The views of Registered Intellectual Disability Nurses’ regarding the future of nurse education in Ireland.

1. The views of Registered Intellectual Disability Nurses’ regarding the future of nurse education in Ireland. Colin Griffiths. School of Nursing and Midwifery, Trinity College Dublin annual conference 2012. 7/8th November 2012.

2. Aim of the presentation • To report on the views of Registered Intellectual Disability Nurses [RNID] on the undergraduate degree programme: its current status and it’s future.

3. Background. • Intellectual disability nursing in Ireland. • ID nursing commenced in 1959. • Schools opened in Clonsilla, Stewarts, Drumcar, St Raphael's, Cope, Sligo, Lisnagry, Moore Abbey. • Certificate course upgraded to Diploma in the 1990s. • Degree started in 2002. • 180 places available across 8 sites: Letterkenny IT, Dundalk IT, St Angela’s college Sligo, DCU, TCD, UCC, Waterford IT and UL. • In the UK there is an ongoing argument regarding ID nurses role and existence but according to the RCN there is a “growing need for nurses in the field of intellectual disability” (Brown et al 2011)

4. Current and future service provision in Ireland. • Congregated settings report. • New Directions [personal support for adults with disabilities]. • Value for Money report. • National Housing Strategy. • All point to personalised [individualised?] support based on the social model. • How does the RNID fit into this framework? • What type of nurse education is required to fit the RNID to the identified roles?

5. Catalyst for the study. • Broad representation of nurses’ views had been received by the DOH at the end of January 2012. • In February the Nurse Manager’s Association for Intellectual Disability in Ireland decided to make a separate submission. • TCD was commissioned to ascertain the views of nurse managers and RNIDs across the country. • Submission of completed research by end of March 2012.

6. Methodology • Qualitative study, using a focus group methodology. • Five venues were selected across the country: Letterkenny, Sligo, Cork, Dublin and Athlone. • Flyers were sent to academic institutions, service providers and nurse managers. • Sample. 67 self selected RNIDs participated. They were 22 Nurse Managers, 12 Nurse Practice staff, 30 Nurses and 3 Lecturers. • Each focus groups lasted between 2 and 2.5 hours. Questions were based on the Department of Health questionnaire regarding the review of the nurse education programme. • Data was recorded on flip charts. • Data was analysed using general thematic analysis (Thomas 2003).

7. Findings. • Key finding. • The importance of retaining intellectual disability nursing as a discrete specialism was emphasized in all the workshops. Retention of the 5 points of entry was therefore considered to be vital.

8. Strengths of the programme. • The unique focus on people with intellectual disability. • Only course that is solely concerned with supporting people with ID. • Graduate is comfortable as a member of the MDT. • The role of the Clinical Placement Coordinators. • The supernumerary - rostered progression. • Reflective practice enables students to assimilate experience into knowledge. • Students develop as critical thinkers.

9. Strengths 2. • The holistic nature of the course • Theory based on evidence. • Graduate nurses are: • Articulate • Reflective • Capable of critical thinking. • Assertive. • Confident • Dynamic • Able to critique research for practice. • Better clinical decision makers. • Questioning.

10. Weaknesses of the Programme. • Failure to fail students in practice. • Placements are too short. • Need for community placements • Preceptors need more support. • Theory-Practice gap. • Insufficient: pharmacology, epilepsy, time spent on physical diseases.

11. Changes to the degree programme -content. • Programme needs to fit the configuration of support services for 2020. • Person-centredness should replace Person Centred Planning. • Assessment of the person with ID should be developed. • Support for people living independently. • Rights based. • Management and leadership to be emphasised. • Change management.

12. Changes to the degree programme –structure. • Retain 5 points of entry. • Academics and practitioners should work more closely together to support the student. • Retain health focus. • Students increasingly learn from non nurses-OTs, SLTs, teachers etc.. These staff need CPC support. • Intern year should be 52 weeks [rather than 36]. • An BordAltranais standards and requirements are too prescriptive, should be more flexible.

13. The Role of the RNID. • The future was seen as community based. RNIDs would be based in primary care teams. • Intervention with those with high support needs. • Liaising with general hospitals. • Teaching and supporting parents. • Home care and support. Care coordination • Early intervention • Managerial and Supervisory. • Service brokerage and care coordinator roles may develop.

14. Role of the RNID-specialisms • Palliative care • People with profound intellectual disability • People with dementia • The elderly • Support role in prisons.

15. The Identity Crisis of the RNID. • Losing the ID nurse would impact adversely on the quality of care for people with ID. • RNIDs have an inferiority complex. • RNIDs need to assert their profile in terms of what they do and how they contribute to people with ID. • Need to convince ID service providers of the value of the RNID. • Need to establish clear career pathways for the RNID. • Leadership in ID nursing needs to be enhanced.

16. Conclusion. • Registered Intellectual Disability Nurses stand at a cross roads. • Services that support people with intellectual disability are being reoriented to become person centred and relocated to small community settings. At the same time there is an ever increasing need for quality healthcare for people with ID. • RNIDs are aware of the challenges, Nurse education can refocus to meet them. • RNIDs must adapt their practice to address the challenges.