Mediating the interface between voluntariness and coercion: A qualitative study of learning disability nurses’ work in medical examinations of people with intellectual disability

Abstract

Aims and Objectives:To gain knowledge of prevention and use of restraints in provision of medical care to people with intellectual disability. To this end, we explore how learning disability nurses in community services support the individual through medical examinations when facing resistance.Background: Despite increased focus on limiting restraints, there is a lack of knowledge of how restraints are prevented and used in the delivery of physical health care to people with intellectual disability. Design:We used an ethnographic comparative case design (n = 6). Methods:The study was carried out in Norway. The analysis is based on data from semi-structured interviews, participant observation and document studies, in addition to health sociological perspectives on how to support individuals to make their body available for medical examination and intervention. The SRQR checklist was used.Results: Learning disability nurses strove to ensure that examinations were carried out on the individual's terms, supporting the individual in three phases: preparing for the examination, facilitating the examination and, when facing resistance, intervening to ensure safe and compassionate completion of the examination. Conclusions:Supporting the person was a precarious process where professionals had to balance considerations of voluntariness and coercion, progress and breakdown, safety and risk of injury, and dignity and violation. Through their support, learning disability nurses helped to constitute the "resistant" individual as "a cooperative patient," whose body could be examined within the knowledge and methods of medicine, but who could also be safeguarded as a human being through the strain of undergoing examination.Relevance to clinical practice: The article sheds light on how restraints are used in the medical examination and treatment of people with intellectual disabilities and demonstrates the significance of professional support workers' contributions, both

Health checks for adults with intellectual disabilities

“…Fastleger kan vaere utrygge i møtet med pasienter som har en medfødt kognitiv funksjonsnedsettelse, og undersøkelsessituasjonen er ofte krevende for pasienten (6). Det vil vaere behov for opplysninger fra naerstående personer, støtte til kommunikasjon og til å få gjennomført helsekontrollen (6). Nasjonalt senter for aldring og helse har utarbeidet informasjonsmateriell for fastleger og for personer med utviklingshemming.…”

Behavioral interventions addressing needle-based medical procedures in individuals diagnosed with intellectual and developmental disabilities: A scoping review.

“…Approximately 30–40% of individuals with IDD are given anesthesia for a variety of diagnostic and medical procedures including blood tests (Chaudhary et al, 2017). The use of sedation or restraint pose additional risks to both patients and medical personnel (Allen & Kupzyk, 2016; Sparby et al, 2020). Sedation, or chemical restraint, can produce undesirable adverse side-effects including but not limited to cardiorespiratory depression, central nervous system depression, tremors, slurred speech, anxiety, distress, and paranoia (Chun et al, 2013).…”