Despite many delays, this report which, identified the future needs and direction of Intellectual Disability Nursing, was finally published and launched in September of last year.
The project represented a comprehensive examination of the present day role of the Registered Nurse Intellectual Disability (RNID) in Ireland. The views of a broad range of stakeholders’ were sought and analysed to address the overall aim of determining the future role of the RNID. The aim of the project was “to determine the future role of the registered nurse intellectual disability (RNID) who provides health and social care services to individuals with an intellectual disability and to their families and carers in this changing landscape”.
This report produced 32 recommendations. There are 31 recommendations for the expansion of the skills and nursing roles of RNIDs to encompass a lifespan approach to care for people with intellectual disabilities, from perinatal to end of life care, in 4 framework themes. There is also a final recommendation of ownership of the delivery of the recommendations, to ensure the future development of the discipline and create and establish much needed new and more specialised roles for RNID’s.
- Theme 1: Person-Centredness and Person-centred Planning
- Theme 2: Supporting Individuals with an Intellectual Disability with their Health, Well-being and Social Care.
- Theme 3: Developing Nursing Capacity, Capability and Professional Leadership
- Theme 4: Improving the Experience & Outcomes for Persons with an Intellectual Disability and their Families
The report states that
‘In the context of integrated workforce planning, this will require senior nurses, planners and managers of services to examine the deployment of RNIDs to ensure that they are assigned to and supported in these roles.
As care from congregated settings continues to move to community settings, some RNIDs may be redeployed from roles where their predominant activity is the direct provision of care, to roles where they are also managing and coordinating health, well-being and social care for the person with an intellectual disability.
Evidence from this review highlighted the need for new and expanded roles and ways of working, and identified critical areas for the development of specialist and advanced RNID clinical practice to meet the growing challenges of supporting people with profound and complex health needs.’
The specific recommendations which the report suggests are required to progress these components in practice are as follows;
Theme 1: Person-Centredness and Person-centred Planning
Recommendation 1
RNIDs will ensure that their practice is informed by the values and principles of person centredness and person centred support in the assessment, planning and delivery of health and social care to individuals with an intellectual disability in all settings.
Recommendation 2
RNIDs will receive professional development in supporting self-determination and person-centred planning, including advanced advocacy skills in order to continue to assist individuals with an intellectual disability and their carers in linking with and navigating community based and general health and social care services.
Recommendation 3
The HSE will develop specific policy and systems for professional supervision within Intellectual disability services in accordance with the HSE’s overall HR circular on clinical supervision. RNID’s will be supported to engage with regular and effective professional supervision to ensure that the values of person centeredness are applied consistently in practice.
Recommendation 4
The focus, knowledge, skills and competence of RNID’s will support the increasingly interdisciplinary, community based and person-centred services world of individuals with an intellectual disability.
Recommendation 5
RNID’s will work collaboratively with other disciplines to support families in pursuing and achieving positive opportunities in the lives of their family member with an intellectual disability.
Recommendation 6
RNID will be supported to undertake training to understand the components of the Assisted Decision Making (Capacity) Act (2015) in respect of the need for legally recognised decision-makers to support a person maximise their decision making powers and to develop an understanding of what this means for staff caring for individuals with an intellectual disability.
Theme 2: Supporting Individuals with an Intellectual Disability with their Health, Well-being and Social Care.
Recommendation 7
Individuals with an intellectual disability will have access to RNID’s in a variety of roles in primary, secondary and tertiary care settings who have specialist knowledge and skills in their health and social care support requirements and in alternative communication approaches.
Recommendation 8
RNID liaison posts will be developed within acute hospital services to support the individual with an intellectual disability throughout their entire acute hospital journey.
Recommendation 9
RNIDs will be embedded within existing health and social care provision and be clearly identified as key members of multidisciplinary teams working with individuals with an intellectual disability and their carers in intellectual disability-specific and more general health and social care settings with designated leadership and governance roles.
Recommendation 10
Specialist RNID roles will be available in all locations to support individuals with an intellectual disability including for example community agencies, schools and other educational facilities, workplaces, legal and business services and the criminal justice system.
Recommendation 11
RNID’s will undertake a care management and liaison role in mainstream health services ensuring timely access to care and support to the person with an intellectual disability.
Theme 3: Developing Nursing Capacity, Capability and Professional Leadership
Recommendation 12
Pre and post registration educational curricula will be strengthened to better prepare RNID’s to respond effectively to the increased complexity of health, well-being and social care needs of people with an intellectual disability across the lifespan.
Recommendation 13
A broader range of intellectual disability placement opportunities will be developed for undergraduate nursing students and new supervision guidelines developed so that the expectation of RNID supervision does not preclude the utilisation of some placements.
Recommendation 14
Continuing professional development and post graduate education programmes for RNID’s will be developed informed by service need and delivered using a blended learning approach as appropriate. Examples of areas requested for development include (1) autism; dementia; ageing; epilepsy; bone health; behavioural support; advanced and augmented communication; and community care support and (2) general and specialist health assessments, providing health and social care, supporting families, and liaising with other professionals in work with individuals with intellectual disability across the lifespan.
Recommendation 15
Higher Education Institutions will further develop collaborative partnerships with intellectual disability services to enhance the skills and competencies of nurses to ensure positive health outcomes for individuals with an intellectual disability.
Recommendation 16
Persons with an intellectual disability will increasingly be involved in the design and delivery of education programmes and policy.
Recommendation 17
RNID’s will work to ensure their practice is evidence based by strengthening their involvement with practice development initiatives, availing of continuing professional development opportunities, engaging with research activity and participating in professional supervision.
Executive Summary
Recommendation 18
Policies, procedures, protocols and guidelines will be developed to support areas of intellectual disability nursing practice in all settings; to include autism, dementia, ageing, epilepsy, bone health, behavioural support, advanced and augmented communication, primary, community and social care, acute general and mental health services to include hospital based services and primary care practices.
Recommendation 19
Clinical Nurse Specialist and Advanced Nurse Practitioner roles will be developed in accordance with the criteria identified by the Nursing and Midwifery Board of Ireland and in response to identified service need: to address disparities in health policy implementation, health service delivery and health outcomes for individuals with an intellectual disability.
Recommendation 20
Consideration should be given to the appointment of joint posts between intellectual disability services and higher education institutions to progress the development of an evidence base for intellectual disability nursing practice.
Recommendation 21
Bespoke leadership development programmes should be developed and provided for nurses working at all levels within intellectual disability services.
Recommendation 22
RNID’s throughout the health economy will explore mechanisms to network and share practice and research including the use of journal clubs, networks, conferences and seminars and social media. Specifically RNID’s are encouraged to build a network with colleagues at national (including Northern Ireland) and CHO level to be informed of information sessions and training schedules that are provided in relation to specific topics.
Recommendation 23
RNIDs will respond to contemporary health, well being and social care policy and provide clinical leadership ensuring that the needs of people with an intellectual disability are addressed.
Recommendation 24
Opportunities should be created for RNIDs to have a greater voice at national policy level to articulate, advise and inform contributions by intellectual disability nursing in responding and addressing health disparities for people with intellectual disability.
Theme 4: Improving the Experience & Outcomes for Persons with an Intellectual Disability and their Families
Recommendation 25
Nurse leaders and Persons in Charge within intellectual disability services will be supported to undertake and engage in relevant education and provided with subsequent support to develop a systematic approach to quality measurement and improvement within their area of responsibility.
Recommendation 26
Nurse leaders and Persons in Charge will participate in the wider professional nursing fora at regional level and engage in quality related development activities.
Recommendation 27
The capacity and capability of nurses within disability services will be developed to implement and evaluate evidence based quality improvement methodologies through the provision of relevant education programmes and subsequent support.
Recommendation 28
Nurses at all levels working in disability services will access and implement the resources and tools developed by the HSE’s Quality Improvement Division to support governance and quality improvement.
Recommendation 29
RNID’s will be supported to undertake training in the HSE national risk assessment and safety management guidance for intellectual disability services which will take into account overall HSE policy in this regard. The RNID should be key in its application to practice; specifically in areas of incident reporting, investigation and using findings to inform learning and change.
Recommendation 30
The HSE will develop a national advocacy programme for intellectual disability services to support person centeredness. RNID’s should be actively involved in its development.
Recommendation 31
RNID’s will ensure their practice demonstrates an acknowledgement of the dynamic nature of risk ensuring that there is ongoing multidisciplinary and collaborative review of the type and level of risk and associated updating of safety plans of individuals with an intellectual disability.
Recommendation 32
The Social Care Division, in partnership with the Office of the Nursing and Midwifery Services Director will establish the appropriate structures and processes to lead, drive and monitor the implementation of the recommendations of this report.
Implementation Steering Group
An Implementation Steering Group has been set up to oversee the roll out of the recommendations of the report. The first meeting of this steering group took place on March 12th 2019, where Terms of Reference for the group were set out and agreed. Sub-groups have been formed to examine and oversee the implementation of these recommendations in areas such as
- Education,
- Professional Development,
- Policy Making
- Risk Management.
The Shaping the Future of Intellectual Disability Nursing in Ireland project recognised the value of the RNID in the delivery of high quality person-centred care to people with an intellectual disability. The implementation of the report’s recommendations offers an opportunity for the further development of the RNID discipline. Increased CNS, ANP and leadership roles will be developed to meet the changing needs, demographics and models of service provision for people with an intellectual disability.
The development of the RNID’s capacity and capability to underpin intellectual disability nursing practice in all settings throughout the lifespan of the individual with an intellectual disability requires expansion into areas such as
- Paediatric services
- School services
- Primary care
- Acute hospital care
- Forensics
- Perinatal to end of life approaches
- Working in conjunction with Government systems e.g. housing, justice, education and employment
The aim of the group is to support the implementation of the recommendations of the Shaping the Future of Intellectual Disability Nursing in Ireland report, and monitor the progress of the plan.
Their role in respect to each of the recommendations will be to:
- Develop a detailed action plan
- Identify who has lead responsibility
- Identify the resources required (human and financial)
- Outline the time frames for the implementation of the recommendations
- Drive and monitor the implementation plan.
The PNA, as a stakeholder, will be involved in this implementation group, and will work to ensure that this will guide ID Services in the creation and establishment of much needed new and more specialised roles for RNID’s.
