaubwürdigkeit einer*s Sprecher*in aufgrund eines Vorurteils gegen ihre*seine soziale Identität. Wir analysieren ethische und epistemische Folgen testimonialer Ungerechtigkeit als wichtige Ursachen der schlechteren Gesundheitsversorgung von Menschen mit psychischer Erkrankung. Testimoniale Ungerechtigkeit kann zu medizinischen Behandlungsfehlern führen und für Betroffene schwerwiegende gesundheitliche Folgen nach sich ziehen. Zudem kann sie zu einem Vertrauensverlust von Menschen mit psychischer Erkrankung in das Gesundheitssystem führen. Daher trägt testimoniale Ungerechtigkeit zur strukturellen Diskriminierung von Menschen mit psychischer Erkrankung bei. Vor diesem Hintergrund diskutieren wir, wie die somatische Gesundheitsversorgung unter ethischen Gesichtspunkten verbessert werden kann.
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6
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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7
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Rocheleau JN, Chalghoumi H, Jutai J, Farrell S, Lachapelle Y, Cobigo V. Caregivers' Role in Cybersecurity for Aging Information Technology Users with Intellectual Disability. Cyberpsychol Behav Soc Netw 2021; 24:624-629. [PMID: 34182769 DOI: 10.1089/cyber.2020.0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Information technology (IT) users with intellectual disability (ID) are likely to experience online privacy violations without adequate support from their caregivers. Given that aging users face additional challenges when using IT than their younger counterparts, the goal of this exploratory study is to investigate caregivers' strategies and barriers for helping to protect the privacy of aging IT users with ID. Six caregivers (four paid caregivers, two family members) of aging users with ID completed a series of six focus groups about their experiences assisting the people they support with using IT, including their strategies and barriers for helping to protect these users' privacy. Participants were also asked about their own attitudes and experiences related to online privacy and information security. Based on our inductive thematic analysis of the qualitative data, participants used three main strategies to help protect the privacy of aging users with ID: (1) restricting access to personal information, (2) limiting disclosure of personal details, and (3) providing just-in-time instruction and feedback. We also identified four key barriers to privacy protection: (1) limited awareness and knowledge about information security, (2) balancing privacy and autonomy, (3) maintaining professional boundaries, and (4) residential care services' policies. Inclusive and transdisciplinary research is needed to address the elevated privacy and security risks for aging IT users with ID, and provide caregivers with training on how to support this population to use IT safely. Technology developers should create solutions to decrease aging users with ID's dependence on caregivers for privacy protection.
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Affiliation(s)
| | | | - Jeffrey Jutai
- Interdisciplinary School of Health Sciences and LIFE Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Yves Lachapelle
- Département de Psychoéducation, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Virginie Cobigo
- School of Psychology, University of Ottawa, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,Centre for Research on Education and Community Services, Ottawa, Canada
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8
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Drozd M, Chadwick D, Jester R. A cross-case comparison of the trauma and orthopaedic hospital experiences of adults with intellectual disabilities using interpretative phenomenological analysis. Nurs Open 2021; 8:858-869. [PMID: 33570307 PMCID: PMC7877147 DOI: 10.1002/nop2.693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 11/12/2022] Open
Abstract
AIM To present the cross-case comparison component of a qualitative study exploring and describing the experiences of adults with an intellectual disability who have received trauma and orthopaedic hospital care for musculoskeletal conditions or injuries in the United Kingdom. DESIGN A qualitative, exploratory study was conducted using 1:1 semi-structured interviews to describe the lived experiences of trauma and orthopaedic hospital care from the perspectives of people with intellectual disabilities and a carer of a person with profound and multiple intellectual disabilities. The data were analysed using interpretative phenomenological analysis. The Standards for Reporting Qualitative Research guidelines were applied. RESULTS There were common and interconnected experiences across the five participants: communication challenges; lack of person-centred care; issues related to pain management; lack of confidence in hospital care; the valuable support and expertise of carers; and incompetence of hospital staff and isolation and loneliness.
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Affiliation(s)
- Mary Drozd
- University of WolverhamptonWolverhamptonUK
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9
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Vlot‐van Anrooij K, Koks‐Leensen MCJ, van der Cruijsen A, Jansen H, van der Velden K, Leusink G, Hilgenkamp TIM, Naaldenberg J. How can care settings for people with intellectual disabilities embed health promotion? J Appl Res Intellect Disabil 2020; 33:1489-1499. [PMID: 32627935 PMCID: PMC7689850 DOI: 10.1111/jar.12776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/07/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with intellectual disabilities (ID) depend on their environment to live healthily. Asset-based health promotion enhances a settings' health-promoting capacity starting with identifying protective or promotive factors that sustain health. METHOD This inclusive mixed-methods study used group sessions to generate and rank ideas on assets supporting healthy nutrition and physical activity in Dutch intellectual disability care settings. Participants included people with moderate intellectual disabilities and family and care professionals of people with severe/profound intellectual disabilities. RESULTS Fifty-one participants identified 185 assets in group sessions. They include the following: (i) the social network and ways "people" can support, (ii) assets in/around "places," and person-environment fit, and (iii) "preconditions": health care, prevention, budget, and policy. CONCLUSION This inclusive research provides a user perspective on assets in the living environment supporting healthy living. This gives insight in contextual factors needed for development and sustainable embedment of health promotion in the systems of intellectual disability support settings.
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Affiliation(s)
- Kristel Vlot‐van Anrooij
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Monique C. J. Koks‐Leensen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Anneke van der Cruijsen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Henk Jansen
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Koos van der Velden
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Geraline Leusink
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Thessa I. M. Hilgenkamp
- Department of General Practice, Intellectual Disability MedicineErasmus MC, University Medical CenterRotterdamThe Netherlands
- Department of Physical TherapyUniversity of NevadaLas VegasNVUSA
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Intellectual Disabilities and HealthRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
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Drozd M, Chadwick D, Jester R. An integrative review of the hospital experiences of people with an intellectual disability: Lack of orthopaedic and trauma perspectives. Int J Orthop Trauma Nurs 2020; 39:100795. [DOI: 10.1016/j.ijotn.2020.100795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 01/13/2023]
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11
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Spassiani NA, Abou Chacra MS, Selick A, Durbin J, Lunsky Y. Emergency department nurses’ knowledge, skills, and comfort related to caring for patients with intellectual disabilities. Int Emerg Nurs 2020; 50:100851. [DOI: 10.1016/j.ienj.2020.100851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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Ailey SH, Johnson TJ, Cabrera A. Evaluation of Factors Related to Prolonged Lengths of Stay for Patients With Autism With or Without Intellectual Disability. J Psychosoc Nurs Ment Health Serv 2019; 57:17-22. [PMID: 30753733 DOI: 10.3928/02793695-20190205-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Patients with autism spectrum disorder and/or intellectual disability (ASD/ID) face unique health care challenges. In addition to hospital experiences characterized by fear and insufficient staff training, these patients have 1.5-times longer lengths of stay (LOS) than patients without ASD/ID, and 3.4% of patients with ASD/ID have prolonged LOS (i.e., ≥30 days). Little research exists on factors related to prolonged LOS of patients with ASD/ID, hindering efforts to develop and implement evidence-based practices to improve care and reduce prolonged LOS. The purpose of the current study was to describe factors related to prolonged LOS of adult patients with ASD/ID in acute care settings using a retrospective chart review of 10 patients discharged from one academic medical center. Findings indicate that health care institutions should evaluate performance with this patient population and identify evidence-based strategies to provide a safe environment for care and reduce LOS that is due to non-health care needs. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 17-22.].
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Abstract
Emeritus Professor Alan Glasper, University of Southampton, discusses a new initiative for additional training for health professionals in England. An open consultation is inviting nurses and others to comment on the proposals.
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Gibson RC, Bouamrane MM, Dunlop M. Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts. JMIR Rehabil Assist Technol 2019; 6:e10449. [PMID: 30829575 PMCID: PMC6421513 DOI: 10.2196/10449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 11/30/2018] [Accepted: 12/31/2018] [Indexed: 01/12/2023] Open
Abstract
Background Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs—the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients.
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Affiliation(s)
- Ryan Colin Gibson
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matt-Mouley Bouamrane
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Mark Dunlop
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Beighton C, Victor C, Carey IM, Hosking F, DeWilde S, Cook DG, Manners P, Harris T. 'I'm sure we made it a better study…': Experiences of adults with intellectual disabilities and parent carers of patient and public involvement in a health research study. J Intellect Disabil 2019; 23:78-96. [PMID: 28812949 PMCID: PMC6383106 DOI: 10.1177/1744629517723485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 05/26/2023]
Abstract
Patient and public involvement is considered integral to health research in the United Kingdom; however, studies documenting the involvement of adults with intellectual disabilities and parent carers in health research studies are scarce. Through group interviews, this study explored the perspectives and experiences of a group of adults with intellectual disabilities and a group of parent carers about their collaborative/participatory involvement in a 3-year study which explored the effectiveness of annual health checks for adults with intellectual disabilities. Thematic analysis identified five key themes consistent across both groups; authenticity of participation, working together, generating new outcome measures, dissemination of findings and involvement in future research. Although reported anecdotally rather than originating from the analysis, increased self-confidence is also discussed. The groups' unique perspectives led to insights not previously considered by the research team which led to important recommendations to inform healthcare practice.
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Affiliation(s)
- Carole Beighton
- Carole Beighton, Population Health Research
Institute, St Georges University of London, London SW17 ORE, UK.
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Nicholas DB, Orjasaeter JD, Zwaigenbaum L. Considering Methodological Accommodation to the Diversity of ASD: A Realist Synthesis Review of Data Collection Methods for Examining First-Person Experiences. Rev J Autism Dev Disord 2019. [DOI: 10.1007/s40489-019-00164-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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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: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Lee RLT, Brown M, Leung C, Chen H, Louie L, Chen JL, Lee PH. Family carers' experiences of participating in a weight management programme for overweight children and adolescents with intellectual disabilities: An exploratory study. J Adv Nurs 2018; 75:388-399. [PMID: 30187576 DOI: 10.1111/jan.13845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To gain insight into the experiences of family carers participating in a weight management programme via mHealth tools for overweight children and adolescents with intellectual disabilities. BACKGROUND Many weight reduction programs fail to show positive and sustainable impacts due to not involving parents, who are usually unavailable to attend school-based health programs. The mHealth interactive interventions were carried out in September 2015-August 2016, engaging carers to monitor and sustain their children's healthy lifestyle behaviours at home being one way to achieve this. DESIGN Qualitative research design to conduct focus group discussion with family carers involved in a school-based weight management programme via the mHealth interventions. METHODS An exploratory study was used to examine family carers' views of participating in a weight management programme. Focus group interviews examined the in-depth experiences of 20 family carers in providing social support and monitoring lifestyle behaviours via the mHealth interactive interventions. RESULTS Twenty family carers were recruited and four themes emerged: (a) improving family carer-child interactions and communications; (b) gaining useful and practical health information from experts; (c) supporting each other via an mHealth platform; and (d) appreciating the collaborative effort between school personnel and family carers. Family carers stressed the usefulness of the mHealth interactive interventions in monitoring and sustaining the children's healthy lifestyle behaviours at home. CONCLUSION The mHealth interactive interventions for increasing family carers' involvement and monitoring were well received. The findings provide new insights into using mHealth interventions in future weight management programmes involving parental participation in the home environment.
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Affiliation(s)
- Regina L T Lee
- Faculty of Health and Medicine, School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Cynthia Leung
- Department of Applied & Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Hong Chen
- Department of Health, Center for Health Protection, Hong Kong, Hong Kong
| | - Lobo Louie
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Jyu-Lin Chen
- Faculty of Nursing, University of California San Francisco, Berkeley, California
| | - Paul H Lee
- World Health Organization Collaboration Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Witham G, Haigh C. A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities. Eur J Oncol Nurs 2018; 36:9-15. [PMID: 30322516 DOI: 10.1016/j.ejon.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The experiences of cancer care can be mediated by many different factors and this narrative literature review aims to explore the experiences of cancer care in relation to people with intellectual disabilities receiving cancer treatment. METHOD We undertook a search for articles in English from (Jan) 2000-(Feb) 2018 using Medline, CINAHL, ScienceDirect, ASSIA and Wiley. The inclusion criteria are 2000-2018, English language and focussing on experiences of cancer journey. We used a narrative approach and thematically analysed the data. RESULTS There were 10 papers that met our inclusion/exclusion criteria. The themes generated included communication issues, information giving and decision-making. The literature suggests that communication and decision-making within cancer care are often mediated through support workers or family carers with minimal involvement of the person with intellectual disabilities. Information-giving by health professionals and support workers to people with intellectual disabilities was limited. This was often justified by the perceived distress this may cause. CONCLUSION Training for health professionals and support workers in supporting people with intellectual difficulties is required for more effective communication in cancer care.
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Affiliation(s)
- Gary Witham
- Manchester Metropolitan University, Department of Nursing, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester, M15 6GX, United Kingdom.
| | - Carol Haigh
- Manchester Metropolitan University, Department of Nursing, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester, M15 6GX, United Kingdom.
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20
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Affiliation(s)
- Lauren Harris
- Academic Foundation Doctor, Haringey Learning Disabilities Partnership, London
| | - Rory Sheehan
- Academic Clinical Fellow in Psychiatry of Intellectual Disability, Division of Psychiatry, University College London, London W1T 7NF
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21
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Brown M, Taggart L, Karatzias T, Truesdale M, Walley R, Northway R, Macrae S, Carey M, Davies M. Improving diabetes care for people with intellectual disabilities: a qualitative study exploring the perceptions and experiences of professionals in diabetes and intellectual disability services. J Intellect Disabil Res 2017; 61:435-449. [PMID: 28247543 DOI: 10.1111/jir.12369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Globally, diabetes is increasing with concerns about the impact on outcomes, including premature death and the costs associated with managing the condition. Research indicates that adults with intellectual disabilities (ID) are two to three times more likely to develop diabetes; however, there has been limited focus on diabetes service utilisation in this population. The aim of this study is to explore the perceptions and experiences of diabetes and ID practitioners. METHODS A series of 1:1 semi-structured interviews were undertaken in one Scottish health service area. In total, 29 qualitative interviews were conducted: 10 with diabetes practitioners from primary and secondary care, 14 from ID services and 5 from community care services regarding diabetes service provision for this population. Thematic content analysis was undertaken to identify the themes and subthemes. RESULTS Three main themes were identified: (1) enabling access to services to meet diabetes-related care needs of people with ID; (2) communication and service improvements between staff, patients and across services; and (3) providing person-centred diabetes care and developing adapted resources to increase patient self-care. CONCLUSIONS The findings of this study have important international implications in how diabetes practitioners plan and deliver services for people with ID and other vulnerable groups with limited cognitive ability and communication skills and difficulties in self-management. The findings highlight that access to diabetes education and adapted resources is needed, and if 'reasonable adjustments' are made to service provision and practice, people with ID can benefit from improved healthcare. Developing joint clinics to share knowledge and resources between diabetes and ID practitioners may improve service delivery and continuity of care, and thereby diminish the costs of not providing quality care.
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Affiliation(s)
- M Brown
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Department of Clinical Psychology, Specialist Learning Disability Services, NHS Lothian, Edinburgh, UK
| | - L Taggart
- Department of Nursing, Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - T Karatzias
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Department of Clinical Psychology, Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - M Truesdale
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - R Walley
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - R Northway
- Department of Nursing and Midwifery, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - S Macrae
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - M Carey
- Leicester Diabetes Centre, Department of Health Sciences, University Hospitals of Leicester, Leicester
| | - M Davies
- Leicester Diabetes Centre, Department of Health Sciences, University Hospitals of Leicester, Leicester
- Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, UK
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Pelleboer-Gunnink HA, Van Oorsouw WMWJ, Van Weeghel J, Embregts PJCM. Mainstream health professionals' stigmatising attitudes towards people with intellectual disabilities: a systematic review. J Intellect Disabil Res 2017; 61:411-434. [PMID: 28198094 DOI: 10.1111/jir.12353] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/08/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Equal access to mainstream healthcare services for people with intellectual disabilities (ID) still requires attention. Although recent studies suggest that health professionals hold positive attitudes towards people with ID, stigmatising attitudes may influence their efforts to serve people with ID in community healthcare practice. To stimulate inclusion in mainstream healthcare services, this systematic review focussed on barriers in attitudes of mainstream health professionals towards people with ID. METHOD Five electronic databases were systematically searched and references in full text articles were checked for studies published in the English language between January 1994 and January 2016. A social-psychological triad of cognitive, affective and behavioural dimensions of stigmatising attitudes is used to structure and discuss the results. RESULTS The literature search generated 2190 records with 30 studies that passed our exclusion criteria. Studies were mostly cross-sectional and of moderate quality. With respect to stigma, a lack of familiarity with and knowledge about people with ID was found. ID was considered as a stable condition not under personal control. Moreover, mainstream health professionals had either low or high expectations of the capabilities of people with ID. Professionals reported stress, lack of confidence, fear and anxiety, a tendency to treat people with ID differently and a lack of supporting autonomy. CONCLUSIONS Stigmatising attitudes towards people with ID appeared to be present among mainstream health professionals. This might affect the ongoing challenges regarding inclusion in mainstream healthcare services. To facilitate inclusion in mainstream healthcare services, it is recommended to include contact and collaboration with experts-by-experience in education programs of health professionals. Future research should progress beyond descriptive accounts of stigma towards exploring relationships between cognitive, affective and behavioural dimensions as pointers for intervention. Finally, inclusion would benefit from an understanding of 'equal' treatment that means reasonable adjustments instead of undifferentiated treatment.
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Affiliation(s)
- H A Pelleboer-Gunnink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Dichterbij Innovation and Science, Gennep, The Netherlands
| | - W M W J Van Oorsouw
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - J Van Weeghel
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Phrenos Centre of Expertise, Utrecht, The Netherlands
- Parnassia Group, Dijk en Duin Mental Health Centre, Castricum, The Netherlands
| | - P J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
- Dichterbij Innovation and Science, Gennep, The Netherlands
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Tuffrey-Wijne I, Abraham E, Goulding L, Giatras N, Edwards C, Gillard S, Hollins S. Role confusion as a barrier to effective carer involvement for people with intellectual disabilities in acute hospitals: findings from a mixed-method study. J Adv Nurs 2016; 72:2907-2922. [PMID: 27292794 DOI: 10.1111/jan.13041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/28/2022]
Abstract
AIMS To understand issues around carer roles that affect carer involvement for people with intellectual disabilities in acute hospitals. BACKGROUND There is evidence that a lack of effective carer involvement can lead to poorer health outcomes for people with intellectual disabilities, but there is a lack of insight into the reasons for poor carer involvement in acute hospitals. DESIGN Mixed methods in six acute hospital trusts in England (2011-2013). METHODS Electronic hospital staff survey (n = 990), carer questionnaires (n = 88), semi-structured interviews with hospital staff (n = 68) and carers (n = 37). Data were triangulated and analysed using a conceptual framework. RESULTS There was strong support for carer involvement among hospital staff, and most carers indicated that they felt welcomed and supported. However, an investigation of negative experiences showed that there were discrepancies in the perspectives of hospital staff and carers on the scope of 'carer involvement'. An important contributory factor to the effectiveness of carer involvement was the degree to which staff understood the importance of carer expertise (rather than simply carer work) and welcomed it. Carers' contributions to basic nursing care tasks could be taken for granted by hospital staff, sometimes erroneously. CONCLUSION The roles and contributions of carers should be clarified on an individual basis by hospital staff. The authors propose a new model to support this clarification. Further research is needed to assess the suitability of the model for patients with intellectual disabilities and other vulnerable patient groups.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University and George's University of London, UK.
| | - Elisabeth Abraham
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Lucy Goulding
- King's Improvement Science, King's College London, London, UK
| | | | - Christine Edwards
- Institute of Leadership and Management in Health, Kingston University Business School, UK
| | - Steve Gillard
- Social and Community Mental Health, Population Health Research Institute, St George's University of London, UK
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Hemsley B, Georgiou A, Carter R, Hill S, Higgins I, van Vliet P, Balandin S. Use of the My Health Record by people with communication disability in Australia: A review to inform the design and direction of future research. Health Inf Manag 2016; 45:107-115. [PMID: 27269277 DOI: 10.1177/1833358316652060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. OBJECTIVE The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, 'My Health Record' (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. METHOD The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. RESEARCH OUTCOMES This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. CONCLUSION In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.
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Sheehan R, Gandesha A, Hassiotis A, Gallagher P, Burnell M, Jones G, Kerr M, Hall I, Chaplin R, Crawford MJ. An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Open 2016; 6:e010480. [PMID: 27091821 PMCID: PMC4838729 DOI: 10.1136/bmjopen-2015-010480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING Nine acute general hospital Trusts and six mental health services. PARTICIPANTS Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | - Aarti Gandesha
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | | | - Pamela Gallagher
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Matthew Burnell
- Faculty of Population Health Sciences, University College London, London, UK
| | - Glyn Jones
- Abertawe Bro Morgannwg University Health Board, Cardiff, UK
| | - Michael Kerr
- Welsh Centre for Learning Disabilities, Cardiff University, Cardiff, UK
| | - Ian Hall
- Tower Hamlets Community Learning Disability Service, London, UK
| | - Robert Chaplin
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Michael J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
- Centre for Mental Health, Imperial College London, London, UK
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Hemsley B, Georgiou A, Hill S, Rollo M, Steel J, Balandin S. An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital. Patient Educ Couns 2016; 99:501-511. [PMID: 26566195 DOI: 10.1016/j.pec.2015.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To review the research literature on the experiences of patients with communication disabilities in hospital according to the Generic Model of patient safety. METHODS In 2014 and 2015, we searched four scientific databases for studies with an aim or result relevant to safety of hospital patients with communication disabilities. The review included 27 studies. RESULTS A range of adverse event types were outlined in qualitative research. Little detail was provided about contributing or protective factors for safety incidents in hospital for these patients or the impact of the incidents on the patient or organisations involved. CONCLUSION Further research addressing the safety of patients with communication disabilities is needed. Sufficient detail is required to identify the nature, timing, and detection of incidents; factors that contribute to or prevent adverse events; and detail the impact of the adverse events. PRACTICE IMPLICATIONS In order to provide safe and effective care to people with communication disabilities in hospital, a priority for health and disability services must be the design and evaluation of ecologically appropriate and evidence-based interventions to improve patient care, communication, and reduce the risk of costly and harmful patient safety incidents.
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Affiliation(s)
- Bronwyn Hemsley
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia.
| | - Andrew Georgiou
- Australian Institute for Health Innovation, Macquarie University, Sydney, Australia
| | - Sophie Hill
- Department of Public Health, La Trobe University, Australia
| | - Megan Rollo
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia
| | - Joanne Steel
- Faculty of Education and Art, The University of Newcastle, Newcastle, Australia
| | - Susan Balandin
- Faculty of Health, Deakin University, Melbourne, Australia
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Bye A, Aston M. Brenna's story: A critical reflection and analysis of one mother's experience of navigating the medical system with a child with intellectual disabilities. J Intellect Disabil 2016; 20:82-92. [PMID: 25952335 DOI: 10.1177/1744629515583417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 06/04/2023]
Abstract
Children with intellectual disabilities spend more time in the health-care system than mainstream children. Parents have to learn how to navigate the system by coordinating appointments, understanding the referral process, knowing what services are available, and advocating for those services. This places an incredible amount of responsibility on families. This article is one mother's personal story and reflection about her journey through the Canadian health-care system in Nova Scotia, with her daughter who has an intellectual disability. The reflection identifies moments of tension experienced by a mother and how she was expected to be a medical system navigator, doctor-educator, time manager, and care coordinator and the roles that led to feelings of repression, extreme frustration, and fear. A final discussion offers an analysis of her experience, using concepts from feminist post-structuralism.
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Abstract
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.
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Affiliation(s)
- Chris Taua
- The University of Queensland, Brisbane, Australia
| | - Christine Neville
- School of Nursing and Midwifery, The University of Queensland, Ipswich, Queensland, Australia
| | - Theresa Scott
- School of Nursing and Midwifery, The University of Queensland, Ipswich, Queensland, Australia
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Flynn S, Hulbert-Williams L, Bramwell R, Stevens-Gill D, Hulbert-Williams N. Caring for cancer patients with an intellectual disability: Attitudes and care perceptions of UK oncology nurses. Eur J Oncol Nurs 2015; 19:568-74. [DOI: 10.1016/j.ejon.2015.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/27/2015] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
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Perez CM, Ball SL, Wagner AP, Clare ICH, Holland AJ, Redley M. The incidence of healthcare use, ill health and mortality in adults with intellectual disabilities and mealtime support needs. J Intellect Disabil Res 2015; 59:638-652. [PMID: 25363017 DOI: 10.1111/jir.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (ID) experience a wide range of eating, drinking and/or swallowing (EDS) problems, for which they receive diverse mealtime support interventions. Previous research has estimated that dysphagia (difficulty swallowing) affects 8% of all adults with ID and that 15% require some form of mealtime support. People with ID (whether they require mealtime support or not) also experience a greater burden of ill health and die younger than their peers in the general population with no ID. METHODS Using an exploratory, population-based cohort study design, we set out to examine health-related outcomes in adults with ID who receive mealtime support for any eating, drinking or swallowing problem, by establishing the annual incidence of healthcare use, EDS-related ill health, and all-cause mortality. This study was conducted in two counties in the East of England. RESULTS In 2009, 142 adults with mild to profound ID and a need for any type of mealtime support were recruited for a baseline survey. At follow-up 1 year later, 127 individuals were alive, eight had died and seven could not be contacted. Almost all participants had one or more consultations with a general practitioner (GP) each year (85-95%) and, in the first year, 20% reportedly had one or more emergency hospitalizations. Although their annual number of GP visits was broadly comparable with that of the general population, one-fifth of this population's primary healthcare use was directly attributable to EDS-related ill health. Respiratory infections were the most common cause of morbidity, and the immediate cause of all eight deaths, while concerns about nutrition and dehydration were surprisingly minor. Our participants had a high annual incidence of death (5%) and, with a standardized mortality ratio of 267, their observed mortality was more than twice that expected in the general population of adults with ID (not selected because of mealtime support for EDS problems). CONCLUSIONS All Annual Health Checks now offered to adults with ID should include questions about respiratory infections and EDS functioning, in order to focus attention on EDS problems in this population. This has the potential to reduce life-threatening illness.
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Affiliation(s)
- C M Perez
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S L Ball
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A P Wagner
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
| | - I C H Clare
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - A J Holland
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - M Redley
- Cambridge Intellectual and Development Disabilities Research Group (CIDDRG), Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough, Cambridge, UK
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MacArthur J, Brown M, McKechanie A, Mack S, Hayes M, Fletcher J. Making reasonable and achievable adjustments: the contributions of learning disability liaison nurses in 'Getting it right' for people with learning disabilities receiving general hospitals care. J Adv Nurs 2015; 71:1552-63. [PMID: 25682796 DOI: 10.1111/jan.12629] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/29/2022]
Abstract
AIMS To examine the role of learning disability liaison nurses in facilitating reasonable and achievable adjustments to support access to general hospital services for people with learning disabilities. DESIGN Mixed methods study involving four health boards in Scotland with established Learning Disability Liaison Nurses (LDLN) Services. Quantitative data of all liaison nursing referrals over 18 months and qualitative data collected from stakeholders with experience of using the liaison services within the previous 3-6 months. METHODS Six liaison nurses collected quantitative data of 323 referrals and activity between September 2008-March 2010. Interviews and focus groups were held with 85 participants included adults with learning disabilities (n = 5), carers (n = 16), primary care (n = 39), general hospital (n = 19) and liaison nurses (n = 6). RESULTS/FINDINGS Facilitating reasonable and achievable adjustments was an important element of the LDLNs' role and focussed on access to information; adjustments to care; appropriate environment of care; ensuring equitable care; identifying patient need; meeting patient needs; and specialist tools/resources. CONCLUSION Ensuring that reasonable adjustments are made in the general hospital setting promotes person-centred care and equal health outcomes for people with a learning disability. This view accords with 'Getting it right' charter produced by the UK Charity Mencap which argues that healthcare professionals need support, encouragement and guidance to make reasonable adjustments for this group. LDLNs have an important and increasing role to play in advising on and establishing adjustments that are both reasonable and achievable.
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Affiliation(s)
- Juliet MacArthur
- Western General Hospital, Edinburgh, UK.,Health Services Research Unit, Edinburgh, UK
| | - Michael Brown
- Edinburgh Napier University, UK.,NHS Lothian, Edinburgh, UK
| | - Andrew McKechanie
- NHS Lothian, Edinburgh, UK.,The Patrick Wild Centre & The Division of Psychiatry, The University of Edinburgh, Royal Edinburgh Hospital, UK
| | - Siobhan Mack
- School of Health Sciences, Queen Margaret University, Musselburgh, UK
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McGillivray JA, Kershaw M. Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability? J Intellect Disabil Res 2015; 59:105-115. [PMID: 24372867 DOI: 10.1111/jir.12110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND A growing literature suggests that people with mild intellectual disability (ID) who have depressed mood may benefit from cognitive-behavioural interventions. There has been some speculation regarding the relative merit of the components of this approach. The aim of this study was to compare (i) cognitive strategies; (ii) behavioural strategies; and (iii) combined cognitive-behavioural (CB) strategies on depressed mood among a sample of 70 individuals with mild ID. METHODS Staff from three participating agencies received training in how to screen individuals with mild ID for depressive symptoms and risk factors for depression. Depressive symptoms and negative automatic thoughts were assessed prior to and at the conclusion of the intervention, and at 6-month follow-up. The interventions were run in groups by the same therapist. RESULTS A post-intervention reduction in depression scores was evident in participants of all three interventions, with no significant difference between groups. A significant reduction in negative automatic thoughts post-intervention was evident in the CB combination group and was maintained at follow-up. Examination of clinical effectiveness suggests some advantage of the CB combination in terms of improvement and highlights the possible short term impact of behavioural strategies in comparison with the longer-term potential of cognitive strategies. CONCLUSIONS The findings support the use of group cognitive-behavioural interventions for addressing symptoms of depression among people with ID. Further research is necessary to determine the effectiveness of components.
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Affiliation(s)
- J A McGillivray
- School of Psychology, Deakin University, Burwood, Vic., Australia
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Hemsley B, Balandin S. A metasynthesis of patient-provider communication in hospital for patients with severe communication disabilities: informing new translational research. Augment Altern Commun 2014; 30:329-43. [PMID: 25229213 PMCID: PMC4266100 DOI: 10.3109/07434618.2014.955614] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 06/06/2014] [Indexed: 11/13/2022] Open
Abstract
Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.
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Affiliation(s)
- Bronwyn Hemsley
- School of Humanities and Social Science, Faculty of Education and Arts, The University of Newcastle, New South Wales, Australia
| | - Susan Balandin
- School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
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Abstract
Children with intellectual disabilities (IDs) and their parents continue to experience stigma within health-care systems. Whilst some research studies have examined the stigma associated with children who have IDs, there continues to be a gap in understanding how the experiences of these children, their parents and nurses have been constructed personally, socially and institutionally. Face-to-face semi-structured interviews were conducted with 17 mothers, 12 nurses and 8 children. Feminist post-structuralism and discourse analysis were used to examine the experiences of children, parents and nurses with the intent of understanding the dominant taken-for-granted everyday practices as well as hidden or marginalized practices. Four main themes emerged, which included the theme of Diagnoses, Labels and Stereotypes, which will be discussed in this article. Participants provided rich detail about their experiences in the hospital and how they addressed and often attempted to challenge the stigma associated with children with IDs.
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Affiliation(s)
- Megan Aston
- School of Nursing Dalhousie University, Canada
| | - Lynn Breau
- Glenrose Rehabilitation Hospital, Canada
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35
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Iacono T, Bigby C, Unsworth C, Douglas J, Fitzpatrick P. A systematic review of hospital experiences of people with intellectual disability. BMC Health Serv Res 2014. [PMID: 25344333 DOI: 10.1186/s12913‐014‐0505‐5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
BACKGROUND People with intellectual disability are at risk of poor hospital experiences and outcomes. The aims were to conduct a content and quality review of research into the acute hospital experiences of both people with intellectual disabilities and their carers, and to identify research gaps. METHOD A systematic search was conducted of primary research between 2009 and 2013 that addressed the experiences of the target group in general acute care hospitals. Quality appraisal tools yielded scores for quantitative and qualitative studies, and overarching themes across studies were sought. RESULTS Sixteen studies met inclusion criteria. Quality scores were 6/8 for a survey, and 2/11-9/11 (mean =5.25) for qualitative studies/components. Content analysis revealed seven over-arching themes covering individuals' fear of hospital encounters, carer responsibilities, and problems with delivery of care in hospitals including staff knowledge, skills and attitudes. CONCLUSIONS Our review of eligible papers revealed that despite 20 years of research and government initiatives, people with intellectual disability continue to have poor hospital experiences. The need for research to identify and investigate care at specific points of encounter across a hospital journey (such as admission, diagnostic testing, placement on a ward, and discharge) as well as to include people with a diversity of disabilities is discussed in terms of potential to influence policy and practice across health and disability sectors.
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Affiliation(s)
- Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Bendigo 3552, Victoria, Australia.
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36
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Iacono T, Bigby C, Unsworth C, Douglas J, Fitzpatrick P. A systematic review of hospital experiences of people with intellectual disability. BMC Health Serv Res 2014; 14:505. [PMID: 25344333 PMCID: PMC4210514 DOI: 10.1186/s12913-014-0505-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with intellectual disability are at risk of poor hospital experiences and outcomes. The aims were to conduct a content and quality review of research into the acute hospital experiences of both people with intellectual disabilities and their carers, and to identify research gaps. METHOD A systematic search was conducted of primary research between 2009 and 2013 that addressed the experiences of the target group in general acute care hospitals. Quality appraisal tools yielded scores for quantitative and qualitative studies, and overarching themes across studies were sought. RESULTS Sixteen studies met inclusion criteria. Quality scores were 6/8 for a survey, and 2/11-9/11 (mean =5.25) for qualitative studies/components. Content analysis revealed seven over-arching themes covering individuals' fear of hospital encounters, carer responsibilities, and problems with delivery of care in hospitals including staff knowledge, skills and attitudes. CONCLUSIONS Our review of eligible papers revealed that despite 20 years of research and government initiatives, people with intellectual disability continue to have poor hospital experiences. The need for research to identify and investigate care at specific points of encounter across a hospital journey (such as admission, diagnostic testing, placement on a ward, and discharge) as well as to include people with a diversity of disabilities is discussed in terms of potential to influence policy and practice across health and disability sectors.
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Affiliation(s)
- Teresa Iacono
- />La Trobe Rural Health School, La Trobe University, Bendigo, PO Box 199, Bendigo, Victoria 3552 Australia
| | - Christine Bigby
- />Department of Social Work and Social Policy, La Trobe University, Melbourne, Australia
| | - Carolyn Unsworth
- />Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- />Department of Human Communication Sciences, La Trobe University, Melbourne, Australia
| | - Petya Fitzpatrick
- />Department of Social Work and Social Policy, La Trobe University, Melbourne, Australia
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Hemm C, Dagnan D, Meyer TD. Identifying Training Needs for Mainstream Healthcare Professionals, to Prepare Them for Working with Individuals with Intellectual Disabilities: A Systematic Review. J Appl Res Intellect Disabil 2014; 28:98-110. [DOI: 10.1111/jar.12117] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Cahley Hemm
- Newcastle Behavioural Analysis and Intervention Team; Northumberland Tyne and Wear NHS Foundation Trust; Newcastle upon Tyne UK
- Doctorate in Clinical Psychology; Newcastle University; Newcastle upon Tyne UK
| | - Dave Dagnan
- Community Learning Disability Services; Cumbria Partnership NHS Foundation Trust; Cumbria UK
| | - Thomas D. Meyer
- Department of Psychiatry and Behavioral Sciences; University of Texas Health Science Center; Houston TX USA
- Doctorate in Clinical Psychology; Newcastle University; Newcastle upon Tyne UK
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38
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Aston M, Breau L, MacLeod E. Understanding the importance of relationships: Perspective of children with intellectual disabilities, their parents, and nurses in Canada. J Intellect Disabil 2014; 18:221-237. [PMID: 24951491 DOI: 10.1177/1744629514538877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Effective and therapeutic relationships between health care providers and clients are important elements for positive health outcomes. Children with intellectual disabilities (IDs) and their parents face unique challenges in establishing relationships with health care providers due to social and institutional stigma and stereotypes associated with children with IDs. In this article, we discuss the theme of building relationships in a hospital setting that emerged from a qualitative feminist poststructuralist study conducted in Canada with 8 children with IDs, 17 mothers, and 12 nurses who cared for them. Our research provides examples of how nurses and mothers worked in and through the system sometimes with frustration but also sometimes with positive excitement to develop supportive relationships. We can learn from these moments of tension and moments of success about how to work together to ensure positive relationships are provided to children with IDs, their parents, and health care professionals.
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Affiliation(s)
| | - Lynn Breau
- Glenrose Rehabilitation Hospital, Canada
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39
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Hemsley B, Lee S, Munro K, Seedat N, Bastock K, Davidson B. Supporting communication for children with cerebral palsy in hospital: views of community and hospital staff. Dev Neurorehabil 2014; 17:156-66. [PMID: 24102353 PMCID: PMC4046877 DOI: 10.3109/17518423.2012.741149] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to investigate the views of allied health and nursing staff on supporting the communication of children with cerebral palsy (CP) and complex communication needs (CCN) in hospital. METHOD We conducted 12 focus groups with 49 community- and hospital-based allied health professionals and hospital nurses. RESULTS Participants reported having active roles in supporting children's seating, mobility, equipment, mealtime management and psychosocial needs, but not in supporting the children's communication in hospital. Participants described several environmental barriers to supporting children's augmentative and alternative communication (AAC) in hospital, and suggested a range of strategies to ease communication difficulties at the bedside. CONCLUSION Results indicate a potential new role for community- and hospital-based health professionals in supporting nurses to implement AAC strategies at the bedside. Supporting nursing staff to remove environmental barriers and use communication technologies might create a more communicatively accessible hospital ward for children with CP and CCN.
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Affiliation(s)
- Bronwyn Hemsley
- Faculty of Education and the Arts, The University of Newcastle, Newcastle, Australia
| | - Sabrena Lee
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kathleen Munro
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nadeera Seedat
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kaely Bastock
- Speech Pathology, The Cerebral Palsy League, Queensland, Brisbane, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
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40
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Abstract
BACKGROUND This paper explores how group home staff in Victoria, Australia, responded to residents with an intellectual disability (ID) as they developed age-related health conditions. METHOD The analysis was based on a longitudinal study that followed 17 ageing group home residents over a 3-year period. Eighty-three interviews were conducted with 30 group home staff in 17 group homes. Dimensional analysis, a variant of grounded theory, guided data collection and analysis. RESULTS Findings revealed that the organisations all had systems in place to address health issues. However, the results also suggest an inability of staff to differentiate between significant health conditions and normal age-related changes, thus contributing to delays in care for serious medical conditions. CONCLUSIONS Lack of knowledge about normal ageing and an absence of organisational policies influence timeliness of diagnosis and treatment for people with ID. Group home staff could be more effective advocates for older residents, leading to improvements in health outcomes, if they had basic knowledge about normal ageing and symptoms of common age-related illnesses and if group home agencies provided clearer guidance to their staff. The study has implications for staff education and organisational policy development for group homes.
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Affiliation(s)
- Barbara Bowers
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin USA
| | - Ruth Webber
- Faculty of Education and Arts, Australian Catholic University, Melbourne, Australia
| | - Christine Bigby
- Department of Social Work and Social Policy, La Trobe University, Melbourne, Australia
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41
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Brown M, Karatzias T, O'Leary L. The health role of local area coordinators in Scotland: a mixed methods study. J Intellect Disabil 2013; 17:387-402. [PMID: 24166152 DOI: 10.1177/1744629513509795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The study set out to explore whether local area coordinators (LACs) and their managers view the health role of LACs as an essential component of their work and identify the health-related activities undertaken by LACs in Scotland. A mixed methods cross-sectional phenomenological study involving local authority service managers (n = 25) and LACs (n = 40) was adopted. Quantitative data from LACs were obtained using online and postal questionnaires. Qualitative data from local authority service managers and LACs were collected using one-to-one interviews and focus groups. Thematic analysis was undertaken of the qualitative data. The results indicate that there is a need to develop further the wider public health role of LACs to incorporate health-related activities focused on broader community-based outcomes such as empowerment and community integration. By adopting a public health role, LACs will be able to contribute to the reduction of health inequalities in people with learning disabilities.
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Affiliation(s)
- Michael Brown
- Edinburgh Napier University, UK, and NHS Lothian, UK
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Abstract
OBJECTIVE The aim of this study was to understand the communication needs and experiences of parents and children with cerebral palsy (CP) and complex communication needs (CCN) in hospital. METHODS Focus groups with 10 parents and interviews with seven children with CP and CCN were analysed for content themes. RESULTS Results demonstrated that children often want to communicate directly with hospital staff to: gain attention, answer yes/no, convey basic physical needs, give and receive information, control their environment and participate in preferred activities. Barriers to communication included lack of access to augmentative and alternative communication (AAC), staff preferring to communicate with parents and lack of time to communicate. CONCLUSIONS Results highlight strategies for successful communication, the role of the parents in supporting communication and provision of AAC systems for children in hospital. Policy and practice implications in the preparation of children with CP and CCN for communication in hospital are discussed.
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Affiliation(s)
- Bronwyn Hemsley
- Faculty of Education and the Arts, School of Humanities and Social Science, The University of Newcastle , Callaghan, Newcastle , Australia
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Tuffrey-Wijne I, Giatras N, Goulding L, Abraham E, Fenwick L, Edwards C, Hollins S. Identifying the factors affecting the implementation of strategies to promote a safer environment for patients with learning disabilities in NHS hospitals: a mixed-methods study. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01130] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere has been consistent evidence that people with learning disabilities experience health inequalities and poor NHS health-care provision, leading to avoidable harm and premature, avoidable death.ObjectivesTo describe the factors in NHS hospitals that promote or compromise a safe environment for patients with learning disabilities, in the light of national recommendations that hospitals should (1) identify patients with learning disabilities, (2) provide reasonably adjusted services, (3) involve carers as partners in care and (4) include patient and carer views in service development.DesignA 21-month mixed-method study carried out between 2011 and 2013, using questionnaire surveys, interviews, observation and monitoring of safety incidents.SettingSix NHS hospitals in the south of England.MethodsThe study employed mixed methodologies in three stages. Stage I involved mapping the systems and structural changes within each hospital site, with senior strategic managers asked to provide data on relevant policies. Stage II examined the effectiveness of implemented measures. Methods for this stage included an electronic questionnaire survey sent to all clinical staff (n = 990); face-to-face semi-structured interviews with clinical staff and strategic hospital managers (n = 68); semi-structured face-to-face interviews with adults with learning disabilities who had used the hospital in a 12-month period (n = 33); questionnaire survey (n = 88) and semi-structured interviews (n = 37) with carers of patients with learning disabilities who had been a patient during the 12-month period; and participant observation with patients (n = 8). Stage III assessed generalisability to other vulnerable patient groups and involved expert panel discussions with senior managers and senior clinicians at four sites (n = 42).ResultsExamples of good practice were not consistently replicated hospital-wide. The most common safety issues were delays and omissions of treatment and basic care. The main barriers to better and safer hospital care for people with learning disabilities were (1) the invisibility of patients with learning disabilities within hospitals, owing to a lack of effective flagging systems and a lack of staff knowledge and willingness to flag this group; (2) poor staff understanding of the specific vulnerabilities of people with learning disabilities, the reasonable adjustments to services that these patients may need and the Mental Capacity Act (Great Britain.Mental Capacity Act 2005. Chapter 9. London: The Stationery Office; 2005); (3) a lack of consistent and effective carer involvement and misunderstanding by staff of the carer role; and (4) a lack of clear lines of responsibility and accountability for the care of each patient with learning disabilities. The main enablers were the learning disability liaison nurse (LDLN), provided that this role was properly supported by senior management and carried sufficient authority to change practice; and ward managers who facilitated a positive ward culture and ensured consistent implementation of reasonable adjustments.ConclusionsThe vulnerabilities of people with learning disabilities can, and do, lead to compromised patient safety in NHS hospitals. Further research is needed as follows: (1) identifying the most frequently needed reasonable adjustments within the hospital care pathways of people with learning disabilities and their cost implications; (2) identifying the most effective structures for ensuring clear lines of responsibility and accountability for the care of patients with learning disabilities, including support needed by ward managers in order to carry day-to-day accountability; (3) investigating practical and effective ways of flagging patients with learning disabilities across NHS services and within NHS hospitals; (4) investigating, implementing and evaluating protocols for shared care; (5) evaluating LDLN posts nationwide; and (6) extending research recommendations (1) and (3) to patients with dementia and those with mental health problems.Study registrationComprehensive Clinical Research Network Portfolio, 10998; Integrated Research Application System Coordinated System for gaining NHS Permission, 74907.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- I Tuffrey-Wijne
- Faculty of Health, Social Care and Education, St George’s, University of London and Kingston University, London, UK
| | - N Giatras
- Division of Population Health Sciences and Education, St George’s, University of London, London, UK
| | - L Goulding
- Division of Population Health Sciences and Education, St George’s, University of London, London, UK
| | - E Abraham
- Division of Population Health Sciences and Education, St George’s, University of London, London, UK
- Florence Nightingale School of Nursing and Midwifery, King’s College London, London, UK
| | - L Fenwick
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - C Edwards
- Institute of Leadership and Management in Health, Kingston University, London, UK
| | - S Hollins
- Division of Population Health Sciences and Education, St George’s, University of London, London, UK
- House of Lords, London, UK
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44
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Ali A, Scior K, Ratti V, Strydom A, King M, Hassiotis A. Discrimination and other barriers to accessing health care: perspectives of patients with mild and moderate intellectual disability and their carers. PLoS One 2013; 8:e70855. [PMID: 23951026 PMCID: PMC3741324 DOI: 10.1371/journal.pone.0070855] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022] Open
Abstract
Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability.
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Affiliation(s)
- Afia Ali
- Mental Health Sciences Unit, University College London, London, UK.
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45
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Bradbury-Jones C, Rattray J, Jones M, MacGillivray S. Promoting the health, safety and welfare of adults with learning disabilities in acute care settings: a structured literature review. J Clin Nurs 2013; 22:1497-509. [DOI: 10.1111/jocn.12109] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Janice Rattray
- School of Nursing & Midwifery; University of Dundee; Dundee UK
| | - Martyn Jones
- School of Nursing & Midwifery; University of Dundee; Dundee UK
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46
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McGillivray JA, Kershaw MM. The impact of staff initiated referral and intervention protocols on symptoms of depression in people with mild intellectual disability. Res Dev Disabil 2013; 34:730-738. [PMID: 23220049 DOI: 10.1016/j.ridd.2012.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/06/2012] [Accepted: 11/06/2012] [Indexed: 06/01/2023]
Abstract
It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body of literature indicates that people with ID and depression may benefit from CB strategies. The aim of the current study was to compare (i) CB group intervention strategies with referral to a GP; (ii) CB group intervention strategies only; and (iii) referral to a GP only on symptoms of depression among people with mild ID. Staff from six participating agencies received training in (a) how to identify and screen individuals with mild ID for depressive symptoms and risk factors for depression, and (b) supportive referral of identified individuals to GPs for mental health services. In addition, staff from four of the agencies undertook (c) training on how to deliver group CB intervention strategies. Eighty-two participants were allocated to one of the three intervention groups. Depressive symptoms and negative automatic thoughts were assessed prior to the intervention, at the conclusion of the intervention, and at eight months follow-up. Compared to GP referral alone, those participants who received CB strategies both with and without GP referral displayed significant reductions in depressive symptoms. The use of CB strategies only also resulted in a significant reduction in frequency of negative automatic thoughts. The findings of this study support routine screening of individuals with mild ID for depression and the delivery of group CB intervention programmes by trained staff within community-based disability agencies.
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Affiliation(s)
- Jane A McGillivray
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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47
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Brown M, MacArthur J, McKechanie A, Mack S, Hayes M, Fletcher J. Learning Disability Liaison Nursing Services in south-east Scotland: a mixed-methods impact and outcome study. J Intellect Disabil Res 2012; 56:1161-1174. [PMID: 22142456 DOI: 10.1111/j.1365-2788.2011.01511.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND There have been significant concerns about the care and treatment of people with intellectual disabilities (ID) when attending general hospitals, which have led to inquiries that highlight service and systems failures. One response has been the development of Learning Disability Liaison Nursing (LDLN) Services across the UK that aim to ensure that additional, specialist support is available for patients, their carers and general healthcare professionals. METHODS A mixed-methods study to investigate the impact of LDLN Services across four Scottish NHS boards was undertaken. In total, 323 referrals made over 18 months were analysed along with qualitative data drawn from interviews and focus groups with a sample of 85 participants including patients with ID (n = 5), carers (n = 16), primary care healthcare professionals (n = 39) and general hospital professionals (n = 19) and learning disability liaison nurses (n = 6). RESULTS The referral patterns to the four liaison nursing services closely matched the known health needs of adults with ID, with common admissions being due to neurological, respiratory and gastrointestinal issues. The LDLN role was seen to be complex and impacted on three key areas: (i) clinical patient care; (ii) education and practice development; and (iii) strategic organisational developments. Specific patient outcomes were linked to issues relating to capacity and consent to treatment, fostering person-centred adjustments to care, augmenting communication and the liaison nurses acting as positive role models and ambassadors for people with ID. CONCLUSIONS The LDLN Services were valued by stakeholders by achieving person-centred outcomes. With their expert knowledge and skills, the liaison nurses had an important role in developing effective systems and processes within general hospital settings. The outcomes highlight the importance of supporting and promoting LDLN Services and the challenges in delivering the multifaceted elements of the role. There is a need to take account of the complex and multidimensional nature of the LDLN role and the possible tensions between achieving clinical outcomes, education and practice developments and organisational strategic initiatives.
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Affiliation(s)
- M Brown
- Faculty of Health and Life Sciences, Edinburgh Napier University, UK.
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Tuffrey-Wijne I, Giatras N, Butler G, Cresswell A. People with intellectual disabilities who are affected by a relative or friend with cancer: A qualitative study exploring experiences and support needs. Eur J Oncol Nurs 2012; 16:512-9. [DOI: 10.1016/j.ejon.2012.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/02/2011] [Accepted: 01/15/2012] [Indexed: 11/27/2022]
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Beadle M, Needham Y, Dearing M. Collaboration with service users to develop reusable learning objects: The ROOT to success. Nurse Educ Pract 2012; 12:352-5. [DOI: 10.1016/j.nepr.2012.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 04/05/2012] [Accepted: 04/21/2012] [Indexed: 11/18/2022]
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