Parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability: A qualitative descriptive study

Aim: To describe parents' perspectives on reasonable adjustments in acute healthcare  for people with intellectual disability (ID). Background: People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments  are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited. Design: A qualitative descriptive study. Methods: Qualitative semi-structured interviews were conducted with six parents  of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio-recordings were  transcribed and thematically analysed. Results: Parents described limited or no experiences of reasonable adjustments when  accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting  the future. The findings highlight a lack of implementation of reasonable adjustments  in acute healthcare which negatively impacts the experience of all stakeholders. Conclusion: There is a pressing need for reasonable adjustments to be implemented  at a strategic level across acute healthcare services, so that people with ID and their  families can access person-centred acute healthcare when needed. Impact: The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights  of people with ID. Reporting Method: This study adhered to the Equator research reporting checklist:  Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups. Patient or Public Contribution: A parent of a child with an ID was part of the research  team informing the design, data collection, data analysis and write-up of this article </p

Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

Objectives People with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services. Design Scoping review. Setting Acute care settings. Methods Five databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes. Results Of the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice. Conclusions The scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings

Mental health nurses experience of the introduction and practice of the safewards model: a qualitative descriptive study

Background: A lack of safety experienced by patients and staff in acute psychiatric units is a major concern and containment methods used to manage conflict have the potential to cause harm and upset to both staff and patients. To ensure safety for all, it is highly desirable to reduce levels of conflict and containment and the Safewards model is an evidence-based model aimed at reducing conflict and containment rates by improving nurse-patient relationships and safety. Methods: The aim of this study was to explore mental health nurses’ experience of the introduction and practice of three Safewards interventions; reassurance, soft words and discharge messages. A qualitative descriptive research design utilising a purposive sample (n = 21) of registered psychiatric nurses (n = 16) and managers (n = 5) in an acute psychiatric unit in Ireland. Following a 12-week implementation of Safewards, three focus groups were conducted, two with nursing staff and one with nurse managers. Data were analysed using Braun and Clarke thematic analysis framework which supported the identification of four themes: introducing Safewards, challenges of Safewards, impact of Safewards and working towards success. Results: The findings indicate that the process of implementation was inadequate in the training and education of staff, and that poor support from management led to poor staff adherence and acceptance of the Safewards interventions. The reported impact of Safewards on nursing practice and patient experience were mixed. Overall, engagement and implementation under the right conditions are essential for success and while some participants perceived that the interventions already existed in practice, participants agreed Safewards enhanced their communication skills and relationships with patients. Conclusion: The implementation of Safewards requires effective leadership and support from management, mandatory training for all staff, and the involvement of staff and patients during implementation. Future research should focus on the training and education required for successful implementation of Safewards and explore the impact of Safewards on nursing practice and patient experience

Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research

Objectives To capture the extent and nature of intellectual disability nursing publications in Ireland. Design Scoping review using Arksey and O’Malley approach. Data sources Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. Eligibility criteria Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. Data extraction and synthesis Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. Results The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. Conclusions This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health managemen

The role and key activities of clinical nurse specialists and advanced nurse practitioners in supporting healthcare provision for people with intellectual disability: An integrative review

Background: People with intellectual disability have poorer health than the general population and experience difficulties accessing healthcare. In addition, attitude and stigmatisation by healthcare professionals can lead to poorer health outcomes for people with intellectual disability. This is often driven by the fact that many healthcare professionals lack the knowledge, skill or experience in supporting people with intellectual disability. As lead roles within the nursing profession Clinical Nurse Specialists and Advanced Nurse Practitioners have a key role in supporting person-centred care and health outcomes. However, little is known about the effects of these roles on care provision for people with intellectual disability. Objective: To identify the effect of Clinical Nurse Specialists and Advanced Nurse Practitioners on care provision for people with intellectual disability. Design: A systematic search of six academic databases (CINAHL, EMBASE, PsycINFO, Scopus, Medline and Academic Search Complete) relevant to nursing and health care was performed. Setting(s): Nursing care environment. Participants: Clinical Nurse Specialists and Advanced Nurse Practitioners providing care to people with intellectual disability. Methods: A pre-defined systematic search of six academic databases was conducted and two reviewers screened each study against the inclusion criteria. Additional hand searching of the reference lists (backward chaining) and citations (forward chaining) of papers that met the inclusion criteria was conducted. The methodological details of each paper were extracted and assessed for quality and rigour utilizing the Mixed Methods Appraisal Tool and the AACODS checklist for appraising grey literature. Thematic analysis was undertaken (Braun and Clarke, 2006) and the review is reported in line with PRISMA guidelines (Page et al. 2021). Results: All papers included in this review were from Ireland and spanned an eighteen-year period. Seven papers met the inclusion criteria: quantitative (n = 2), qualitative (n = 2), mixed methods (n = 2) and grey literature (n = 1). Thematic analysis enabled the development of three themes; maintaining core nursing skills; the maintenance of professional competence and providing a quality service. Conclusions: It is evident from the findings of this review that intellectual disability nursing in Ireland is actively engaged in research and professional development. Intellectual disability nursing in Ireland positively contributes to the individual, family and community and the international body of evidence that supports individualised care provision for persons with intellectual disabilit

The value and contribution of intellectual disability nurses/ nurses caring for people with intellectual disability in intellectual disability settings: A scoping review

Background: People with intellectual disability experience poorer health and health-care access issues. As a leading role in healthcare provision for people with intellectual disability nurses are key to supporting person-centred care and health outcomes. However, little is known about specialist intellectual disability nursing and their contribution to care provision for people with intellectual disability. Methods: A systematic scoping review. Searches of seven academic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO, Embase, Scopus and Web of Science were conducted to identify relevant literature. Literature addressing intellectual disability nursing or nursing care for people with intellectual disability in intellectual disability centres/ units/care homes were reviewed and reported as per PRISMA-ScR checklist and PRISMA flow diagram

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

Navigating learning and teaching in expanding culturally diverse higher education settings

Developing a deeper understanding of factors that influence learning  and teaching in widening culturally diverse learning environments is  necessary in proactively planning supports and pedagogical approaches that encourage integration, intercultural understanding  and respect for cultural difference. This qualitative descriptive study  reports on the experiences and perceptions of teaching faculty and  students (domestic and international) of learning and teaching in  postgraduate culturally diverse environments. Three themes were  generated from the data: ‘early apprehension’, ‘cautious engagement’  and ‘shared acceptance’, highlighting the multifaceted responses to  cultural diversity in the learning environment. These findings illuminate how learning and teaching in widening culturally diverse education settings require careful, sensitive and proactive planning and  supports. The individuality of learning experiences, self-preservation  of identities, narrow perceptions of cultural difference and unconscious ‘othering’, influenced learning behaviours, integration and  cohesive learning. The findings also highlight the necessity of adopting culturally responsive pedagogies. </p

Final year undergraduate nursing and midwifery students’ perspectives on simulation-based education: a cross-sectional study

Background: Simulation-based education is a teaching and learning approach that can enhance learning experiences for students on healthcare programmes. Within undergraduate nursing and midwifery education, simulation can support students in developing graduate attributes necessary to become practice-ready professionals. This paper reports on the evaluation of a simulation-based education initiative, which was introduced to support fnal year undergraduate nursing and midwifery students in preparation for their upcoming clinical internship in practice. Methods: This study aimed to evaluate a simulation-based education initiative from the perspectives of fnal year undergraduate nursing and midwifery students (N= 95). An online survey, using the validated Simulation Efectiveness Tool – Modifed (SET-M), was distributed to fnal year nursing and midwifery students at one university in Ireland. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Results: The results of the study highlight fnal year nursing and midwifery students’ perceptions, experiences, and satisfaction with learning in a simulated environment. Students reported their simulation-based learning experiences as worthwhile, motivating, and as important opportunities to build on previous learning, increase confdence and gain experience in preparation for real-life practice. Students reported feeling more confdent in their assessment skills, in providing care and interventions in responding to changes in a person’s health status. All students reported that the simulation-based learning experiences enabled them to think more critically about the clinical case scenarios and critically question their actions and decision-making processes. Pre-briefng and debriefng sessions were highlighted as important aspects of the simulation which helped to increase student confdence and cultivate meaningful learning. Conclusion: Simulation-based education is a valuable teaching and learning modality, particularly for fnal year students who are transitioning to real-life clinical practice. Student-centred simulation-based learning experiences can cultivate professional development and support learners in their transition from university student to healthcare professional.</p