Case study discussion: The important partnership role of Disability Nurse Navigators in the context of abrupt system changes because of COVID-19 pandemic

Abstract

Background Rapidly implementing telehealth-facilitated healthcare services in a COVID-19 environment generates relational challenges for people with intellectual disability. Disability Nurse Navigators assume a critical intermediary role between the healthcare system and this population. Aim To discuss the impact that rapid service change, in response to the COVID-19 pandemic, can have on people with disability and the work of Disability Nurse Navigators who support them. Methods This clinical case discussion comprises two parts. First, a discussion on the impact that COVID-19 pandemic management has had on one person with an intellectual disability is framed using intersecting notions of cumulative complexity and Burden of Treatment Theory. Following, through a Latourian lens, the role of the Disability Nurse Navigator is explored. Findings During COVID-19, telehealth has proved an important tool for healthcare continuity. Yet, for some people with some disabilities who live with additional and cumulative layers of health and social complexity, the healthcare workload that is transferred to them is exacerbated as they try to interact with disabling infrastructure. Discussion The Disability Nurse Navigator recognises that people with disability are not independent of the technologies and structures that make up the healthcare system but that they are mutually constitutive. The Disability Nurse Navigator thus works to stabilise the relationships between changed service provision and the healthcare workload and capacity of people with disability. Conclusion The work of the Disability Nurse Navigator ultimately mitigated the disruption and additional treatment burden that is transferred to people with disability because of unintended consequences arising from the rapid introduction of service change.

Supporting the needs of people with intellectual and developmental disabilities 1 year into the COVID‐19 pandemic: An international, mixed methods study of nurses' perspectives

“…In Australia, the preregistration IDD nursing specialty was discontinued in 1999 in favor of general nursing education. In 2015, in Queensland, Australia, the disability nurse navigator role was rolled out to assist people with complex health needs and disability to move efficiently and effectively through acute, sub‐acute, and community care (Brunelli et al, 2021 ). In the United States, general nursing education has been the long‐standing paradigm, with little to no disability content in undergraduate or graduate nursing curricula (Auberry, 2018 ).…”

inclusive, social space-oriented participation of people with disabilities in the Bavaria–Tyrol border region during the COVID-19 pandemic

“…The pre-existing lack of barrier-free options for public transport between Bavaria and Tyrol, accompanied by differences in regional tariff systems, benefits, eligibility requirements, application processes and the recognition of the disability card, was expanded to include frequency limitations of public transport, heightened restrictions on passengers and the cancellations of crossborder public transport during the pandemic. This confined the individuals' agency to their home countries instead of promoting cohesion and elevating a sense of participation (Mazzoni et al, 2018), but also reduced the already scarce social participation of PWD (Kim, 2021); this further impoverished the social networks of PWD and their social interactions (Brunelli et al, 2021) via a decreased contact with family and friends and participation in the community (Koon et al, 2021).…”

The Financial Costs of Registered Nurse-Led Relationship-Centred Care: A Single-Case Australian Feasibility Study

“…Intellectual Disability Nurse Specialists have been shown to be effective in promotion person-centred care, facilitating systems co-ordination, and conduct professional development activities to enhance the knowledge and skills of a range of health care professionals for the benefit of clients and their families in the UK [35]. The equivalent Australian nursing role of Disability Nurse Navigator has proved to be an effective support for people with intellectual disability who might otherwise experience compromises to their health due to changes in service delivery models, for example, the expansion of telehealth, necessitated by the restrictions imposed in response to the COVID-19 pandemic [8]. A delegated care model might be justified by the financial saving to the disability service, as outlined in Scenarios 3 and 4, but it is difficult to justify in terms of the health and wellbeing of an individual client such as Derek and cost shifting to the health sector.…”

“…With respect to the recent COVID-19 virus that has spread globally, people with intellectual disability are reported to have up to a 2.2 times greater fatality rate when compared to the general population [7]. In addition, the social and other restrictions have had an added impact upon people with intellectual disability where specialised nursing support-support that is often not available within a generalised health system-has made a difference to enabling access and better outcomes from health services [8].…”