Mafuba, Kay ORCID: https://orcid.org/0000-0002-2184-9623, Gates, Bob ORCID: https://orcid.org/0000-0001-7822-6905 and Shanley, Oliver (2014) Report of a systematic review of literature on learning disability nursing staffing levels, and its relation to the safety, quality and the delivery of compassionate nursing care. Project Report. University of West London, London, UK.

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Abstract

Aim
This review sought to summarise best available evidence on safe staffing levels for intellectual disability nurses to inform the implementation of the UK’s national Compassion into Practice Programme, task and finish group for intellectual disability nursing; task area 5. Specifically three questions were asked;

• What, studies, if any, nationally or internationally have been undertaken, and reported on to inform safe staffing levels of learning disability nurses in the delivery of care in a range of different care contexts?
• What themes of relevance to intellectual disability nursing, and the delivery of safe, compassionate care can be surfaced from national and international literature?
• To identify whether there are any intellectual disability specific workforce tools, which could be used in a range of practice settings to inform the level of intellectual disability nursing staff needed to deliver safe and compassionate care for people with intellectual disabilities?

Method
A three-step search strategy was used. First, an initial search of MEDLINE and CINAHL was undertaken, this was followed by analysis of text words contained in the title and abstract, and of the index terms used to describe each relevant article. A second search used all identified keywords. Finally, the reference lists of all identified reports and papers were searched for additional studies. Databases included; CINAHL Medline, PsychArticles, ScienceDirect, Google Scholar, Academic Search Elite. A search for unpublished studies included; Index to Theses [UK only]; ETHOS; Theses.com and Dissertations Abstracts. Further parameters included a limitation to studies undertaken and published prior to commencement of this review 2013, but no earlier than 1993. A time parameter of 20 years was set as it was believed studies earlier than this would be unlikely as the decline in learning disability nurse numbers is a relatively contemporary phenomenon (CfWFI, 2012). The search terms identified for group A ‘ID nursing / staffing levels were combined with those in group B safety/ quality/compassion/communication/ stress/ staffing tools/violence/ restraint / stress / burnout / work overload / exhaustion / caseload, case management, crisis intervention, community outreach, primary care, school nursing, and health facilitator.
Papers selected for retrieval were assessed by the two reviewers undertaking this systematic review for methodological validity, and relevance to the overall aim of the review prior to inclusion in the final review, using the standardised critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Any disagreements arising between the reviewers were resolved through discussion with a review panel comprising members of the Learning Disabilities Task and Finish Sub Group. Data were extracted using a modified Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI); the two reviewers undertook this independently.

Findings
This review anticipated paucity of work undertaken in this area, and that data and material retrieved would be heterogeneous, as well as disparate in nature. 73 papers were retrieved. 12 were excluded after initial appraisal, 3 were untraceable and, 5 were concerned with instrument development. 3 were reviews of literature that included papers in this review. 1 paper was excluded because it focused on general issues of disability, and a further because it focused on support workers. 7 papers were excluded because they were not original studies, and 7 focused on service development. 1 paper was excluded because it focused on physical disability, and a further paper was excluded because it focused on the work of support workers. Finally, 4 were excluded because they focused on staffing issues not relevant to nursing practice. Subsequently, a total of 30 papers were included in this review of literature. Citations were presented chronologically, and a standardized nomenclature was used for their reporting. Reviewed literature was grouped into eight themes that included; level of client need; staff attributes; staff perception of challenging behaviour; job satisfaction; working as a team; stress, burnout and work overload; and finally organisational support including staff feedback and, working in the community.

Conclusions
This systematic review of literature has been conducted in a robust and transparent manner. A number of themes were identified that make sense of the data extracted from the studies reviewed. Subsequently a proposal was made to develop an evidenced based valid and reliable tool based on the concept of ‘context of care’ (Shogren, et al., 2014) located in this evidence base for the delivery of safe and compassionate intellectual disability nursing care to people with intellectual disabilities in a range of settings. This work is timely and contributes to on-going debate in the UK, as to how services ensure that they have the right people, with the right skills, in the right place at the right time, and this may have international resonance (NHSE, 2014).

Item Type:	Report (Project Report)
Keywords:	systematic review; nursing; learning disabilities
Subjects:	Medicine and health Medicine and health > Nursing
Depositing User:	Kay Mafuba
Date Deposited:	13 Sep 2023 14:50
Last Modified:	13 Sep 2023 14:50
URI:	https://repository.uwl.ac.uk/id/eprint/9898

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