The working group, established in 2002, under the auspices of the Eastern Regional Health Authority (ERHA) comprised representatives from the Nursing /Midwifery Planning and Development Unit (NMPDU) in the Eastern Regional Health Authority, nursing service providers within the region, and the Nursing Policy Division of the Department of Health and Children. The terms of reference of the group were to:
- establish the context in which mental handicap nursing is carried out within intellectual disability services in the ERHA,
- identify where nursing services can contribute to further development in primary, secondary and tertiary bands of care,
- advise on the development and planning of nursing education and training programmes, and
- identify the clinical pathways in mental handicap nursing to inform the development of clinical nurse specialists and advanced nurse practitioners within existing services in the Eastern Regional Health Authority.
This report clearly reinforces the pivotal role that the Registered Mental Handicap Nurse plays as part of the multidisciplinary team in the provision of services for people with an intellectual disability within the Eastern Regional Health Authority (ERHA). It sets out 28 recommendations to maximise the nursing contribution within intellectual disability services. It is envisaged that implementing these recommendations will ultimately improve the quality of care for clients with an intellectual disability and their families, and provide the direction necessary for informing and developing nursing practice and service development at a regional level.
The report is divided into seven chapters. Chapter One outlines the background and context of the report and puts into perspective the recent relevant national reports which have impacted upon and influenced intellectual disability nursing in Ireland. It highlights that service providers and RMHNs working in such services must be prepared to respond to the needs and demands of people with an intellectual disability as identified by the National Intellectual Disability Database (2002).
Chapter 2 acknowledges the unique knowledge of the RMHN. It outlines the key difficulties pertaining to recruitment, staffing and retention, and the challenge that these difficulties pose for service providers, higher education institutes and nursing to develop a strategy to market and raise the profile of mental handicap nursing. It recommends that service managers need to have a clear vision of what mental handicap nursing can contribute to their service and put in place policies to establish and maintain career pathways that will not only attract nurses, but also retain nurses committed to maintaining high professional standards.
Chapter 3 focuses on the role of the RMHN and issues pertaining to professional development. The working group advocates and reinforces the partnership approach to care within a multidisciplinary context and identifies two frameworks that outline the role of the nurse in primary, secondary and tertiary care—one which uses a lifespan / chronological approach across the locations of care, and the second which is adapted from Whoriskey and Brown’s framework and outlines the role of the RMHN according to the client’s level of dependency. In acknowledging that the scope of professional nursing practice within intellectual disability services is poorly understood and requires clarification, the working group recognise that the development of clinical nurse specialists and advanced nurse practitioners are needed to provide the expertise and leadership necessary to meet the complex needs of people with an intellectual disability.
Chapter 4 emphasises the need for services to invest in and develop a training, development and education strategy specific to their organisational needs and highlights the significance of this in ensuring that staff have the appropriate knowledge and skills for competent practice. The working group also stress that senior nurses and service managers must be committed to enabling staff to utilise their skills and competence effectively within the service.
Chapter 5 focuses on issues pertaining to professional leadership and practice development. It purports that practice development is an organisational challenge, as opposed to an individual one, and it identifies the key attributes and characteristics conducive to practice development.
Chapter 6 recognises that the development of specialisation within intellectual disability services is a priority and calls for clinical nurse specialists and advanced nurse practitioners within intellectual disability nursing. The working group have recommended seventeen areas of practice as the basis for specialist practice and three areas of practice for advanced nurse practitioners. It concludes by highlighting the need for RMHNs to be engaged in research at a professional and service level, although it also acknowledges the need to put in place the infrastructure to support nursing research.
The report clearly acknowledges the central coordinating role of the RMHN within a multidisciplinary context and firmly establishes the RMHN as an integral part of intellectual disability services. It suggests that the nurse should remain central to assessment, planning, implementation and evaluation of client care, and to the supervision and delegation of activities associated with client care. It is envisaged that the recommendations of the working group, which should be embraced and acted upon within a multidisciplinary context, will ensure the RMHN has the necessary knowledge skills, attitudes and competence to meet the needs of persons with an intellectual disability and their families in a valuable and meaningful way.