Shared Status and Advocating Practices: Nurses Who Work with Clients Who Have a Co-existing Intellectual Disability and Mental Health Problem

This research is informed by the interpretive phenomenology of van Manen, and explores the lived experience of nursing fiom the perspective of nurses who provide care for people with a co-existing intellectual disability and mental health problem. Although nursing research is commonly informed by phenomenology, there is a dearth of literature of any description written fiom the perspective of nurses who provide care for people with intellectual disabilities and mental health problems. As a result of the closure of many large institutions in New Zealand there are not many nurses who work with people who have intellectual disabilities and co-existing mental health problems. The study participants were four nurses purposefully selected because they provided care for people with intellectual disabilities and mental health problems. Data was collected using semi-structured interviews, and the researcher identified and wrote about the recurring themes in the transcribed interview data, which best captured the lived experience of the participants. The themes were: criticism of services, holistic caring, working with the client, issues of status, need for specialist knowledge, enduring relationships, diagnostic issues, advocating, modelling good practice; and working alongside. After further analysis the themes were encompassed within the larger interrelated themes of "Status and positioning" and "Advocating practices", and fmally within a single theme of: "The status and positioning of the nurse and the client leads to advocating practices." These themes were found to be consistent with the nursing literature and with the researchers own lived experience as a nurse who works in a specialist mental health intellectual disability service.  The fmdings of this research have implications for a number of groups in New Zealand. Input is required fiom the Nursing Council ofNew Zealand, the nursing profession, nurse educators and the New Zealand Government to raise the status of clients with co-existing intellectual disabilities and mental health problems and the nurses who work with this client group. The roles for nurses who work with this client group are emerging and are likely to be diverse and there is a need for further research to capture the different experiences of these nurses.