The transition from child to adult health services for young adults with intellectual disabilities: An evaluation of a pilot of an online learning resource for Registered Nurses

AimThis study formed the third phase of a national study on the experience of transition from child to adult health services for young adults with intellectual disabilities. The aim of this phase was to evaluate the accessibility and acceptability of an on-line learning resource for Registered Nurses.BackgroundThe population of young adults with intellectual disabilities and complex needs is increasing. Consequently, more will move from child to adult healthcare, with evidence highlighting that for some their experiences of the transition process is poor. The main study provided contemporary evidence to raise the awareness of Registered Nurses of the needs of young adults with intellectual disabilities and their role in enabling an effective transition from child to adult services.MethodsThe online learning resource was developed and piloted with Registered Nurses involved in the transition from child to adult health services for young adults with intellectual disabilities and complex needs. Data collection involved an online survey and semi-structured interviews.ResultsTwelve Registered Nurses from 2 Scottish NHS Boards completed the questionnaire and 3 participated in a follow-up interview. The findings suggest that the mode of on-line delivery and most of the content of the learning resource were both acceptable and accessible to Registered Nurses across a range of areas of nursing practice. The learning resource was further adapted in response to the participant data.ConclusionThis on-line learning resources offers the potential for Registered Nurses, and potentially other healthcare professionals to undertake evidence-based, structured further education regarding the effective transitions for young adults with intellectual disabilities and their families.Tweetable abstractRegistered Nurses have key contributions to enable the transition from child to adult healthcare for young adults with intellectual disabilities.     

The needs of older people with learning disabilities

There has been a growing realization that the needs of older people with learning disabilities are not being met. There has been little attention paid in nursing literature to the needs of this client group. This article will explore the issues about older people with learning disabilities and highlight some of the important areas that learning disability nurses may need to address. It is evident that there needs to be more collaboration between a range of different services and professionals. Areas of good practice can be used in developing innovative and flexible services, which are client led. Learning disability nurses may need to update their skills and knowledge and develop a 'critical practice' approach to meet the many challenges that older people with learning disabilities may pose.     

A new research agenda: improving health care in general hospitals

Aim and objectives. To set out the research required to improve the health of people with learning disabilities in general hospital settings. The objectives are: (i) to share service developments in a mapping exercise to provide a picture of current work in this area, and (ii) to identify practice issues and experiences that can contribute to a broader research agenda. Background. It is recognized that people with learning disabilities are high users of all healthcare systems and have different pattern of health needs that often go unidentified, with some requiring general hospital care. The research evidence base in this area of practice needs to be developed to promote and improve health care. Method. A facilitated focus group design was employed at a conference event to identify areas for research in the future and determined that action is required on four broad research fronts. Results. Research is required to establish core principles of care, service developments, practical care measures and influencing change in practice. Conclusion. Research collaborations need to be established to support activity in this area and requires action in the future. Relevance to clinical practice. The evidence base and understanding of the high and differing pattern of health needs of people with learning disabilities continues to evolve and develop, with considerable scope to identify new areas for research. A conference approach was used to identify research questions to improve the care of this group in general hospital settings and offers a model that may be helpful in defining new areas of enquiry in the future.     

Caring for older adults with learning disabilities

Older patients with learning disabilities have greater physical and mental healthcare needs than the general population. However, because of a lack of knowledge about learning disabilities and low confidence in working with this patient group, their healthcare needs are often misinterpreted or neglected. By learning more about this group and developing skills that can aid the nurse-patient relationship, nurses will become more confident in their working practice and older patients with learning disabilities can receive the same quality health service as other patients.     

People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems

This study describes the evaluation of an assessment and treatment unit for people with learning disabilities. Results showed the main reasons for admission for the 48 people admitted to the unit were because of challenging behaviours and mental health problems. Valid and reliable scales were used to measure the behaviours and mental health problems of those admitted across three-time periods: pre-admission, during admission and post-admission. The analysis found significant reductions in challenging behaviours and mental health problems following admission to the unit. The unit was staffed by a multidisciplinary team with nurses making up the largest group of staff. A number of issues of concern are discussed including access to mental health services for people with learning disabilities, the need for robust community services and areas that require further research. In conclusion, the study found evidence supporting the value of the unit and how it may lessen distress in learning disabled people who are behaviourally disturbed. It is suggested that nurses played a key role in the unit but they need to make the support and caring they provide more visible. Nurses need to harness and make explicit the caring they provide for people with learning disabilities.     

The Prevalence,Incidence, and Factors Predictive of Mental Ill‐Health in Adults with Profound Intellectual Disabilities

Background There are no previous studies of the prevalence and incidence of mental ill‐health in adults with profound intellectual disabilities. Method In this population‐based prospective cohort study, adults with profound intellectual disabilities underwent psychiatric assessment (n = 184), with further assessment after 2 years (n = 131). Results Point prevalence of mental ill‐health was 52.2% by clinical, 45.1% by Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC‐LD), 10.9% by the ICD‐10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research (1993) (DCR‐ICD‐10) and 11.4% by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2004) (DSM‐IV‐TR) criteria. The highest 2‐year incidence rates were for affective disorders (6.1%) and problem behaviours (6.1%). Type of accommodation/support, and the number of preceding life events were predictive of incidents of mental ill‐health, but age, gender, living in areas of greatest deprivation, and having special communication needs were not. Conclusions Mental ill‐health is more commonly experienced by adults with profound intellectual disabilities than the general population, or other adults with intellectual disabilities, warranting proactive supports/interventions. Predictive factors differ, compared with the general population.     

Online professional development for digitally differentiated nurses: An action research perspective

Professional development opportunities for nurses are increasingly being offered in the online environment and therefore it is imperative that learning designers, nurse educators and healthcare organisations consider how best to support staff to enable Registered Nurses to capitalise on the resources available. Research participants explored educational strategies to support digitally differentiated nurses' engagement with professional development activities in an online environment through a participatory action research project that collected data over a 16 month period through six focus groups before being analysed thematically. The reality of work-based, e-learning while managing clinical workloads can be problematic however specific measures, such as having a quiet space and computer away from the clinical floor, access to professional development resources from anywhere and at any time, can be effective. A ‘one-size-fits-all’ approach to resources offered will not meet the needs of diverse staffing groups whereas heutagogical learning offers tangible benefits to Registered Nurses seeking professional development opportunities in this context. Apparent proficiency with technological skills may not reflect a Registered Nurse's actual ability in this environment and face-to-face support offered regularly, rather than remedially, can be beneficial for some staff. Implementing specific strategies can result in successful transition to the online environment.     

The perceptions of students and teachers regarding the introductory module of an enrolled nurse conversion course

This study sets out to explore the perceptions of students' and their teachers' regarding the Introductory Module of a course to convert Enrolled Nurses to Registered General Nurses. The course has been developed as a joint venture with two local Schools of Nursing as an experiment in joint course management. An illuminative evaluation approach has been adopted utilising the techniques of observation, questionnaires and interviews, in order to provide information by a variety of means upon which the course management team can base their future decisions regarding the course. The findings suggest that the introductory module was perceived by the students and teachers as a valuable learning experience. Issues specific to the course which were highlighted included the need for the involvement of the course teachers from each School of Nursing in the teaching programme, the introduction of negotiated student learning, a joint approach to the assessment of theory and practice and a modification of the maternity and community care experience. General issues related to the students as mature learners included the need for pre-course preparation for the students, the assessment of individual learning needs, the inclusion in the content of essay writing skills and stress management and the need for a comprehensive staff development programme for the teaching staff. The study highlighted the need for evaluation of nurse education programmes and teaching methods in order to provide professional accountability and to ensure nurse education practice is research-based.     

Pediatric rehabilitation nursing: Education and certification

Pediatric rehabilitation nurses specialize in providing care and services to children and adolescents with disabilities. Although few formal education experiences exist, there are a myriad of opportunities to gain the knowledge, skills, and expertise to provide the care that yields the most benefit to this population. Certification recognizes the nurse's proficiency and excellence in a specialty practice area. Examples of certification options for pediatric rehabilitation nurses include Certified Rehabilitation Registered Nurse (CRRN), Registered Nurse Certification in Developmental Disabilities (CDDN), Certified Pediatric Nurse (CPN), Clinical Nurse Specialist (CNS), and Certified Pediatric Nurse Practitioner (CPNP).     

The specialist learning disability nurse in Wales

Fisher M. International Journal of Nursing Practice 1997; 3: 188–190
The specialist learning disability nurse in Wales
This paper reflects on the development of services for people with learning disabilities within the United Kingdom and focuses on the role of the specialist nurse. The nurse's contribution to the care of this client group has been the subject of debate and controversy for a number of years. Developments within the learning disability field in Wales in particular are explored, with the All Wales Strategy for People with Learning Disabilities providing the background and context for these developments. An example of how specialist nurses from around Wales came together in order to share good and best practice is discussed. The conclusion is that the specialist learning disability nurse has a great deal to offer, but must be prepared to work together with other professionals as well as service users and their families.     

Overview of Health Issues of Older Women with Intellectual Disabilities

Health researchers, educators and providers have begun to address the health needs of women and girls with disabilities in the U.S. Older women with intellectual disabilities, however, remain underrepre-sented in the national health research agenda. As this population becomes more visible and empowered through policies that support greater community integration and longevity, they and their families, professionals and advocates need more accurate information about their health concerns and options. A critical problem is that professionals receive little training regarding the health concerns and experiences of women with intellectual disabilities who are growing older. This paper provides an overview of primary health issues related to aging for women with intellectual disabilities in the following areas: (1) general health, (2) reproductive health, (3) mental health, and (4) access to health services. The paper concludes with a discussion of implications for practice and research, and recommendations for future research and health service provision for women with intellectual disabilities.     

Development and preliminary validation of a tool to measure nurses' support for facilitating the learning of others

BackgroundNurses guide and support learning of students and new graduates in the workplace. A plethora of literature exists about learners needs in the workplace however nursing leadership teams also need to support experienced nurses who facilitate others’ learning.AimThis study sought to develop a tool for Registered Nurses’ to report on the support they receive when they facilitate the learning of others.Scale developmentAn extensive literature review identified 28 papers about support RNs need to facilitate learning. Five re-occuring themes pertaining to workload, communication, acknowledgement, teamwork and preparation for role emerged from analysis of these papers. These were verified independently through focus groups. A 30-item instrument was generated based on the themes; further RN focus groups were conducted to ensure clarity of items.Testing of instrumentData were collected from RNs working in medical and surgical areas across three acute care hospitals (ranging from 300 to 750 beds). A total of 372 registered nurses responded. Principle component analysis identified 5 distinct sub scales represented by 17 items with good reliability: workload 0.953; communication 0.847; acknowledgement 0.858; teamwork 0.852; preparation 0.942.ConclusionThis newly developed tool measures Registered Nurses perceptions of support they receive to fulfil their role in supporting the learning of others. The data generated from use of this tool can inform nursing leadership about the effectiveness of existing infrastructure and resources to support RNs.     

People with learning disabilities who also have mental health problems: practice issues and directions for learning disability nursing

The plight of people with learning disabilities who have mental health problems has become an issue of contemporary importance in the provision of health services to this section of the population. This paper will argue that learning disability nursing has a central role to play in the promotion of mental health for this client group ( Department of Health 1995a ). However, learning disability nursing presently operates without a clear model of mental health. Therefore, before this potential can be realized there is a need to establish the common ground between the discourses of learning disability nursing and those of psychiatric nursing which might be related to this client group. This paper begins by identifying the background issues relating to the problems of meeting the mental health needs of people with learning disabilities. It then proposes that an applied behavioural approach has the potential to provide a coherent theory that can link the discourses of normalization, developmental psychiatry and mental health nursing, whilst also establishing the applied behavioural approach as a powerful technology upon which meaningful interventions can be designed.     

Designing and implementing a 'dual diagnosis' module: a review of the literature and some preliminary findings

People with a learning disability experience the full range of mental health problems, with prevalence greater than in the general population. The literature suggests that the move to community care has highlighted their special needs, as they face a complexity of life experiences and risks. Nurses play a key role, and must be equipped with appropriate knowledge and expertise to respond to the mental health problems of people with a learning disability ('dual diagnosis'). Major national initiatives support research and propose access to appropriate education for care professionals. In order to respond to locally identified educational needs a 'dual diagnosis' module was developed for nurses working with people with a learning disability who experienced mental health difficulties. The aims were to increase knowledge, to consider implications for learning disability nursing, to increase awareness of research and policy issues, and ultimately to enhance practice. Preliminary findings suggest that participants have moved from an entry position of professional bias and lack of knowledge and skill, to a changed perspective and enhanced practice relating to the mental health needs of clients with a learning disability. These changes are, however, speculative and may be attributable to variables other than module completion. Implications for further research and development are suggested.     

Active learning and leadership in an undergraduate curriculum: How effective is it for student learning and transition to practice?

Nurses are being increasingly asked to develop leadership skills in their practice and to be actively involved in continuous change processes in the workplace. Nursing students need to be developing leadership skills prior to entering the workplace to ensure they are able to meet the challenges associated with organisations and the cultures present in nursing, along with having highly tuned communication skills and leadership attributes that contribute to best patient care and outcomes. This paper looks at how the use of Active Learning in an undergraduate setting enabled the development and implementation of a leadership subject for nursing students preparing for professional practice. Through the use of a specific model of Active Learning, incorporating multiple intelligences into education allows students to bring deeper learning to their conscience so that whole person learning is an engaged experience. It seems apparent that Active Learning is an effective means of learning about leadership in undergraduate students who are developing towards a career as a health professional.     

Assessing the Educational Needs of Mental Health Nurses Working in an Adolescent Inpatient Psychiatric Ward in Japan

PROBLEM: In Japan, preregistration education is not sufficient to prepare nurses to work as child adolescent mental health nurses. METHODS: Nominal group technique (NGT) using focus group discussions, and Knowles' Adult Learning Theory, were used to examine the continuing educational needs of nurses in a Japanese adolescent mental health unit. FINDINGS: Nurses caring for adolescent patients with mental health issues need continuing education. This research demonstrates the utility of nominal group technique in needs analysis in this context. CONCLUSIONS: Educational priorities include instruction on patients' developmental stage, promoting patient self‐sufficiency, and strategies for meeting the needs of families. A family‐centered care approach is recommended.     

Out-of-area placements in Scotland and people with learning disabilities: a preliminary population study

People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population.     

Health facilitation for people with learning disabilities

Health facilitation is a concept introduced in the white paper 'Valuing People: A New Strategy for Learning Disability for the 21st Century' (DH, 2001a). A project was set up in the West Midlands regions to look at what Primary Care Trust and specialist learning disability services were planning to do in respect of health facilitation in learning disabilities and to develop a resource tool for use by individuals working in this role. This article reiterates the extent of unmet health need experienced by people with learning disabilities and suggests that everyone involved in a caring role should be responsible for addressing their health needs. Primary and secondary care staff from across the legion were consulted, and a range of educational needs were identified for these professionals. Recommendations were made for health facilitators to support the primary and secondary care teams to enable improved access to mainstream health services for people with learning disabilities. The recommendations can be applied nationally.