Nursing Support and Nurse Staffing: Guidelines to Improve the Health of People with Intellectual and Developmental Disabilities.

Abstract

People with intellectual and developmental disabilities not only experience commonly occurring illnesses but also may have more - and be at increased risk for - health problems. Given their vulnerabilities and health disparities, people with intellectual and developmental disabilities must have access to high quality and consistent health care provided by nurses who understand and address their health needs. Nurses with extensive experience and expertise in the field of intellectual and developmental disabilities worked collaboratively to develop "Guidelines to Improve the Health of People with Intellectual and Developmental Disabilities". These guidelines focus on nursing support and nurse staffing and offer important recommendations for nursing education, practice, and research.

Keywords: developmental disabilities , health disparities , intellectual disabilities , nurse staffing , nursing guidelines , nursing support

INTRODUCTION

People with intellectual and developmental disabilities (I/DD) not only experience commonly occurring illnesses and health problems but also may experience health problems more often or be at increased risk for health problems.^{1, 2} Health disparities between people with and without disabilities include obesity, reduced physical activity, increased stress, limited emotional support, greater reliance on publicly financed health insurance, and less frequent mammograms for women over age 55.³ Secondary health conditions, more prevalent in people with disabilities,⁴ can be prevented by interventions that address the relationship between individual risk factors and environmental factors influencing health and quality of life.^5,6 In a study of women with and without physical disabilities, more secondary conditions were found in women with physical disabilities than women without physical disabilities. One-third of the secondary conditions were significant or chronic. Prevention and management of secondary conditions in women with physical disabilities can be enhanced through creative problem solving by primary care providers and disability specialists and a willingness to include women with disabilities when developing treatment strategies.⁷

When people with disabilities have access to adequate health care, they can lead healthy lives.⁸ However, many people with I/DD experience difficulty accessing needed health and medical care.³ In a survey of persons with physical or sensory disabilities, 85 percent reported facing environmental barriers related to their disability and 22 percent had difficulty accessing the health provider's office.⁹ In a comparison of women with and without disabilities, women with disabilities had similar or better potential health care access than women without disabilities. The women with disabilities had poorer health care, postponed acquiring needed medical care and medications, and were less satisfied with their care. Although their disabilities may increase the health care needs of these women, having access to health care did not always lead to acquisition of care.¹⁰ Increasing access to health and wellness treatment programs and reducing barriers to participating in daily activities are Healthy People 2010 disability and secondary conditions objectives that should be addressed by nurses.³

Concerned over the current nursing shortage, educational needs of nurses working in this field, and the health of people with I/DD, the authors (nurses with extensive expertise and experience in the field of I/DD) developed guidelines on nursing support and nurse staffing. The guidelines began as a project of the American Association on Intellectual and Developmental Disabilities (AAIDD), formerly known as American Association on Mental Retardation (AAMR), Nursing Interests Action Group and evolved to include members of the Developmental Disabilities Nurses Association (DDNA). These guidelines were reviewed and approved by the AAIDD Board of Directors in July 2006.

NURSING SUPPORT

Nursing support in educational, employment, healthcare, and residential settings enhances the health and quality of life of people with I/DD.¹¹ Guidelines for nursing support are presented in Table 1. The clinical skills and knowledge needed by nurses working with people with I/DD are determined by specific needs of each individual with I/DD. Nurses must seek opportunities to acquire new skills and participate in formal and informal education, and their employers must provide them with opportunities to develop new skills and obtain needed education. Resources such as the "Core Curriculum for Specializing in Intellectual and Developmental Disability" offer nurses opportunities for ongoing education.¹² Content on I/DD must be included in the curricula of undergraduate and graduate nursing programs. Continuing nursing education on I/DD must be expanded and offered through local, regional, and national agencies and organizations. For example, continuing education and training on assistive technology may be needed by many nurses. Assistive devices and technology allow people with I/DD to work, go to school, and participate fully in community life.³

Nurses should assess the educational needs of staff who are unfamiliar with I/DD, as described by Tuffrey-Wijne, Hollins, and Curfs in their survey of palliative care staff.¹³ Educational projects such as the Birmingham Acute Hospital Liaison Project should be developed and expanded to assure adequate nursing support for people with I/DD in acute care settings.¹⁴

NURSE STAFFING

Nurses with appropriate educational preparation and clinical expertise should provide care to individuals and groups of persons with I/DD. Guidelines for nurse staffing are presented in Table 2. The ratio of nurses to persons with I/DD, staffing mix, and hours of nursing care provided to individuals with I/DD should be evaluated on an ongoing basis. In a survey of Taiwanese institutions providing care to persons with intellectual disabilities, more than half of the institutions did not employ a nurse.¹⁵ Surveys such as this should be conducted routinely to describe current practice and identify staffing needs. Since quality of work life has been shown to impact the quality of care,¹⁶ ongoing evaluation of trends such as staff illness and injury rates, vacancy rates, overtime rates, use of supplemental staffing, salary, and levels of nurse satisfaction must be conducted.¹⁷

A database similar to the National Database of Nursing Quality Indicators (NDNQI^®)¹⁸ should be developed to examine and compare data from agencies providing services to persons with I/DD. Data on the structure, process, and outcomes of nursing care would provide administrators with the information needed to improve the quality of care and, in turn, the health of persons with I/DD.

SUMMARY

Health disparities are known to exist for many people with I/DD and secondary health conditions are more prevalent. Nurses are in key positions to assist with implementation of strategies to attain Healthy People 2010 Disability and Secondary Conditions objectives. Educating nursing students and practicing nurses about I/DD can help improve the health of people with I/DD and recruit nurses into the field. Improved nurse staffing ratios should be priorities of agencies and organizations providing services to people with I/DD. The relationship between the health of people with I/DD and nurse staffing and education must be examined through research. These guidelines on nursing support and nurse staffing are one step toward improving the health of people with I/DD.