Identifying the prevalence of aggressive behaviour reported by registered intellectual disability nurses in residential intellectual disability services: an Irish perspective

Purpose – Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach – This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs’ within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. In total, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings – The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value – The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland

The effect of stress on health and its implications for nursing

Stress is an important issue within nursing and it is difficult to find agreement among those who are expert in the area regarding a concise definition of stress. Nevertheless stress is seen as a negative feeling affecting people’s health either physically and/or psychologically. However, stress is a normal part of life and considered necessary to increase functional capacity, whereas stress over a prolonged period or when extreme can cause distress which may have debilitating effects that reduce work output, increase absenteeism and reduce one’s ability to cope with situations. The most important resource in any organisation is the employee; therefore maintaining and supporting their health is vital to ensure their ability to work, maintain standards and continuously improve standards of care. Leadership styles within organisations must facilitate staff to be involved in decision making; thereby staff feel more valued and work in an autonomous way. This article identifies and discusses the effect of stress on health and its relationship to nursin

Surveying community nursing support for persons with an intellectual disability and palliative care needs

Palliative care services have developed over the years to support all persons with life-limiting conditions. Moreover, services for people with an intellectual disability have moved from the traditional institutional setting to supporting people with an intellectual disability to live in their own community and family home. The expansion of palliative care services and integration of people with intellectual disability into their communities has resulted in an increased demand and greater diversity in the population groups accessing palliative care services. This study aims to describe the provision of community nursing support for persons with an intellectual disability and palliative/end-of-life care needs from the perspective of community nurses. A quantitative descriptive cross-sectional survey was employed. On receipt of ethical approval, data were collected through self-reporting questionnaires and descriptive analysis was conducted to describe frequencies and to identify patterns of the respondents using spss version 18. Only 85 people with an intellectual disability were referred to palliative/end-of-life care services over a 3-year period. Those delivering care expressed challenges including, understanding communication styles, late referrals, lack of time, knowledge and skills. Highlighted within the study were the benefits of liaison between family and professional and nonprofessional carers. Findings provide insight into the importance of teamwork, advance planning, knowing the person and best practice in providing palliative/end-of-life care for people with intellectual disability through collaboration

Primary care for persons with intellectual disabilities: issues for practice

Primary care for persons with intellectual disabilities: issues for practic

Nursing and midwifery quality care-metrics: intellectual disability services research report to OMNSD

This report presents the findings of a Nursing and Midwifery Quality Care Metrics project for Intellectual Disability (ID) Services in Ireland. The aim of the project was to identify a final suite of nursing quality care process metrics and associated indicators. To achieve this purpose, seven work streams (acute, mental health, public health nursing, children, midwifery, older person, and intellectual disability services) were established and led by the Nursing and Midwifery Planning and Development Units (NMPDU) project officers (Appendix 1, 2, 3). Academic support was provided from three universities in Ireland (National University of Ireland Galway, University College Dublin and University of Limerick). It was agreed that a Quality Care Process Metric is a quantifiable measure that captures quality in terms of how (or to what extent) nursing care is being done in relation to an agreed standard. A Quality Care Process Indicator is a quantifiable measure that captures what nurses are doing to provide that care in relation to a specific tool or method

Older persons services nursing quality care metrics final report to ONMSD.

This report presents the findings of a Nursing and Midwifery Quality Care-Metrics project for Older Persons Services (OPS) in Ireland. The aim of the project was to identify a final suite of nursing quality care process metrics and associated indicators. To achieve this purpose, seven work-streams (acute, mental health, public health nursing, children, older persons services, intellectual disability and midwifery) were established and led by Nursing and Midwifery Planning and Development (Appendix 1, 2, 3). Academic support was provided from three universities in Ireland. It was agreed that a Quality Care Process Metric is a quantifiable measure that captures quality in terms of how (or to what extent) nursing care is being done in relation to an agreed standard. A Quality Care Process Indicator is a quantifiable measure that captures what nurses are doing to provide that care in relation to a specific tool or method

The provision of community nursing support for persons with an intellectual disability and palliative care needs: a descriptive survey

Forward On behalf of the research team, I am pleased to introduce this report which presents the findings of a regional evaluation entitled: The provision of community nursing support for persons with an intellectual disability and palliative care needs. The broadening of the World Health Organisation (2002) position on palliative care, developed to include the provision of palliative care for all persons with a life threatening illness regardless of diagnosis, has resulted in increased numbers of patients and families accessing palliative/end of life care services. It is known that people with an intellectual disability have a disproportionate health burden when compared with the general population and accessing health service can be difficult. In today’s society people with an intellectual disability have largely moved away from a long term residential model of care, and are accessing wider health services. They are entitled to receive equitable care and support from a workforce that recognises all as equal citizens. However, internationally it is acknowledged that there is an inequity of experience for people with an intellectual disability within mainstream health services, and this is not satisfactory. This report provides a snapshot of community nursing practice in an Irish setting of palliative/end of life care for people with an intellectual disability in a health region. The report is a welcome addition to the existing international literature which includes a small number of Irish studies. I would like to take this opportunity to sincerely thank the respondents for giving of their time to complete the questionnaire and the Irish Hospice Foundation and the University of Limerick for their continued interest and support

Presenting problem/conditions that result in people with an intellectual disability being admitted to acute hospitals in Ireland: An analysis of NQAIS data from 2016-2020

The wide range of health conditions and complex needs experienced by people with intellectual disability (ID) means that they are more likely to utilise acute care services in comparison with the general population. ID accounts for 1% to 3% of the world’s population and has an onset before the age of 18 years (22 years from an American perspective according to the American Association on Intellectual and Developmental Disabilities (AAIDD) 2021). ID is characterised by lifelong limitations in cognitive and adaptive functioning and experiences of social and environmental restrictions which create barriers to effective participation in daily life. With increased childhood survival rates and improved diagnostic, screening and identification, this percentage has the potential to increase in the coming decades

A guidance framework to aid in the selection of nursing and midwifery care process metrics and indicators

Aim: To describe the development of a guidance framework to assist nurses and midwives in selecting nursing and midwifery care process metrics and indicators for use in practice. Background: Process metrics are measures of care provision activities by nurses and midwives. Methods: Phase 1 was a rapid review assessment of the literature conducted to identify an initial framework. Six electronic databases were searched with Google Scholar and reference tracking performed. Phase 2 was expert review of the developing framework by nursing and midwifery experts in practice, academia and an international expert in quality care metrics. Results: The literature assessment yielded 28 papers with 59 metric attributes identified. From this, a six‐domain framework was developed. Following expert review, the framework was reduced to four domains: “Process Focused,” “Important,” “Operational” and “Feasible.” Conclusions: This is the first framework specifically to guide nurses and midwives in selecting nursing and midwifery process metrics and indicators

A rapid realist review of quality care process metrics implementation in nursing and midwifery practice

Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation