Indonesian nurses' awareness and application of reasonable adjustments when caring for people with intellectual disability and/or autism.

AIM: This study aimed to understand Indonesian nurses' familiarity with the concept of reasonable adjustments, and the frequency of its application within their practice. BACKGROUND: People with intellectual disability and/or autism are exposed to significant barriers when accessing healthcare and have poorer health outcomes than those without developmental disabilities. Reasonable adjustments can improve accessibility and quality of healthcare for people with disabilities and involves adapting practices and environments to promote equitable healthcare. INTRODUCTION: There is a scarcity of literature focused on the application of reasonable adjustments in the Indonesian nursing context. A greater understanding of the application of reasonable adjustments in this context can help inform nursing curricula and policy. METHODS: A cross-sectional, descriptive survey -was undertaken and is reported in accordance with the Strengthening the Reporting of Evaluations and Non-randomised Designs. Following descriptive analysis, bivariate analyses were undertaken between key demographic, workplace, and self-reported capability variables, and familiarity and implementation of reasonable adjustments. RESULTS: The majority of respondents were not familiar with the concept of reasonable adjustments and self-reported sometimes applying it within their practice. Higher levels of educational and clinical exposure to intellectual disability and/or autism, and self-capability variables, were significantly associated with familiarity with reasonable adjustments and their application. CONCLUSIONS: An increase in nursing curricula focused on caring for people with intellectual disability and/or autism, including content focused on applying reasonable adjustments, is indicated. IMPLICATIONS FOR NURSING POLICY: Given that, internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, findings highlighting gaps in understanding and application of reasonable adjustments of Indonesian nurses have substantial implications for nursing policy and curriculum.

Barriers to communication with people with developmental disabilities: A reflexive thematic analysis.

People with Intellectual Disability and/or autism internationally experience some of the worst health outcomes of any population group. Registered nurses have been identified as having educational deficits in this domain, which include knowledge of adjustments to communication. This study aimed to explore perceived barriers to communication with people with Intellectual Disability and/or autism. A thematic analysis of data from an open-ended free-text survey question exploring barriers to communicating in a cross-sectional survey of 279 Australian registered nurses conducted in 2020 was undertaken. Six interrelated themes were identified. Increased educational content in undergraduate and postgraduate level nursing courses is indicated. The findings identify the benefit of educational design based on the foundation of understanding the diversity in thinking and information processing represented by the forms of neurodiversity in Intellectual Disability and Autism Spectrum Disorder.

A survey of Indonesian nurses' educational experiences and self-perceived capability to care for people with intellectual disability and/or autism spectrum disorder.

AIMS: To describe Indonesian nurses' educational experience regarding care for people with intellectual disability and/or autism and to explore if these educational experiences are associated with their self-perceived confidence, comfort, knowledge and preparedness to care for these cohorts. DESIGN: Cross-sectional descriptive survey. METHODS: A descriptive survey tool utilized in a study of Australian registered nurses was replicated and adapted for this study. Following descriptive analysis, chi-square analyses were undertaken to explore associations between educational experiences, and self-rated measures of confidence, comfort and knowledge to work with people with intellectual disability and/or autism. Although there was no end-user involvement in the design of the study, the concepts explored have all been raised by those with lived insights of intellectual disability and/or autism as being critical to their healthcare experiences. RESULTS: There were 544 complete responses, and 51.7% were not exposed to any educational or clinical content relevant to caring for people with intellectual disability and/or autism. Moderate to low levels of self-perceived confidence, comfort, knowledge and preparedness to address healthcare needs of these cohorts were reported. Significant associations were identified between educational and clinical experiences during undergraduate training, and higher levels of self-perceived confidence, comfort and knowledge. CONCLUSION: Mirroring international literature, the findings of this study highlight a large proportion of Indonesian nurses had little educational experience relevant to caring for people with intellectual disability and/or autism, and have relatively low levels of self-reported capability. IMPACT: This study highlights gaps in the educational experiences, and self-perceived confidence, comfort, knowledge and preparedness of Indonesian nurses regarding caring for people with intellectual disability and/or autism. Given that internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, these findings have substantial implications for nursing curriculum, policy and professional development.

Filling the Gaps: Evaluation of an Online Continuing Professional Development Program for Australian Registered Nurses to Build Capacity to Care for People With Developmental Disability.

BACKGROUND: People with autism spectrum disorder and/or intellectual disability have some of the worst health outcomes of any population group. Internationally, it has been identified that RNs are not adequately prepared to provide care to these groups through mainstream health care services. METHOD: A cross-sectional online evaluation survey of participants who completed learning to build the capacity of RNs to care for people with autism spectrum disorder and/or intellectual disability was conducted. RESULTS: The learning site was found to be easily accessible and engaging, and it facilitated knowledge construction. A statistically significant increase in self-reported comfort, confidence, and preparedness compared with the sample of RNs in a national survey conducted before the site launch was identified. CONCLUSION: This online continuing professional development program facilitated RNs' perceived comfort, confidence, and preparedness to care for people with autism spectrum disorder and/or intellectual disability. Findings suggest the merit of high-quality online continuing professional development programs to fill this educational gap. [J Contin Educ Nurs. 2023;54(12):554-560.].

Barriers and Enablers to Nurses' Engagement With Continuing Professional Development: A Survey.

BACKGROUND: Continuing professional development (CPD) is perceived as a pivotal component of building and maintaining nursing skill and capacity. Exploring motivators for CPD engagement can aid program adaptation and improvement. The goal of this study was to survey the barriers, enablers, and changes of Australian RNs' engagement with CPD in general during the coronavirus disease 2019 (COVID-19) pandemic. An additional goal was to understand factors influencing the interest of participants to engage with programs focused on care for people with intellectual disability and/or autism. METHOD: This study was a cross-sectional exploratory survey. RESULTS: Most of the sample had engaged with CPD in the previous 12 months, and the most reported topics were related to COVID-19. Sixty percent of nurses saw a change in volume of CPD. Younger nurses, with fewer years of experience, and practicing in major cities, were significantly more likely to report less CPD. CONCLUSION: It is pivotal that the design and promotion of CPD curricula consider the motivators and barriers for nurses' engagement with them. [J Contin Educ Nurs. 2023;54(9):405-412.].

A scoping review to inform an auditing framework evaluating healthcare environments for inclusion of people with intellectual disability and/or autism.

People with intellectual disability and/or autism are likely to be in hospital more often, for longer, and have poorer health outcomes. Few audit tools exist to identify their barriers in mainstream healthcare environments. This study aimed to identify evidence of audit characteristics of healthcare contexts specifically for people with intellectual disability and/or autism, for conceptual development of an auditing framework. A scoping review of evaluations of healthcare environments was completed in January 2023. Findings were presented using the PAGER framework. Of the sixteen studies identified, most originated in the UK, nine focused on intellectual disability, four on autism, and three were concerned with mixed diagnosis. Six domains for auditing healthcare environments were identified: care imperatives, communication to individuals, understanding communication from individuals, providing supportive environments of care, supporting positive behaviour, and actions to make things go well. Further research is recommended to refine an audit framework.

The Experience of Facilitating Inclusive Research Advisory Groups With Parents and People With Intellectual Disability and/or Autism Spectrum Disorder.

There is little nursing research about process issues in conducting inclusive project advisory groups of people with autism and/or intellectual disability or those who are parents/carers of this cohort. Through a descriptive qualitative design, this article aims to analyze the processes, challenges, and solutions when facilitating these groups for a nursing project in Australia. Reflexive thematic analysis was utilized to analyze field notes and meeting minutes. Results highlight the need for a defined, robust communication process between researchers and advisory groups, skilled facilitators, and careful planning of when in the life of the project the groups can contribute meaningfully. This project offers a proposed framework for the valuable contribution of lived experiences from research advisory groups.

A scoping review of registered nurses' delegating care and support to unlicenced care and support workers.

AIM: To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts. DESIGN: Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA-ScR checklist. METHODS: The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers. RESULTS: A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers. CONCLUSIONS: The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature. IMPLICATIONS FOR THE PROFESSION: Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re-distribution of nurses' work. RELEVANCE TO CLINICAL PRACTICE: Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.

Registered nurses' awareness and implementation of reasonable adjustments for people with intellectual disability and/or autism.

AIM: To describe Australian registered nurses' awareness, and implementation of reasonable adjustments within their practice when caring for people with intellectual disability and/or autism. Additionally, the association between key demographic, workforce, and respondent variables and familiarity of the term and regularity of use was explored. DESIGN: Cross-sectional survey. METHODS: Survey data were collected between August and October 2020 using an online survey tool. Data were analysed using descriptive and inferential statistics. RESULTS: Familiarity of the concept of reasonable adjustments was relatively low, compared to respondents who report applying adjustments when caring for people with intellectual disability and/or autism. Higher levels of confidence, comfort, and knowledge when caring for this cohort were associated with greater awareness and application of reasonable adjustments. CONCLUSION: A higher volume, and diversity in type of, nursing education related to care for people with intellectual disability and/or autism is indicated.

A cross-practice context exploration of nursing preparedness and comfort to care for people with intellectual disability and autism.

AIMS AND OBJECTIVES: To compare the self-perceived preparedness, knowledge, comfort and confidence of Australian Registered Nurses when caring for people with ID and/or ASD across contexts of practice: primary care and community, intensive care, acute hospital, emergency department, paediatrics and ID/ASD. BACKGROUND: There is limited research comparing nursing preparedness and competency when caring for people with intellectual disability (ID) and/or autism (ASD) across nursing contexts of practice. A greater understanding of the differed educational preparedness, confidence and comfort across contexts of practice can aid the development of tailored educational programmes to improve nursing capacity to care for this cohort. DESIGN: Cross-sectional descriptive study. METHODS: A descriptive survey tool of registered nurses (n = 69.3). Comparative inferential analysis was undertaken between the independent categorical variable of six nursing contexts of practice across several dependent variables including age, years since registration, educational content and exposure, knowledge, comfort and confidence. This cross-sectional study was undertaken according to the STROBE Statement checklist of items. RESULTS: Occupying an ID/ASD nursing role was significantly associated with higher reported levels of educational preparedness, professional development and postgraduate education relevant to caring for people with ID and/or ASD. Levels of self-reported knowledge of care issues, confidence and comfort when undertaking healthcare tasks was significantly associated with the context of practice, with nurses working in ID/ASD settings reporting the highest levels across all variables. CONCLUSION: The findings of the study highlight an association between greater educational exposure to content relevant to working with people with ID/ASD and subsequently working in that field. RELEVANCE TO CLINICAL PRACTICE: This study has highlighted that professional development programmes aiming to improve nursing capacity to care for people with ID and/or ASD, should be informed by and address differing gaps in confidence, comfort and educational preparedness across nursing contexts of practice.