Shifting boundaries: religion, medicine, nursing and domestic service in mid-nineteenth-century Britain

The boundaries between medicine, religion, nursing and domestic service were fluid in mid-nineteenth-century England. The traditional religious understanding of illness conflicted with the newer understanding of anatomically based disease, the Anglican sisters were drawing a line between professional nursing and the traditional role of nurses as domestic servants who looked after sick people as one of their many duties, and doctors were looking for more knowledgeable nurses who could carry out their orders competently. This prosopographical study of the over 200 women who served as government nurses during the Crimean War 1854–56 describes the status of nursing and provides a picture of the religious and social structure of Britain in the 1850s. It also illustrates how religious, political and social factors affected the development of the new nursing. The Crimean War nurses can be divided into four major groups: volunteer secular ladies, Roman Catholic nuns, Anglican sisters and working-class hospital nurses. Of these four groups I conclude that it was the experienced working-class nurses who had the greatest influence on the organization of the new nursing.     

Diagnoses and Interventions Pertinent to Intellectual Disability Nursing*

PURPOSE. The field of intellectual disability care in Ireland has been undergoing significant change, and this has called into question the role of specialist intellectual disability nursing. This review aims to identify the diagnoses and interventions that are employed by intellectual disability nurses. DATA SOURCES. Exploration of the relevant professional literature, drawing on a broad scope of sources, was completed. DATA SYNTHESIS. Examination and discussion within the taxonomic structure of the Nursing Interventions Classification. CONCLUSIONS. Initial data set of diagnoses and interventions identified as a basis and justification for further systematic examination of specialist intellectual disability nursing practice. IMPLICATIONS FOR NURSING PRACTICE. Explication and elaboration of the contribution of specialist nursing within intellectual disability care settings.     

Nursing student perceptions of disability and preparation to care for people with intellectual disabilities

As people with intellectual disabilities live longer and develop more chronic illnesses, nurses will have increasing contact with them. Therefore, nurses must have both an accurate understanding of and a positive attitude toward this population to ensure optimal nursing care is received. A cross-sectional survey of second-year and fourth-year nursing students measured their perceptions of disability, their contact with people with intellectual disabilities, and their perceptions of education to prepare them to care for people with intellectual disabilities. Students most often identified disability as physical, using a wheelchair to represent that perception. Students were confident in their ability to transfer many of the skills they learned to care for people with intellectual disabilities but identified a need for more education about providing that care. Curricular changes to enhance nursing students' awareness and understanding of people with intellectual disabilities are recommended.     

Towards Improving Medical Care for People with Intellectual Disability Living in the Community: Possibilities of Integrated Care

Background Ongoing deinstitutionalization has resulted in several problems in medical care delivery to people with intellectual disability, such as an increased workload for general practitioners (GPs) and a lack of active co‐ordination and co‐operation between healthcare professionals. A major consequence is the incidence of untreated yet treatable medical conditions. An integrated care approach may provide a means for better co‐ordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for people with intellectual disability. Method A literature search was conducted to trace relevant literature on integrated care for people with intellectual disability published between 1995 and 2003. Results Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in medical care for people with intellectual disability and for reducing GP workload, there are few published studies which have evaluated its implementation with people with intellectual disability. Conclusions Even though the potential advantages of integrated care are well known, the applicability of this approach for people with intellectual disability has still to be demonstrated.     

Methodological Issues in Inclusive Intellectual Disability Research: A Health Promotion Needs Assessment of People Attending Irish Disability Services

Background This paper describes a novel combination of inclusive methods to evaluate health and health promotion needs of service users (clients) with intellectual disability. Sixty centres provide disability services to over 900 clients with intellectual disability in the East Coast Area Health Board region of Ireland (population approximately 325 000). This is the first known triangulated large‐scale approach to inclusive needs assessment of clients using regional disability services in Ireland. Method The research included interviewer‐directed surveys of 247 clients with intellectual disability (or advocates) and 180 clients with physical/sensory disability; focus groups for clients, service providers and carers; and a postal survey for centre managers. Modification of existing surveys was required for people with intellectual disability. Results Fifty‐six of 60 (93.3%) centres participated. The response rate at the client level was 98.8% (3/250 refusals). Health behaviours, likes and dislikes were well described by clients and advocates. Clients identified the need for more creative therapy, physical activity, relaxation therapy and social activities. Service providers and carers emphasized more the need for speech and language therapy, counselling, occupational therapy and physiotherapy. Conclusions Inclusive research methods can produce useful outcome measures of the health promotion needs of those with disability. Triangulation is valuable, where clients, carers and service providers are all involved in the research process.     

Historical research: examining documentary sources

In this paper John Sweeney outlines key principles for conducting a study employing an historical design based on documentary analysis. It derives in part from his PhD study, in which he employs an historical design based on documentary analysis to investigate the delay in introduction of intellectual disability nursing into the Republic of Ireland from 1921 until 1958. This study examines the social, political and professional context to the decision to forgo the recognition of a professional nursing qualification and education process in intellectual disability until 1958.     

Intellectual disability nursing and transcultural care

In today's healthcare environment, nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform nursing decisions, actions and interactions with patients. Within the practice setting, there is an increasing challenge to provide care to patients from minority ethnic groups. In order to deliver care to different cultural groups, nurses need to recognize and empathize with patients' belief systems, being mindful of their diverse cultural needs. This article presents the concept of transcultural care and identifies issues within intellectual disability nursing through a focus on the components identified by Campinha-Bacote (2002; 2003) and Cortis (2003): cultural awareness, cultural skill, cultural knowledge, cultural encounter and cultural desire. It highlights the issues which are relevant to nursing practice, cultural care and service provision for persons with intellectual disability from ethnic minorities in Ireland.     

Mortality and Life Expectancy in Dutch Residential Centres for Individuals with Intellectual Disability, 1991–1995

Background Several studies showed that the individuals with intellectual disability have a shorter life expectancy than their intellectually average peers. To gain insight in the present life expectancy of people with intellectual disability, a study with recent data was performed. Methods We used data of the National Case Register (LRZ) with data of almost all residents of residential centres in the Netherlands for the period 1991–1995 (N = 29 290). Approximately 40% of all people with intellectual disability in the Netherlands reside in such centres. Results Results showed that 5‐year‐old people with intellectual disability in Dutch residential centres have a life expectancy of 41 years. The life expectancy of their peers with Down's syndrome in the centres is 46. At the age of 30 years, the respective figures are 36 and 26 years. No statistically significant differences in mortality were found between women and men and between levels of intellectual disability. Conclusions Due to prolonged longevity, the client population in residential centres will continue to age and thus the numbers of older individuals will increase. This ageing process has implications for the care for elderly individuals, because they need other care than before due to physical, psychological and social changes and spiritual challenges.     

An Investigation of Nursing Staff Attitudes and Emotional Reactions Towards Patients with Intellectual Disability in a General Hospital Setting

Background It has been suggested that inequalities in health care for people with intellectual disabilities may be partly explained by negative attitudes of health professionals. This study aimed to investigate the attitudes and emotional reactions reported by nursing staff working in general hospitals towards caring for patients with intellectual disabilities. Method Attitudes and emotional reactions were measured using a self‐report, vignette style questionnaire, tested for validity and reliability. Attitudes towards patients with physical disabilities were also assessed to act as a comparison. Results Nursing staff reported less positive attitudes, more negative emotions and fewer positive emotions, in response to caring for a patient with an intellectual disability compared to a patient with a physical disability. Occupational status (registered general nurse, student nurse, nursing assistant) had no effect upon respondents reported attitudes or emotions. Finally, attitudinal and emotional variables were significantly correlated, with positive emotions being associated with more favourable attitudes. Conclusions Although caution needs to be exercised when inferring actual behaviour from attitudes expressed, it is suggested that the presence of less positive attitudes and feelings amongst nursing staff towards patients with intellectual disabilities may affect the quality of care. Recommendations for future research and service development includes: the need to focus upon improving attitudes of nursing staff through training, and increased joint working between acute care services and Community Intellectual Disability Teams.     

Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution

while a.e . & clark l.l. (2009) Journal of Nursing Management  18, 166–172
Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution Aim To propose a strategy for overcoming stigma and discrimination against people with intellectual disabilities within healthcare. Background Evidence of poor healthcare for those with intellectual disabilities resulted in an independent inquiry. The subsequent report has charged healthcare organizations to address current organizational failings. Evaluation The origins of discriminatory practices in health services and the evidence of persisting poor care and stigmatization of this patient group despite UK Government policy are set out. Key issue The stigmatization and resulting discrimination of people with intellectual disabilities persists. Conclusion In addition to investment in core training, organizational change is needed to bring about change and a reduction in health inequality. Implications for nursing management The development of a new framework for nursing is recommended with leadership at all levels of healthcare so that people with intellectual disabilities and their families can expect to receive high quality care in all healthcare settings.     

The Process of Perceiving Stigmatization: Perspectives from Taiwanese Young People with Intellectual Disability

Background There is a dearth of studies about the causes of stigmatization in people with intellectual disability. This study is aimed at gaining an understanding of how feelings of stigmatization are formed and perceived among young people with intellectual disability in Taiwanese cultural and social contexts. Materials and Methods Fourteen young people with intellectual disability, ranging in age from 17 to 22 years, participated in this study. Data were collected and analysed using grounded theory. Results Three persistent themes were noted in regard to the formation of feelings of stigmatization among these young people with intellectual disability. (i) Being labelled: the sources of their stigma often resulted from the educational and social welfare systems. (ii) Perceiving oneself: they viewed themselves as ‘not good’ students, as troublemakers, as sick people and as odd people. (iii) Living with the labelling: they attempted to manage the impression that their intellectual disability had on others by using avoidance, isolation and self‐promotion. Conclusions Stigmatization among this intellectual disability group is invisibly formed while attending school and receiving social services. The value of the intellectual performance is not yet waived for young people with intellectual disability in Taiwan. Changing the social opinions of intellectual disability can help to avoid stigmatizing these people with intellectual disability.     

Service to the poor: The foundations of community nursing in England, Ireland and New South Wales

This paper describes the foundations of community nursing in England, Ireland and New South Wales. It is guided by Foucault's work on power, discourse and knowledge, and argues that the common discourse of poverty coupled with the influence of socially advantaged women in the nineteenth century was the impetus for the development of community nursing in England, Ireland and New South Wales. Throughout the nineteenth century in Great Britain, economic and industrial development, coupled with an unprecedented growth in the population (particularly among the poor) inspired socially advantaged women to extend traditional gender-specific roles to address the needs of the poor. Protestant women in England advanced professional nursing as a career for women and in Ireland and New South Wales; Catholic women pioneered professional nursing, targeting the poor as the focus of their practice. These women used prevailing social conditions to enhance their life options within the limits prescribed by social norms.     

Development and Preliminary Validation of the QUALITRA‐ID‐P: A User‐Orientated Questionnaire for Parents and Relatives to Assess the Quality of Care and Service Trajectories for Intellectually Disabled Persons

Background Care and service trajectories for people with intellectual disabilities are routes within the health care delivery system that consist of all the steps that people with intellectual disability and their families have to take in order to realize needed care and services. In contrast to the growing body of system‐orientated knowledge concerning quality of care delivered through collaborative relationships between care providers, specific user‐orientated knowledge is still largely lacking. Aim This article aims to describe the development and the preliminary validation of a user‐orientated questionnaire for parents and/or relatives of people with intellectual disability (QUALITRA‐ID‐P) to assess the quality of care and service trajectories of their children/relatives with intellectual disability. Methods First, the phenomenon ‘care and service trajectories’ was conceptualized on the basis of document analysis and semi‐structured interviews with key informants. Second, quality of care and service trajectories were operationalized using focus group discussions with parents and relatives as well as an extensive literature review. Third, the QUALITRA‐ID‐P was constructed using the results of the conceptualization and operationalization. Fourth, the QUALITRA‐ID‐P was refined in two stages: examination of (i) feasibility, understandability and completeness and (ii) preliminary validation. Results The final QUALITRA‐ID‐P is a 49‐item scale with good reliability and validity. An exploratory factor analysis resulted in a 3‐factor solution with Cronbach’s alpha coefficients of 0.98, 0.83 and 0.91. Organizations in the disability sector can use the QUALITRA‐ID‐P to understand better the experiences of quality of their clients’ relatives and as a result improve the quality of trajectories.     

Pastoral care and moral government: early nineteenth century nursing and solutions to the Irish question

This paper reexamines the role of the early nineteenth century nurses, conventionally depicted in nursing histories as the well-meaning but untrained Catholic nursing nuns or, in post-Reformation Europe, servants and fellow patients. It will be argued here that professional and capable nursing had begun to transform the care of the sick poor and to demonstrate its importance to the success of medical/surgical innovation long before Florence Nightingale and her call to Scutari. Moreover, the case is put that the emergence of nineteenth century forms of care for the sick occurred in response to the pressing problems of population management in Ireland, Great Britain and North America. The pastoral concerns of the first Irish nurses, with their expertise in both the spiritual and material domains, provided the prototype for what was to follow: a spiritual form of life that addressed the governmental concerns of its time. Finally, it is argued that given the overt moral imperatives of nineteenth century nurses of all persuasions, the depiction of nursing history as a crossing from the religious to the secular domain is challenged.     

Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers

Title. Attitudes towards people with physical or intellectual disabilities: nursing students and non‐nursing peers. Aim. This paper is a report of a study of the attitudes of Dutch nursing students towards people with physical or intellectual disabilities. Background. Attitudes of healthcare professionals are a major factor in the rehabilitation and self‐acceptance of persons with disabilities. Consequently, it is important that nurses develop or maintain positive attitudes towards people with disabilities during their education. However, more knowledge is needed about current attitudes of nursing students and factors influencing these attitudes. Methods. A sample of Dutch nursing students (n = 81) and an age‐matched group of non‐nursing peers (n = 48) completed standardized scales measuring attitudes about physically or intellectually disabled people. Data were collected in 2006. Findings. Nursing students were more positive towards physically disabled people than their peers, and more strongly endorsed empowerment and similarity of intellectually disabled people. These attitudinal differences generally remained statistically significant after multivariate adjustment for demographic variables and experience and contact with individuals with disabilities. An important independent determinant of a positive attitude towards physically disabled people in the total sample was having a relative or friend with a physical disability. This association, however, was not apparent in attitudes towards intellectually disabled persons. Conclusion. Educational interventions aimed at improving attitudes towards people with disabilities should include focus on forms of contact beyond the context of formal care relationships.     

Residential Provision for Adult Persons with Intellectual Disabilities in Ireland

Background The type of accommodation provided for persons with an intellectual disability is a major indicator of the social policy for this client group. This is likely to vary within and across countries; hence the importance of undertaking national and international comparisons. Estimations of future need are also required to assist service planning. Method A database of all persons in receipt of intellectual disability services has been operating in the Republic of Ireland since 1995. In Northern Ireland, regional databases were used to provide similar information. Results Around 10 000 people live in some form of residential provision: 56% in special settings, 35% in ordinary housing and 9% in hospitals. Most residents were classed as having ‘severe’ disabilities and were aged over 35 years. There were marked differences in the amount and type of provision provided in the two parts of the island. This was also mirrored in differences across health service areas within each country. The demand for future places was greater in Northern Ireland. Conclusions A planning target of 3.5 places per 1000 adult population is proposed although substantial investments in services is required to achieve this. Longitudinal surveys are an important way of monitoring the impact of new policy initiatives.     

Religious Expression amongst Adults with Intellectual Disabilities

Background Although religion is an important part of many people's lives, little is known about the role of religion in the lives of people with intellectual disabilities. Method Semi‐structured face‐to‐face interviews were conducted with 29 people with intellectual disabilities of a range of faiths (various Christian denominations, Islam and Hindu dharma). Participants were asked about the meaning of religion for them, the role of religion in their lives and the attitudes of others towards religious expression. All interviews were audio‐recorded, transcribed and thematically analysed. Results Participants expressed strong religious identities. Prayer was a particularly popular form of religious expression, with other forms of religious expression often hindered by services or faith agencies. Some individuals expressed how their religious faith was not recognized by services or faith agencies. Conclusions Services and faith agencies need to recognize the importance of religion in the lives of many people with intellectual disabilities, and support religious expression in this group.