Negotiating complexities: An ethnographic study of intellectual disability and mental health nursing in New Zealand

Abstract

This paper presents the findings from a study undertaken to describe nursing practice in one dual diagnosis (DD; coexisting mental illness and intellectual disability) inpatient unit in New Zealand. A focused ethnographic approach (using fieldwork observations, a review of documents, and five semistructured interviews) was used to gather data. A model of culture was used to analyze data to allow a description of DD nursing practice. Additionally, this framework allowed for an exploration of the artefacts, values, and assumptions that underpin these practices. Three key themes emerged from the data: keeping everyone safe, managing the complexities in assessment, and narrating their work. Together, these themes indicate that in the absence of a defined model of DD nursing, practice is based on an institutional psychiatric model. We argue that DD nursing models need to be made explicit in order to advance nursing in this area.

A literature review exploring the preparation of mental health nurses for working with people with learning disability and mental illness

“…The origin of the primary research papers could be identified as: UK (Barriball and Clark, 2005;Clark, 2007;Jenkins, 2009;Donner et al, 2010;Bollard et al, 2012;Read and Rushton, 2013;Rose et al, 2012aRose et al, , 2012b, US (Hahn, 2003), Netherlands (Klooster et al, 2009) New Zealand (Taua and Farrow, 2009;Taua et al, 2012) and Israel (Werner and Stawski, 2012). Of the 13 articles included, three distinct categories were apparent which will be discussed:…”

“…Without clear guidance and frameworks for practice, nurse's confusion will remain problematic. In addition a lack of appropriate assessment tools leaves nurses lacking in confidence when they are faced with a person with learning disability and mental illness (Taua and Farrow, 2009;Taua et al, 2012;Donner et al, 2010). A lack of knowledge may promote the continued problem of diagnostic overshadowing with the complex needs of these individuals not being identified (Taua et al, 2012;Donner et al, 2010).…”

“…Apparent mental health problems may be attributed to the person's learning disability (Donner et al, 2010) because dual diagnosis nursing does not have a specific framework for practice (Taua and Farrow, 2009). Instead assessment frameworks are adapted from psychiatric models which tend to emphasise psychiatric needs to the detriment of recognising and responding to needs that are associated with a learning disability.…”

Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: A literature review

“…However, the multiple challenges that nurses face in responding to the mental health needs of this group is critical to understanding the development of best care (Doyle 2000). Effective, evidenced‐based DD nursing practice is dispersed, inadequately defined, and has a poor research infrastructure, yet it is required to respond to all of the contemporary policy and practice requirements related to both ID and mental health nursing (Doyle 2000; Taua & Farrow 2009). What is evident is that there is a clear absence of the articulation of the roles and responsibilities of the nurse.…”

Service use and perceptions of service effectiveness by parents of individuals with intellectual disabilities: comparing Jewish and Arab Israeli parental caregivers

“…Individuals with intellectual disabilities (ID) and dual diagnosis of ID and psychopathology (i.e. behavioural, emotional or psychiatric disturbances) have a wide range of cognitive, physical, psychiatric, communication and social needs (Taua & Farrow ), requiring various services (Schieve et al . ).…”