Following on from Michael McKeon’s article in the last issue of Frontline, Paul Horan examines some the hard facts facing models of care for people with intellectual disability.


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 it.

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 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, as some might say, a medical model of provision.

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 standpoint.

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 may in real terms earn more than their nursing colleagues, in some ways 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 governmental 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, families and people intellectual 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?

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 the whole spectrum of lifespan. Outlined below is a range of skills and roles which nurses working in the intellectual disability sector possess and engage in.


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