People with intellectual disability (ID) constitute 2.9% of the Australian population and access healthcare more frequently than the general population. This cohort experience chronic and complex health issues, with poorer physical health, mental health, and health outcomes. Unmet health needs of people with ID are substantial. Health conditions are often undiagnosed or inappropriately treated that impact health inequalities which are evidenced by higher mortality rates, including premature death from preventable causes.
The 2006 United Nations ‘Convention on Rights for people with disability’ (UNCRPD) cemented the most extensive recognition of human rights, includes health delivery. As a signatory to the UNCRPD the Australian government have committed to ensuring that people with ID have the highest attainable standards of health. The Council of Australian Governments (COAG) National Disability Strategy 2010-2020, was developed as part of that strategy.
As the largest health professional group in Australia, nurses play a key role in delivering healthcare services to people with ID, including treatment, health promotion and disease detection. Research into the impact of intellectual disability nurse specialists identified that Australia currently do not have an acute intellectual disability nurse specialist within the Australian healthcare system. To achieve optimal healthcare provision for Australian people with ID, a systematic review was conducted to evaluate the impact of International intellectual disability nursing specialist effectiveness in person centred care in the general healthcare sector.
Methods:
Original research studies published between 2007-2017 were identified using electronic databases, reference lists and by searching ‘grey literature’. Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). From 189 studies initially identified, 8 original research papers were included. Six studies were conducted in the United Kingdom evaluating two Intellectual Disability nurse specialist models and two studies were conducted in Ireland evaluating one Intellectual Disability nurse specialist model.
Results:
Three main themes were identified: person-centred care, organisational development, and practice development. Sub-themes were identified: person-centred care theme identified holistic and communication; whilst organisational development theme identified systems and co-ordination of care; and practice development theme identified professional development and client/family education.
Conclusion:
The systematic review identified three models of Intellectual Disability nurse specialists within the United Kingdom and Ireland that have achieved an impact on the overall healthcare delivery and healthcare outcome of people with ID. The chronic and complex health issues and significant unmet health needs of this vulnerable group were addressed through the person-centred care approach. Intellectual disability nurse specialists are well situated to inform organisational development through reasonable adjustments and inclusive policy development. The inclusion of ID professional development and delivery of teaching and research is a requirements of human rights legislation. The impact of the Intellectual Disability nurse specialists impact on practice development developed within the general healthcare sector, informed health professionals that impacted on person-centred care practice.
This systematic review provides evidence of the need to develop Intellectual Disability nurse specialists within Australian healthcare sector. The Intellectual Disability nurse specialist expert knowledge and skills contributed positively on the development of effective systems and processes, thereby improving patient outcomes. The results from this systematic review highlight the complex nature of the Intellectual Disability nurse specialist role and the importance of ongoing development, promotion and evaluation and their contribution to care within the general healthcare setting.
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