A Social Constructionist Appreciation of the mental health inpatient nursing care for people with intellectual disability

Taua, Christine (2015). A Social Constructionist Appreciation of the mental health inpatient nursing care for people with intellectual disability PhD Thesis, School of Nursing, Midwifery and Social Work, The University of Queensland. doi:10.14264/uql.2015.1109

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Author Taua, Christine
Thesis Title A Social Constructionist Appreciation of the mental health inpatient nursing care for people with intellectual disability
School, Centre or Institute School of Nursing, Midwifery and Social Work
Institution The University of Queensland
DOI 10.14264/uql.2015.1109
Publication date 2015-12-03
Thesis type PhD Thesis
Supervisor Christine Neville
Theresa Scott
Total pages 300
Language eng
Subjects 111003 Clinical Nursing: Secondary (Acute Care)
111714 Mental Health
111703 Care for Disabled
Formatted abstract
Background

The prevalence of mental health issues for people with intellectual disability is purported to be up to 40% compared with a 20% prevalence rate in the non-intellectually disabled population. The history of care for this group reveals long term stays in psychiatric or intellectual disability institutions. Since deinstitutionalisation most people with intellectual disability now live within community settings. They are however regular consumers of inpatient mental health services. Mental health services have progressed also since deinstitutionalisation and care is now focussed on the short term specialist care to meet the needs of consumers. Conversely, inpatient mental health care of people with intellectual disability is frequently complicated requiring longer admissions and highly specialised care strategies. Nurses in these settings are required to respond to numerous complex and challenging situations with minimal evidence to guide their practice.

Research in this field is increasing however it is more often focussed on debates regarding where to provide care – specialist or generic services. A review of the literature in regard to the nursing care in this field revealed a great deal of theoretical and anecdotal knowledge but a paucity of empirical research. There is extensive advocacy for more qualitative research methodologies to identify the views and experiences of all persons involved in care relationships in order to contribute to future care strategies in this field. By understanding patients and carers needs nurses can be equipped with the knowledge and skills to provide evidenced based care.

Aim

This research aimed to explore inpatient mental health nursing care for people with intellectual disability and mental health issues from the perspective of the three key parties to the care relationship: 1) people with intellectual disability and mental health issues; 2) carers of people with intellectual disability and mental health issues; and, 3) nurses who work in inpatient mental health settings caring for people with intellectual disability. The outcome was to develop a model of nursing care informed by the comprehensive set of findings.

Research Design

This qualitative study undertaken in New Zealand/Aotearoa utilised the fundamentals of an Appreciative Inquiry methodology to explore inpatient care as constructed by aforementioned participants. Appreciative Inquiry looks at how participants describe positive experiences within the field of study. This is elucidated through enquiries into a ‘what works well’ paradigm.

There are four ‘Phases’ within an Appreciative Inquiry design. Given the diversity of each cohort, Phase one data termed ‘Discovery’, explored positive experiences of participants. Data from all three cohorts were collected and analysed separately utilising the Leximancer online analytical tool to identify key themes. Leximancer is a data mining tool that draws out themes, concepts and semantic relationships within the data. Phase two data sought ‘Dreams’ or visions for the future. The data from all three cohorts was this time amalgamated and thematically analysed to identify common themes. For Phase three, ‘Design’, a subset of participants from each cohort formed a collaborative. This subgroup contemplated and guided strategies for future care informed by the earlier findings. Phase four of the methodology was the ‘Destiny’ phase where the model of care for the future was elucidated.

Results

Results from Phase one revealed ten themes. Themes from cohort one (n=9) were ‘meaningful activity’, ‘emotion focussed care’ and ‘feeling safe’. Cohort two (n=9) revealed themes around ‘the role of the nurse’, ‘talking matters’ and ‘managing feelings’. For cohort three (n=13) themes included ‘contextualising behaviour’, ‘communication – core or specialised’, ‘confidence to care’ and ‘it takes time’. From each of these themes a range of ‘Purposeful strategies’ were derived to inform nursing care. These strategies are broadly framed in regard to 1) communication 2) relationships and 3) innovative care approaches. Phase two revealed aspects of care that participants desired for the best way forward in service provision and care; their visions. Broadly these included recommendations around i) service provision ii) knowledge and understanding and iii) the supportive environment. Phase three with the collaborative subgroup (n=4) validated and reflected findings to inform the development of a Multidimensional Integrated Framework of Care (Phase four).

The framework begins with the fundamental skills and strategies inherent in nursing care, labelled as ‘Embedded strategies’. Also embedded are the collaborations between the various parties to the care relationships, (the Community of Care). Following these is the aforementioned ‘Purposeful Strategies’. The final outcome of the Framework are the ‘Five C nursing attributes’ which reveals a nurse that is able to practice in a Collaborative way, is Confident, considers the Context of each situation, is Creative in responding to complex needs and has Communication skills to best meet the needs of people with intellectual disability and mental health issues.

Conclusion

Contemporary mental health inpatient care for people with intellectual disability is a complex area of care. Nurses in inpatient mental health units work hard to respond to the complex and unique requirements for individuals with intellectual disability. Provision of care extends to their carers. To date, this has occurred in the absence of a clear framework to guide their practice. The Multidimensional Integrated Framework of Care developed in this study provides evidence to deliver comprehensive, person-centred, inpatient mental health nursing care for people with intellectual disabilities and mental health issues.
Keyword Appreciative Inquiry
Carer
Inpatient
Intellectual Disability
Leximancer
mental health
Mental illness
Nurse

Document type: Thesis
Collections: UQ Theses (RHD) - Official
UQ Theses (RHD) - Open Access
 
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Created: Thu, 19 Nov 2015, 18:04:16 EST by Christine Taua on behalf of Scholarly Communication and Digitisation Service