Running head: CARE FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES

Proper Care for Individuals with Intellectual Disabilities

In an Acute Mental Health Ward

Samantha Glass

James Madison University

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Proper Care for Individuals with Intellectual Disabilities

In an Acute Mental Health Ward

Proper care of individuals with intellectual disabilities (ID) is an important problem that

needs to be addressed in the United States. Patients with ID often receive care that is

inappropriate considering their diagnosis. In the UK, the government recommendation for

hospitalization for individuals with ID is to admit them to an acute mental health ward (Simpson

& Soni, 2016). According to a study by Chaplin, sometimes the admission may be inappropriate

for the individual and can lead to a poor outcome (2009). In the United States, the care of ID

individuals is also insufficient. Patients with ID do not often receive the care that they need or

have access to facilities that can appropriately address their condition (Bakken & Martinsen,

2013). The lack of facilities and proper judgment by medical professionals in admitting a patient

with ID clearly makes it a situation worth addressing and fixing. This is an ethical dilemma that

many health care professionals come across that puts them in moral distress due to the lack of

resources for these individuals.

Background

While attending clinical at Western State Hospital, I came across an ethically difficult

situation that involved a patient, admitted to an acute mental health ward, with ID. The patient

had been admitted the previous night after leaving his father with a concussion and a broken leg.

The individual was diagnosed with autism and was being put into a restraining chair for

becoming violent with the staff. He was restrained for over four hours, but finally released after

being given medication to calm his behaviors. After being released he was put on a two to one

staff ratio. My response to the situation was lacking due to my position as a student nurse. I was

unable to help, comfort, or redirect the individual because of the dangerous situation. However,
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if I were in a different position, and if there were better facility alternatives, I would have liked to

send them to a different location that was more adequate to care for individuals with ID.

Due to the circumstances, this situation caused me moral distress because I knew that

there was a right answer, but the absence of proper care and facilities made it impossible to

achieve. This situation conflicted with a previous experience I had while working at a group

home for individuals with ID. A resident of mine had been taken to the emergency room due to

claims of having a delusion that consisted of her murdering someone. As a facility, we felt that it

was in the best interest of this resident to be admitted to an acute mental health ward. However,

when at the hospital, they refused to admit her due to her diagnosis of bipolar disorder and

because she was currently not a threat to herself or others. I was then told that once an individual

is labeled ID it is very hard for them to receive the proper treatment that is needed for their care.

Methods/Findings

To analyze the scenario, I will be using James Madison University’s Eight Key

Questions. The Eight Key Questions are meant to facilitate decision-making with the use of eight

important values that include: fairness, outcomes, character, responsibilities, empathy, liberty,

rights, and authority (The Madison Collaborative, 2013).

Fairness: It is not morally fair to treat an individual with ID the same as a patient with a

psychiatric diagnosis. As stated above it has been proven that individuals admitted to an acute

mental health ward have poorer outcomes than those who are not treated on a psychiatric ward.

This is because of the different methods that are required to treat an ID patient versus a

psychiatric patient. Although the patients may have similar psychological symptoms, their

cognitive function varies and therefore procedural fairness does not apply to this scenario.
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Outcomes: When caring for an individual with ID we need to be thinking of the long-

term outcomes of that patient and how our care is going to affect them. In this scenario we were

thinking about the short-term outcomes when putting the client in the restraining chair, which

reduced the risk of him harming others. However, we did not care to analyze the long-term

effects and take into consideration that this particular patient has a mind-set of a two-year-old.

Character: My ideal self would be able to stand up for him and be able to provide

information and resources on appropriate care for those with ID.

Responsibilities: As health care professionals, it is our obligation to make sure that our

patients are receiving proper care according to their diagnosis. It is also our responsibility to look

at every detail of the scenario, and if we find a flaw, to speak up and do something about it.

During this situation it was hard for me to fulfill my responsibilities because of the moral distress

and my position.

Empathy: When witnessing this troubling situation, I was able to feel true empathy for

this patient. It troubled me to know that there was not a better option available for him. It also

broke my heart to think that we were putting a grown man with the mentality of a two-year-old

into a restraint chair. This made me question what he would gain from this experience.

Liberty: Although this patient had autism, he still had the right to live his life the way he

thinks is best. However, it is hard to allow an individual with ID this privilege when he is

harming others and may not understand the best way to live.

Rights: The patient had the right to proper treatment from trained individuals who were

prepared to meet his special needs. Unfortunately, this facility was not equipped to handle his

needs.
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Authority: My authorities in this situation expected me to remain safe and out of harm’s

way when dealing with the patient. This expectation limited my ability to help the patient. Staff

that was working on the unit were required by hospital protocol to restrain the patient once he

had become a threat to others, even if they disagreed with the punishment.

Provision number eight of the American Nurses Association Code of Ethics can provide

guided action to this situation. Provision eight states: “the nurse collaborates with other health

professionals and the public in promoting community, national, and international efforts to meet

health needs” (American Nurses Association, 2015). In this provision it describes the nurse’s

responsibility to promote and advocate for the health of all individuals. It also explains their

obligation to the community in being knowledgeable about recent health events and safety

hazards. I believe this applies to my situation at Western State Hospital because it is my

responsibility to make sure that individuals with ID receive the proper care for their diagnosis.

Conclusion

By using the Eight Key Questions I and others can learn how to appropriately analyze situations

that create moral dilemmas or distress. When applying the Eight Key Questions to my scenario, I

learned how to understand different aspects of and see all sides of the situation. I also learned

that you cannot always address the situation at the given time, but can take the experience and

apply it to your values. Although I do not think I could change the outcome of this particular

patient, I do believe that I could change the outcomes for future ID individuals by being an

advocate for them. I would recommend that there be a plan set in place that provides the proper

care needed to treat ID patients during their manic stages. This would include providing a facility

that is equipped with the appropriate amount of staff who are educated on proper care of

individuals with ID.

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Resources

American Nurses Association. (2015). Code of Ethics for Nurses. Retrieved from

https://www.nursingworld.org/coe-view-only

Bakken, T. L., & Martinsen, H. (2013). Adults with intellectual disabilities and mental illness in

psychiatric inpatient units: Empirical studies of patient characteristics and psychiatric

diagnoses from 1996 to 2011 [PDF]. The British Society for Developmental Disabilities,

59(3), 179-190. doi: 10.1179/2047387712Y.0000000006

Chaplin, R. (2009). New research into general psychiatric services for adults with intellectual

disability and mental illness [PDF]. Journal of Intellectual Disability Research, 53(3),

189-199. doi: 10.1111/j.1365-2788.2008.01143.x

Simpson, N., & Soni, S. (2016, May 03). Assessment in an Acute Psychiatry Setting. Retrieved

from http://www.intellectualdisability.info/mental-health/articles/assessment-in-an-acute-

psychiatry-setting

The Madison Collaborative. (2013). The Eight Key Questions Handbook [PDF]. Harrisonburg:

James Madison University.