Paul Horan, Lecturer, School of Nursing and Midwifery, Trinity College Dublin Following on from Michael McKeon’s recent article in Frontline (56, p.25), Paul Horan examines some of the hard facts facing service configurations for persons with intellectual disability in post-modern Ireland.


Recent pay awards, well deserved as they are, for house parent grades have created a pay anomaly which may mean the death knell of the specialist nursing profession for people with intellectual disability in Ireland, as we currently know that role? (otherwise it seems to refer to Ireland??).

In some ways this anomaly has started a debate in public which has been going on in the intellectual disability sector for many years with regard to the merits and demerits of health and social-care provision for people with intellectual disability. Should care provision follow a social model or should it follow a purely health-focused model (or a medical model, as some call it) of provision. Matthews (1996) suggested that the care of people with intellectual disabilities can be seen by some as a social, rather than a health, issue. There are many issues which need to be addressed, notwithstanding the most important one, which is how professional and caring groups can best meet the needs of people with intellectual disabilities. In some ways the argument lies in the middle ground—because of the broad range and spectrum of needs with which the overall population of people of with intellectual disabilities present. Some clients will benefit from a social-care framework and some from a more nursing/healthcare framework of care. Probably the best framework is one which meets the needs of people with intellectual disabilities without necessarily being pigeon-holed into a particular philosophical paradigm.

The recent pay award which has created a situation where house parents who may have no formal training in caring for people with intellectual disabilities can earn more in real terms than their nursing colleagues. In some ways the latter makes a mockery of the hard work and effort exercised by people who study to become nurses in this field. It is also another example of how government policy in the field of intellectual disabilities is ill thought through.

Do we really need nurses to care for people with intellectual disabilities? Would carers and families rather we didn’t have nurses working with people with intellectual disabilities? After all, people with intellectual disabilities are not sick, so why do they need a nurse to care for them?

These are difficult questions which require careful consideration. My first argument is that the essence of nursing is not just caring for sick people but, as Orem (1981) and Florence Nightingale put it, nursing is really much more about helping people achieve an optimum level of healthy functioning. Surely, is that not what nurses for people with intellectual disability excel at—the art and science of helping and enabling people with intellectual disability to achieve their full potential? So what do nurses who work in this sector really do? According to Seal (1998):

Nurses working with clients with intellectual disabilities have a wide range of skills which enable them to care for clients of all ages and with a widely differing levels of ability—carrying out simple and complex nursing tasks in both social and health care settings.

Nurses work with clients in a broad range of intellectual disabilities—from mild to profound and across their lifespan. Outlined below is a range of skills and roles which nurses working in the intellectual disability sector possess and engage in.

Role of Nurses working with People with Intellectual Disabilities
Care Management Activities
  • Assessing
  • Planning
  • Implementing
  • Evaluating
  • Monitoring
  • Delegation
  • Researching
  • Liaison
Caring Role
  • Healing Relationship
  • Providing Comfort
  • Being Present
  • Increasing Client Participation
  • Comfort and Communication – Healing Touch
  • Providing Emotional Support
  • Providing Information Support
  • Providing Guidance
Nursing Roles
  • Nurse Counsellor
  • Nurse Assessor
  • Nurse Clinician
  • Nurse Therapist
  • Nurse Advisor
  • Nurse Manager
  • Nurse Teacher
  • Nurse Mediator
Teaching and Education
  • Coaching
  • Educating
  • Health Promotion
  • Educational Design
  • Lecturing Role
  • Supervising Research
  • Role Model

(Benner, 1984 & Savage, 1998)

In many ways we do need nurses to work with people with intellectual disabilities, nurses who have been specially trained and educated to carry out the many and complex tasks sometimes required to provide high-quality care. If the role of nurses working with people with intellectual disabilities is further encroached upon, ‘there is a danger that this may lead to the general health needs of people with intellectual disabilities being overlooked’, to paraphrase so why is it quotation marks? Matthews (1996). Specialist registered mental handicap nurses are ideally suited to bridging gaps existing service provision. There is also a role for nurses in this arena to work in partnership with primary healthcare teams and networks, as suggested in Primary care: A new direction (Department of Health and Children, 2001).

Although, having said this, the author is not naïve. What is really required are (I’m never sure!) is a range of professionals (including the RNMH) and support workers working in collaboration to meet the needs of clients and their carers.

Would carers, families and people with intellectual disabilities rather we didn’t have nurses working with people with intellectual disabilities? I can’t answer this question, but answers are needed, because I feel if carers and clients don’t advocate for the role of the nurse in the intellectual disability sector, the role may indeed become extinct in its current format.

To conclude, the future provision of care for people with intellectual disability may have been altered? considerably as a result of the stroke of a bureaucratic pen in the Labour Court, creating a pay anomaly which devalues the RMHN/RNMH. In many ways this is unacceptable—nursing and social-care frameworks for people with intellectual disabilities have been disenfranchised as a consequence, which is an intolerable outcome for all concerned.


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