A survey of nursing and multidisciplinary team members' perspectives on the perceived contribution of intellectual disability clinical nurse specialists.

AIM AND OBJECTIVES: To explore multidisciplinary team members' perspectives of clinical nurse specialists in intellectual disability nursing contribution in Ireland. BACKGROUND: While clinical nurse specialist roles have advanced over time, they are viewed as multifaceted and complex roles creating confusion. This confusion is reinforced by the absence of studies on multidisciplinary team members' perspectives on the activities of clinical nurse specialists. DESIGN: A cross-sectional study of multidisciplinary team members (n = 262). The survey instrument was developed based on the literature and the result of a previous qualitative study and survey of intellectual disability clinical nurse specialists. METHODS: SPSS was used for data analyses and descriptive and inferential statistics. The STROBE checklist for cross-sectional studies was used for reporting, and both a university and service providers granted ethical approval. FINDINGS: This study highlights that multidisciplinary team members identify the contribution and support that intellectual disability clinical nurse specialists provide across a range of practice areas. Clinical nurse specialists support the care process through supporting clients, staffs, families, organisations, communities and other agencies. CONCLUSIONS: Overall, the study reports and acknowledges the significance and contribution of intellectual disability clinical nurse specialists, across a range of practice areas and the support they provide for all stakeholders within the care process. RELEVANCE TO CLINICAL PRACTICE: Clinical nurse specialists are central to the nursing profession as a lead clinical role in practice and play a key role within the multidisciplinary team. Highlighting the work of the clinical nurse specialist creates greater clarity and less role ambiguity/confusion.

Families' perceptions of the contribution of intellectual disability clinical nurse specialists in Ireland.

AIM AND OBJECTIVES: To explore families' perceptions of the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. BACKGROUND: Clinical nurse specialists roles have developed over the years and are seen as complex and multifaceted, causing confusion, frustration and controversy. 2001 saw the formal introduction of clinical nurse specialists roles in Ireland across nursing including intellectual disability. DESIGN: A exploratory qualitative approach using semistructured one-to-one interviews with 10 family members regarding their perceptions of the clinical nurse specialists in intellectual disability. METHODS: Data were audio-recorded, transcribed and analysed using Burnard's framework. Ethical approval was gained and access granted by service providers. FINDINGS: The study highlights that intellectual disability clinical nurse specialists contribute and support care deliver across a range of areas, including personal caring, supporting and empowering families, liaison, education and leadership. CONCLUSIONS: Clinical nurse specialists have an important role and contribution in supporting families and clients, and Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared nationally and internationally. RELEVANCE TO CLINICAL PRACTICE: Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have a specialised intellectual disability nurses.

Activities of Intellectual Disability Clinical Nurse Specialists in Ireland.

PURPOSE/AIM: The aim of this study was to identify the contribution of Irish intellectual disability clinical nurse specialists (ID CNSs) to service delivery. DESIGN: A nonexperimental descriptive design was selected to survey ID CNSs presently working in Ireland. The questionnaire was developed based on focus group interviews, available literature, and expert panel views. METHODS: Ethical approval and access were granted to all ID CNSs in Ireland. Thirty-two responded (33.68% response rate) from all work areas (voluntary organizations or health service executive) practicing within residential, community, or school services. Respondents were surveyed across a range of areas (demographic details and support to client, staff, family, organization, community, other agencies, and professional development). RESULTS: Findings identify that ID CNSs are active in all aspects of their roles as clinical specialist, educator, communicator, researcher, change agent, and leader, thus supporting person-centered care and improving service delivery. CONCLUSIONS: To meet changing healthcare demands, promote person-centered care, and improve service delivery, the CNS role in ID should be developed and supported. The findings merit a further study on ID CNS role activity, possible variables influencing role activity, and team members' views.

Focus group interviews examining the contribution of intellectual disability clinical nurse specialists in Ireland.

AIMS AND OBJECTIVES: To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. BACKGROUND: While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy. DESIGN: A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31). METHODS: Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland. RESULTS: The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies. CONCLUSIONS: Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies. RELEVANCE TO CLINICAL PRACTICE: Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses.

Issues in caregiving for older people with intellectual disabilities and their ageing family carers: a review and commentary.

BACKGROUND: In keeping with worldwide demographic changes and an ageing population, people with intellectual disabilities are living longer and all the evidence suggest that this trend will continue. This 'new' population of older people and their carers will pose challenges for health and social care providers. AIM: This paper presents a review of the literature on key issues influencing caregiving for older people with intellectual disabilities and their ageing family carers. METHODS: The review was undertaken using a framework adapted from the NHS Centre for Reviews and Dissemination. Papers were identified through the use of databases including CINAHL, Science Direct, PsychoInfo, Blackwell Synergy, the Cochrane Library and MEDLINE. FINDINGS: The key themes which emerged from the literature and which consequently form the basis of this review include: ageing family carers, future planning and support services. In the context of family caregiving, older people with intellectual disabilities represent a unique group insofar as they are unlikely to be married and therefore have no spouse or dependents to care for them in later life. As a result, parents (usually mothers) have to continue caring for their son or daughter with an intellectual disability as they both grow older, often resulting in a mutually dependent relationship. The caregiving situation is further complicated by poor emergency and future planning and by a lack of appropriate services for this group of individuals. CONCLUSIONS: In light of the emergence of a 'new' population of older people with intellectual disabilities, there is an urgent need to develop services and support structures which will enable these individuals and their ageing carers to 'age in place' and when this is no longer possible, to have appropriate alternatives that recognise the duality of their needs as older people and as people with intellectual disabilities. IMPLICATIONS FOR PRACTICE: Opportunities for supervision could be one way to increase individuals' awareness of their own role in the team.

Focus group interviews part 3: analysis.

The use of focus group interviews as a means of qualitative data collection has gained popularity in health service research in recent years. Despite their popularity, analysing qualitative data-particularly focus-group interviews-poses a challenge to most researchers. This article follows the authors' previous articles on; focus group theory, and the preparation and conduct of focus group interviews. Despite the publications on conducting focus groups, little information exists regarding the analysis of data gathered in such groups in health services. The present paper focuses on the concepts and application of data analysis and the use of analysis frameworks. The article aims to assist researchers and provide practical steps for the analysis of focus-group data. Thus, the authors provide a framework for analysing focus group data through identifying data analysis techniques suited for the study of these data.

A pilot survey of physical activity in men with an intellectual disability.

People with intellectual disability (ID) are reported as a sedentary population with increased risks of poor health due to an inactive and sedentary lifestyle. As the benefits of physical activity are acknowledged, measuring physical activity accurately is important to help identify reasons for low and high physical activity in order to assist and maintain recommended levels for optimal health. This article reports a pilot study undertaken to validate the use of a physical activity monitor (Sensewear Armband) and the International Physical Activity Questionnaire (IPAQ) as instruments for measuring and exploring physical activity of men with ID. The design was a one-group descriptive study and the data were collected over a 7-day period from 17 men. The Sensewear Armband enabled continuous and long-term measurement of 14 objective physical activity metrics. The IPAQ examined details of physical activity reported over 7 days. Equivalent results were obtained from both the instruments, indicating a positive correlation between the Sensewear Armband and the IPAQ. The results show 50% have low activity levels, and the national recommended physical activity levels have been achieved at a very low active intensity. No sustainable high physical activity intensity levels were recorded. The results confirmed the Sensewear Armband and the IPAQ as a practical means of measuring and understanding physical activity levels in men with ID.

Preparing for and conducting focus groups in nursing research: part 2.

Focus group interviews are widely used in health research to explore phenomena and are accepted as a legitimate qualitative methodology. They are used to draw out interaction data from discussions among participants; researchers running these groups need to be skilled in interviewing and in managing groups, group dynamics and group discussions. This article follows Doody et al's (2013) article on the theory of focus group research; it addresses the preparation for focus groups relating to the research environment, interview process, duration, participation of group members and the role of the moderator. The article aims to assist researchers to prepare and plan for focus groups and to develop an understanding of them, so information from the groups can be used for academic studies or as part of a research proposal.

Focus group interviews in nursing research: part 1.

Focus groups are used by researchers in the social and behavioural sciences to explore phenomena and are accepted as a legitimate qualitative methodology. The primary goal of focus groups is to use interaction data resulting from discussion among participants to increase the depth of the enquiry and reveal aspects of the phenomenon assumed to be otherwise less accessible. This article, the first of three articles on focus groups, examines the nature of focus groups, issues regarding planning focus groups, selecting participants and the size of the groups. This article is aimed at students who are undertaking research modules as part of their academic studies or writing a research proposal as well as at novice researchers who intend to use focus groups as a means of data collection.

The development of clinical nurse specialists (CNSs) in intellectual disability nursing in Ireland.

Since the commencement of intellectual disability nurse training in 1959, both education and service provision philosophies have changed over time in Ireland. These changes have occurred in response to national and international reports and attitudes. Coinciding with the changes in education and philosophy have been the development and advancement of the intellectual disability nursing profession. Currently undergraduate intellectual disability nurse education is unique to Ireland and the United Kingdom and, similar to the developments across other disciplines of nursing, advance practice has become a focus of development. This article traces the development of intellectual disability clinical nurse specialists (CNSs) in Ireland and identifies possible challenges and implications for future practice.

Intellectual disability nursing in Ireland: identifying its development and future.

As a profession, intellectual disability nursing has often come under scrutiny and been called into question. Since its inception as an individual nursing profession in 1959 in Ireland, both education and service provision philosophies have changed over time. These changes have been in response to national and international reports and changing attitudes. The changes have led to the current position where intellectual disability nurse education in Ireland is a four-year undergraduate course. As the discipline of intellectual disability nursing is unique to Ireland and the United Kingdom, there is a responsibility on intellectual disability nurses to identify their unique identity and their responses to the demands of changing services. This article traces the development of intellectual disability nursing in Ireland and identifies implications for the future.

Community learning disability teams: developments, composition and good practice: a review of the literature.

This article presents the findings from a literature review related to community learning disability teams (CLDTs). Much of the existing literature on CLDTs is inspirational, theoretical or opinion based rather than evidence based. It was considered that current knowledge is insufficient to allow a systematic review; therefore a structured review of factors that impact on CLDTs was undertaken following some of the principles of a systematic review. The review covers historical and philosophical influences on the development of CLDTs; the structure and common composition of CLDTs; the main challenges facing CLDTs; and the barriers that impact on their effective working. Based on the available evidence a number of good practice suggestions are forwarded that have the potential to enhance the work undertaken by CLDTs, but it is acknowledged that there is a need for more research into the effectiveness of these teams.

Community learning disability teams: perceived effectiveness, multidisciplinary working and service user satisfaction.

The locus of care for people with learning disabilities has shifted from institutional/residential care to community care, with Community Learning Disability Teams (CLDTs) providing support for people with learning disabilities, and their family caregivers, in the community. A survey of the perceived effectiveness of 145 CLDT members, 27 family caregivers and 21 people with a learning disability was undertaken. Findings suggest high levels of perceived effectiveness with the services provided by the CLDTs, but caregivers gave the lowest satisfaction ratings. Although overall effectiveness was rated highly there is no room for complacency. There was limited evidence to support the view that multidisciplinary CLDTs are more effective than unidisciplinary teams. Further research is required in this area and ongoing evaluation of the effectiveness of CLDTs is suggested.

The role of community nurses for people with learning disabilities: working with people who challenge.

The locus of care for people with learning disabilities has transferred from institutional to community-based services. Increasingly people who have learning disabilities and additional challenging behaviours live in community settings. Spearheading the care for these people are community nurses for people with learning disabilities. This study aimed to explicate the role of these nurses in their day-to-day work with people who challenge. Using grounded theory methodology, 22 nurses were selected by theoretical sampling and interviewed. An analytical story and theoretical framework that emerged from the grounded data is presented. It is suggested that this framework has utility for practice.

Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands.

BACKGROUND: There is scant knowledge on the contacts community nurses for people with learning disabilities have with clients who display challenging behaviours, or the numbers of such people on these nurses' caseloads. This study was undertaken in a UK region with a population of 1.68 million people. In this region it is estimated that there are 8500 people with learning disabilities who are in contact with services, this includes around 500 people remaining in hospitals awaiting resettlement. AIMS AND OBJECTIVES: The research aims were to identify the overall caseload sizes of the nurses, the prevalence of people with learning disabilities who have challenging behaviours on the nurses' caseloads and what contact demands these people required. An additional aim was to discover courses or training that helped the nurses to fulfill their roles. DESIGN AND METHODS: A postal survey was undertaken of the total population of community nurses for people with learning disabilities in the region. The method of data collection was a self-completion questionnaire. RESULTS: The study found that people with challenging behaviours accounted for over a quarter of the combined caseloads, and these clients required the most frequent visits from the nurses. There was a wide range in the number of clients on the caseloads of each nurse but overall these were higher than in other parts of the UK. CONCLUSIONS: It is concluded that community nurses for people with learning disabilities have large caseloads and people with learning disabilities who have challenging behaviours, who account for over one-quarter of the clients they visit, require much more frequent contact visits than other clients. The combination of high numbers of clients (or low numbers of these nurses) may impact on how such nurses are able to perform their role and functions. RELEVANCE TO CLINICAL PRACTICE: An increase in the numbers of community nurses for people with learning disabilities and skill development in caring for people with challenging behaviours is recommended. If this is not performed the clinical effectiveness of this group of nurses with respect to their work with people who challenge services may be unduly hampered.

The meaning of caring to nurses: an investigation into the nature of caring work in an intensive care unit.

BACKGROUND: The purpose of the study was to generate knowledge, which informs the discipline of nursing as caring represents an essential human need. Despite the wealth of research discussing caring in nursing, little is related to the highly technological intensive care unit environment. AIMS OF THE STUDY: To explore the meaning of caring to intensive care unit nurses. To determine if the meaning of caring to these nurses has potential for altering nursing practice and to gain an insight into how caring experiences were evident to them. DESIGN AND METHOD: The design of the study was descriptive and qualitative. Semi-structured interviews were conducted to collect data on the experiences of twelve nurses who were selected by purposive sampling. Data analysis involved using Colaizzi's reductive procedure. RESULTS: Findings suggest that the nurses in the study participated in delivering holistic and humane care of the patient and their relatives. The essential structure of caring was identified as a process of competent physical and technical action imbued with affective skills. CONCLUSIONS: This study revealed caring to be synonymous with nursing. The descriptive accounts of the nurses' experiences of caring in this study attempt to illuminate the nature of intensive care unit nursing. It legitimates, from the perspectives of these particular participants, the importance of caring. The participants described caring as a process involving feelings together with professional knowledge, competence, skill and nursing action. This involved the holistic care of the patient and relatives in meeting their individual needs. RELEVANCE TO CLINICAL PRACTICE: This study demonstrated that the lived experience of caring reflects the humanistic nature of nursing. It confirms that to care is human and the capacity to care is affirmed and actualised in caring for the critically ill patient and their relatives.

An investigation of the lived experiences of registered nurses facilitating supernumerary nursing students.

The aim of this study was to explore and describe the everyday lived experiences of registered nurses facilitating supernumerary diploma student nurses in the clinical area. The research question; 'How do registered nurses perceive their role in relation to supernumerary students?' provided the central focus for the study. Using purposive sampling, 10 participants were chosen for the research. Semi-structured interviews were used to collect the data. The themes that emerged from the data are 'supernumerary status', 'facilitating students', 'rewarding experience', 'student interest', 'the diploma programme' and 'issues in nurse education'. The findings revealed positive and negative experiences of facilitating supernumerary students. Since the diploma programme of pre-registration nurse education was in its inaugural stages in Ireland at the time of this study, a foundation for further research is established. The conclusion indicates that facilitating supernumerary student nurses at diploma level can be a complex phenomenon for registered nurses.

Giving voice to the less articulated knowledge of palliative nursing: an interpretative study.

This article details a study that was undertaken in order to give voice and thereby increase understanding of the less articulated knowledge used in practice by palliative care nurses. An additional aim was to explore perceived influences on the development of these nurses. A hermeneutic approach was used to explore the lived experiences of seven nurses who had worked in the field for more than 2 years. The themes that emerged from analysis of the data were: knowing the bigger picture, time (movement and measure), ethical dimensions, knowing and minding yourself, the 'just' and 'simply' of practice, the embodiment of being with unseen tutors. Recommendations relating to the need for further research, practice setting and palliative education are suggested from the findings of the study.