Employing Standardised Nursing Language to Define the Unique Interventions of Intellectual Disability Nursing

Abstract

Communication is central to group activities, both within the human and animal worlds, incorporating systems of signs, symbols, actions or sounds (Oxford University Press 2002) in order to transmit meaning, through the interpretation of shared concepts (Ogden and Richards 1972). In the professional nursing arena, the medium for such communication is language, whether written or spoken. The need to be able to communicate the essence of nursing – its foci, interventions, outcomes, decisions and rationales – was instrumental in the evolution of the nursing diagnosis movement. The development of taxonomies of standardised nursing terminology furthered this process, providing terms which could be used to facilitate description of those components of nursing practice, and permitting explication of the unique contribution of nursing to care. This thesis aims to describe the unique interventions of intellectual disability nursing in Irish residential services, through the employment of standardised nursing language. A group of 614 respondents, comprising nurses, non-nurse care staff, multidisciplinary team members and service managers provided the main body of information for the research. The study was set against a background of changing service provision, with increasing development of community-based residential services and redesignation of direct-care roles as generic positions. Thus, whereas such direct-care positions had previously been nursing discipline specific, the new roles were open to persons with a range of qualifications (including nursing). In view of a similar development that had occurred in the United Kingdom, and the restructuring and refocusing of learning disability nursing there and in the absence of any detailed study into the contribution of intellectual disability nursing in the Republic of Ireland, this study aimed to identify both the issues upon which such nursing was focused, and the interventions that Registered Intellectual Disability Nurses (RNID) employ to address them. The study specifically sought to answer the following questions: • What are the interventional foci of nursing in residential intellectual disability services? • What is the current contribution of nursing in residential intellectual disability services? • Is the nursing terminological approach useful for describing the unique contribution of nursing? A two-stage methodological design was employed, with the first stage incorporating a qualitative approach – Delphi study, focus groups and key informant interviews – which was investigatory in nature, and provided a grounding for the second, quantitative stage. This pan-organisational survey explored the frequency of employment of specific interventions as well as investigating various staff groupings’ perceptions of who was responsible for their performance. The central finding of this study suggests that interventional caring in intellectual disability services is a generic entity which transcends professional boundaries and overlaps greatly with the tasks undertaken by non-nurse care staff, and posits that specialised nursing has, with very few exceptions, no unique interventional complement to add to such caring in residential settings for this population. It is acknowledged, however, that this study expressly set out to address the empirical component of such nursing and that there may be a unique qualitative aspect which will require further investigation. The findings of this study pose a significant challenge for specialist intellectual disability nursing, which has not demonstrated any concerted attempt to address the issues that the changing service context has posed. It is recommended that further research be carried out to examine the qualitative aspect of the intellectual disability nurse’s role and to explore the viability, or perhaps, the restructuring and refocusing, of such nursing.