Essay On Intellectual Disabilities

Michelle is daughter of Maureen McIlquham who had an intellectual disability. She was 28 years old young women who died after getting discharged from hospital in an autumn night in 2009.In May 2009, she became unusually quiet to which a local doctor told it’s an infection and prescribed antibiotics. After some hours she had a seizure and was rushed to the hospital, she was agitated and in pain with uncontrolled headache ("Michelle was discharged after 'temper tantrum', hours later she was dead", 2022). She and her mother faced many challenges during the hospital care when she was admitted and her mother believes that due to the doctor’s decision of discharging her it led to her death.

 

The major challenges were the discrimination faced by them as a patient of intellectual disability. Her mother tells about how Michelle had addressed the sufferings, explaining about ear infection and inappropriate behaviour. She also told the doctors she would love singing and dancing and now could barely speak. She was rocking back and forth on the hospital floor, covering her ears and screaming. Because of this behaviour she was not treated well by the staffs and doctors. They refused to take the case, she needed an appropriate treatment and care but it was not provided by the hospital. Her coroner discovered that her staff did not deliberately discriminate against her, but instead part of her behaviour was not a serious illness because she had intellectual disability. The doctor wrote a discharged paper and she got discharged very next morning.

 

The other challenge was the behaviour faced by hospital staffs and doctors and the way she was discharged without getting proper treatment and advice. The doctor wrote in a note on her discharge form that, Michel had a temper tantrum, which made her mother even got more worried that she was not ill. She had a mental disorder and had a temper tantrum because of her mental disability ("Michelle was discharged after 'temper tantrum', hours later she was dead", 2022). Her mother refuse to go back home as Michelle was still sick but then the security was called and they were made to go from a taxi.  She could barely able to walk when she reached home and after Seven hours of her discharge, Michelle McKilkham held her breath at her home in western Sydney. The doctors tried to revive her, but she did not make it. There was nothing they could do. She died a few minutes later." Maureen has been plagued by her idea that the death of her daughter is inevitable for eight years

 

It is found that one in three deaths in people with an intellectual disability was from a potentially avoidable cause (Trolloret al., 2017). People like Michelle still struggle to be provided by a proper healthcare process suffering with intellectual disabilities and had to face challenges during their treatment.

 

Decision-making in nursing science is major component to facilitate the understanding and informing the practice with education of nursing for enhancement in patient care (Nibbelink& Brewer, 2018). Decision making includes clinical judgements which conclude about the status of patient and the methods for interventions to give best care and assessments needed. Decision making is a process which is influenced with various factors and forces. The process ends with fulfilling the motivating forces (Nibbelink& Brewer, 2018). The perception is also one of the major factors affecting decision making. The individual perception can be affected by goals, environment and values. Making decisions is composite process which involves confidence, knowledge and critical thinking (Bliss & Aitken, 2018). Hence, it is important to provide the nurses with the skill and work on the enhancement to this skill for providing better care and eliminating the cases which lead to serious consequences due to decisions made by healthcare professional. 

 

The strategies which will promote decision making includes-Implementing EPOC (effective Practice and Organisation of care) which aims to maintain and prepare systematic reviews of financial, professional, regulatory and organization interventions which are designed for improving practice and effective delivery of health services (Légaré et al., 2018). This is designed to prepare evidence-based experiences of different conditions or situation of health care, outcomes and treatment. Decision making guidelines are evolved using these evidences which can be used to identify the cases and relate it. the feasibility and acceptability of different options of healthcare for different patients and situations can be implemented using these considerations (Downe et al., 2019). In the case study mentioned above EPOC could have been very effective as, the experiences and evidences may have helped the doctors to know the severity of the situation and come up with a solution and treatment. The doctors may have start with medication and assessments rather than discharging her in absence of appropriate information about intellectual disabilities.

 

Another intervention is to support and facilitate deliberation of interventions, the healthcare experts have to consider that there are reasonable options for providing patient care and they need time to come with a solution, preventing the decision making at single or first visit of the patient (Sullivan & Heng, 2018). Ethically the doctors have to explain about the patient’s case and its possible intervention to their family. It’s the responsibility of doctors to provide correct information about the patient’s condition to their family or caregivers as they rely only on doctors on this. Relating it to Michelle’s case if her mother would have the correct information about her conditions, she would have taken some more steps for her wellness such as consulting another healthcare expert or going to the specialised healthcare institution.

 

Person-centred care is an idea of treating any person with respect and dignity who is receiving healthcare treatment with the consent and involvement of the patient or their care givers about their condition of health. The person has to be involved direct in the case and every step of treatment. Critical elements for person-centred care involves of an individualized care plan which is goal oriented based on the individual’s preference. The care plan and goals have to be reviewed by the person and supported by the inter-professional team.

 

It is recommended because of the evidences that implementing person-centred has been effective. The recommendations from the above evidences are – knowing the patient as it helps in diagnosis and every person has a different personality so needs different approach in treatment. Another recommendation is to accept and recognise the ability of person’s reality which will help the person deal with the condition. (Fazio et al., 2018). Supporting and identifying the opportunity will enhance the person to deal and have the courage to fight with the disease. Person-centred care also nurtures and builds a caring relationship with person and healthcare providers to access the engagement for treatment. Evaluation of care practices on a regular basis is important to regularly evaluate the condition of the patient (Fazio et al., 2018). Relating to the case of Michelle, if she would have taken a person-centred care, she would be clearer about the symptoms and her condition. She would know how to handle and have behaved appropriately rather than being quiet, she would have analysed her symptoms and talked about her sufferings to which the healthcare provider has given appropriate suggestions and treatment. Hence, it would have helped the patient and the health care expert to deal wit the disease and situation for further situation.

 

Bliss, M., & Aitken, L. M. (2018). Does simulation enhance nurses' ability to assess deteriorating patients?.Nurse education in practice, 28, 20-26.https://doi.org/10.1016/j.nepr.2017.09.009

 

 

Fazio, S., Pace, D., Flinner, J., &Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(suppl_1), S10-S19. https://doi.org/10.1093/geront/gnx122

 

 

Glenton, C., Lewin, S., Downe, S., Paulsen, E., Munabi-Babigumira, S., Johansen, M., ... &Bohren, M. A. (2021). Qualitative evidence syntheses within cochrane effective practice and organisation of care: Developing a template and guidance. International Journal of Qualitative Methods, 20, 16094069211041959. https://doi.org/10.1177%2F16094069211041959

 

 

Légaré, F., Adekpedjou, R., Stacey, D., Turcotte, S., Kryworuchko, J., Graham, I. D., ... & Donner‐Banzhoff, N. (2018). Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane database of systematic reviews, (7).https://doi.org/10.1002/14651858.CD006732.pub4

 

 

Michelle was discharged after 'temper tantrum', hours later she was dead. Abc.net.au. (2022). Retrieved 1 August 2022, from https://www.abc.net.au/news/2017-02-08/study-finds-intellectually-disabled-two-times-preventable-death/8248772.

 

 

Nibbelink, C. W., & Brewer, B. B. (2018). Decision‐making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917-928.https://doi.org/10.1111/jocn.14151

 

 

Sullivan, W. F., & Heng, J. (2018). Supporting adults with intellectual and developmental disabilities to participate in health care decision making. Canadian Family Physician, 64(Suppl 2), S32-S36.https://www.cfp.ca/content/64/Suppl_2/S32.short

 

 

Trollor, J., Srasuebkul, P., Xu, H., & Howlett, S. (2017). Cause of death and potentially avoidable deaths in Australian adults with intellectual disability using retrospective linked data. BMJ open, 7(2), e013489. http://dx.doi.org/10.1136/bmjopen-2016-013489