Identifying the prevalence of aggressive behaviour reported by Registered Intellectual Disability Nurses in residential intellectual disability services: an Irish perspective

Abstract

Purpose -Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach -This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs' within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. In total, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings -The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value -The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland.

Transcultural care and individuals with an intellectual disability

“…Two of the determinants of inequity and health disparities articulated in Table 1 considered the concept of health-damaging behaviour, and according to Emerson (2005), two-thirds of people with intellectual disability present with some form of challenging or self-injurious behaviour therefore are considered health damaging. Furthermore, Crotty et al (2014) found prevalence rates of aggression against property and aggression against others which can cause harm to be 48.9% and 50.7%, respectively, within the intellectual disability community. Considering this, these specific behaviours place people within a culture.…”

“…The introduction of care in the community for people with intellectual disability and challenging behaviour has raised concerns regarding inadequate primary care services, health disparities and inequitable cultural care (Crotty et al, 2014; Parrish and Birchenall, 1997). Members of the primary healthcare and community nursing teams have expressed a need for expertise and further training in the area of intellectual disability and its’ associated behaviours (Aspray, 1999; Crotty et al, 2014; Duff et al, 2000; Lakhani and Bates, 1999).…”

“…The introduction of care in the community for people with intellectual disability and challenging behaviour has raised concerns regarding inadequate primary care services, health disparities and inequitable cultural care (Crotty et al, 2014; Parrish and Birchenall, 1997). Members of the primary healthcare and community nursing teams have expressed a need for expertise and further training in the area of intellectual disability and its’ associated behaviours (Aspray, 1999; Crotty et al, 2014; Duff et al, 2000; Lakhani and Bates, 1999). Research also indicates that health inequities and disparities are often related to the poor quality of local services in effectively supporting individuals with intellectual disability and challenging behaviour in local community and residential settings (Beadle-Brown et al, 2006; Crotty et al, 2014).…”

“…Proactive and reactive strategies could then be implemented to reduce the health-limiting behaviour and health-care professionals can work to support positive health behaviours congruent with the communicative and cognitive ability of the individual. However, training and support in such areas is needed for all those who work with people with intellectual disability and has been openly expressed by those working in this area (Crotty et al, 2014).…”

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities: A systematic review

“…Estimates of the prevalence of aggression among individuals with intellectual disability, including those with mild or borderline intellectual disability (MBID), have reported that as many as 20% may engage in some form of aggression (Davies & Oliver, 2013;Lundqvist, 2013). Verbal and physical aggression are the most frequently reported typologies and are the leading cause for treatment referral in this population (Crotty, Doody, & Lyons, 2014). Both severe physical aggression that may result in bodily injury as well as milder forms of aggression (verbal threats) have the potential to adversely affect the individual with MBID, their family and support staff by leading to isolation, stigmatisation, resource drain and mental health sequela (Hensel, Lunsky, & Dewa, 2014;Woods & Ashley, 2007).…”