Author: Susan Elisabeth Paech
Paech, Susan Elisabeth, 2007 TOTALLY DIFFERENT: AN ETHNOGRAPHIC ACCOUNT OF INTELLECTUAL DISABILITY NURSING, Flinders University, School of Medicine
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This study adopted an ethnographic approach to examine the role of the Registered Nurse (RN) in the intellectual disability sector. The research setting (The Centre) is a residential facility for clients with intellectual disability in the northern suburbs of Adelaide that opened in 1971 and was similar to a hospital with the same hierarchy of nursing. Mental deficiency nurse training was conducted there until the 1990s but that qualification is no longer recognised. The Centre is under the umbrella of a large state disability organisation that is in the process of moving clients of the service from institutions (the Centre) to community living options such as group homes. The cessation of mental deficiency nurse training and the introduction of deinstitutionalisation were considered to impact on client health and in the late 1990s a 24 hour nursing service was commenced. There was strong anecdotal evidence the service should be evaluated. A review of the literature found some research had been conducted in overseas countries with a focus on deinstitutionalisation but with a paucity of interest in the role of the RN, particularly in Australia. Ethnography, first used in anthropology as a way of describing different cultures, was chosen as the research methodology because the researcher wanted to discover how the culture influenced the role of the RN. The researcher is an RN employed in the area. As an ethnographer and participant observer, the researcher became the data collection instrument. The entire culture is considered to be the sample in ethnography and data took the form of hundreds of hours of field note entries and interview transcripts. Following analysis, the findings were presented in themes answering the research question which was in two parts. The first ‘from the perspective of the nurse, client and other health care professionals, what constitutes intellectual disability nursing?’ and secondly ‘what are the every day rituals, norms and patterns within the disability culture that shape and influence disability nursing for the Registered Nurse?’. ‘Caring for the client who is institutionalised’, ‘The RN in the disability sector having certain qualities’, ‘Working within a different paradigm’, ‘Having to assume responsibility for large numbers of unregulated workers’, ‘Having to work alongside many professional groups’ and ‘Having different educational needs’ are themes which describe the role. Themes describe the diversity of the role and in describing the registered intellectual disability nurse as ‘different’ the role is compared with that of the nurse in other settings. The current research revealed there is a need for more health related education for unregulated workers and specific intellectual disability education for registered and enrolled nurses. Themes that answer the second part of the research question are ‘hierarchical structure’, ‘the Registered Nurse's position’ and ‘role confusion’. The non-nursing management at the top of the hierarchical ladder was found to significantly limit the role of the RN who was afforded no opportunity for leadership. Confusion over the RN's role and indeed individual workers' roles was observed at all levels. Findings suggest much stronger nursing leadership is required to provide advocacy and holistic care for the client and education for the carer. An outcome of the current research was the development of a model for intellectual disability nursing (see Table 8-1).
Keywords: Intellectual Disability,Nursing,ethnography,Leadership,Disability Nursing,Holistic Care
Subject: Disability Studies thesis
Thesis type: Doctor of Philosophy
School: School of Medicine
Supervisor: Dr Brian Matthews