Need Nursing students and Nurses to answer survey question

hello,

i am a senior nursing student and part of my school's honors program. the culmination of this program involves designing a research project of my choice that combines my interests and my chosen field.

i have worked as a patient care technician for 2 years and have had the opportunity to observe nurses caring for adults with developmental disabilities. i have also worked in a group home for almost four years. from these experiences i have noticed a need for education about how to interact with those adults who have developmental/intellectual disabilities and are in an acute care setting.

for this project i would like to assess the knowledge base and level of comfort of current nurses in caring for this population. i also want to find out from nursing students how they feel that care for this population has been addressed in their program. i would really appreciate it if anyone could answer the questions that i have developed for this project.

questions for nursing students

-give 3 nursing considerations that you have learned in school specific to populations with developmental disabilities

hmm, i am out in los angeles. went to bsn nursing school and family sickness caused me to drop out. became lvn. nothing comes to mind about dev disabled pts other than what is suggested for any pt and/or elderly pt. speak to their level; respect pt; if family is around, speak to the pt (but that would be someone who is not cognitively challenged)

-do you feel that nursing school has addressed appropriate care for individuals with developmental disabilities? please explain

not at all. i worked clinical and acute care. i also have a bachelors in social work. it was my social work training that has helped me. i now work private duty in los angeles area and much of the private duty work is with children with acute to chronic health problems and/or developementally disable with health problems. i picked up much of what i know on the job.

-have you ever taken care of a developmentally disabled patient during any of your clinical experiences? if so, what did you learn and how could this experience have been enhanced?

yes a few. did no peds internship at los angeles children's hospital. it was acute care and other than caring for the dev disabled child, cannot remember anything special. in the acute care setting, one looks at the total person, but the focus is often on the medical problem. dev dis children often have communication problems. i wish i had learned sign language. appears no nursing programs offered in this area.

nurses

-tell me about a time you have cared for a resident of a group home or an individual with developmental disabilities in the hospital

no group home. see above for dev dis in acute care hosp

-name 3 challenges you have faced while caring for these clients

communication especially if not cognitively impaired but must use sign language to communicate. i do not understand sign language and it can be tiring on the client and exasperating to try to communicate (especially for a toddler or pre school who cannot read).

often dev dis clients have numerous medical issues as well as adl/iadl deficits. nurse must be knowledgeable and aware for s/s of problems that may occur with these people.

not a problem, but the parent is often more knowledgeable about the dev dis person's problem. some nurses may be intimidated. i was taught to respect the pt's parent's info as they know the pt and the pt's care intimately. one can learn from the families.

-what is your perception of the "sitter's" role in assisting with the care of the client?

depends on the role. is the sitter there to feed the pt or keep the pt from harming themselves? many sitters are experienced caretakers and/or student nurses. respect the sitter for they are you eyes and ears...but keep an eye on the sitter/client. you are responsible no matter what. my mom had pacemaker installed. she came back from recoverfy, ordered and ate dinner, then they started a quick antibiotic iv. she started acting odd and within hr she was litterally bouncing off the walls. cause: med passed blood brain barrier and she was 90. she had to be restrained but elderly little ladies are strong and quick. she kept getting loose, even with me watching her. when i had to go to work, i insisted the icu get a sitter to keep an eye on her...even though the icu nurse had only one other pt, mom was quick and could easily get out of bed and fall, etc. sitter was great. psychologically gave me reasusrance mom was watched and enabled nurse to do nursing duties.....

-name 1-3 things that you wish you knew about this population

-communication; as previously mentioned, sign language

-whether they are medicaid or have pt insurance. often medicaid (low income) pts must go to county emergency room for treatment. that means moving, wheel chair, arranging for transporation (van, ambulance, etc), then sitting for hours in the er with them being exposed to more germs, etc. often parents with medicaid children have difficulty finding doctors or specdialists who will take medicaid.

-referral programs for respit care for full time caregivers. because caregivers are at high risk for injury/death (similar to caregiver of elderly family member), it is important they get assistance also. was never taught the coincidence of caregiver illness/death and being a full time caretaker of the dev disabled, the disabled, the infirmed, or clients with dementia/alzheimers. schools do not teach this info.

-name 1-3 things you wish employees of group homes and parents knew about the kind of care you are delivering

have not worked gorup homes. from what i have seen in pvt duty with dev disabled children/adults, the parents are knowledgeable about their children. if it is an infant who has dev dis and the parent has no knowlege about care (gt tubes, feedigns, suctioning, vent management, etc) then it is up to the nurse to determine parent's lack of knowlede and teach. have been in this situation, also.

thank you so much for your time, it is greatly appreciated!

as they say out my way day nada (albeit americanized way of saying it) --- :-)

tell me about a time you have cared for a resident of a group home or an individual with developmental disabilities in the hospital

i work on an acute care med-surg/tele floor, and we occasionally get clients from the group homes around here.

-name 3 challenges you have faced while caring for these clients

communication is the key challenge i think we face-communication with the client, caregiver/sitter, and family. i feel like i’m not really sure who to talk to.

-what is your perception of the “sitter’s” role in assisting with the care of the client?

i try not to have perceptions of the sitter’s role in assisting with the care of the client..each one is different. some want to be really involved in the pt. care while others stand back and let you do it all. (sort of like nurses lol) i try to find out which type they are early on in the shift. i also find that the sitters can be really good at noticing a small change that i may miss because i don’t know the patient as well. for instance, i had a nonverbal pt with developmental disabilities that lived in a group home. since i did not know his normal and he couldn’t tell me, his sitter was the one who noticed his increasing lethargy that needed to be addressed. she also was extremely helpful for giving him his meds, told me all the tricks that they used to give him meds.

-name 1-3 things that you wish you knew about this population

i wish i knew more about their circumstances and disabilities. in nursing school, i feel like there was very little time spent with clients in group homes (i had 2 days)

-name 1-3 things you wish employees of group homes and parents knew about the kind of care you are delivering.

this one is kind of hard to answer. i always explain what i am doing when i am doing it.

Thank you both so much for your response. The more experiences I have with this population, the more I am beginning to recognize the challenges in this field! I have not even thought of insurance issues (the group home I work at is a private institution, so most of the individuals come from wealthier families and have decent insurance), and your responses have definately supported my observations in my experience. Anyone else's responses are welcome and needed!