A cross-case comparison of the trauma and orthopaedic hospital experiences of adults with intellectual disabilities using interpretative phenomenological analysis.
Mary Drozd, Darren Chadwick, Rebecca Jester
PMID 33570307WHAT IT FOUND
Adults with intellectual disabilities in trauma and orthopaedic wards reported staff speaking to carers instead of them, ignoring pain reports, and leaving them alone for long periods.
Carers were essential for monitoring complications and explaining care.
Key findings
01Participants reported communication failures where staff spoke to carers rather than directly to the adult with an intellectual disability, or used language the patient did not understand.
02Four of the five participants described unmanaged or unassessed pain, including waiting for analgesia, lack of regular assessment, and distress during procedures without adequate preparation.
03Carers were described as providing essential support for monitoring treatment complications and facilitating understanding, yet felt undervalued and unsupported by hospital staff.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small (n=5) and recruited through self-advocacy groups, meaning it did not include the 'hidden majority' of people with intellectual disabilities who are not in contact with services. Interviews relied on participants' memories of past hospital experiences, which may not be accurate, although the authors note emotional memory is often stable. The study focused on trauma and orthopaedic care, so findings may not generalise to other hospital specialties. One participant was a carer reporting on behalf of an adult who could not be interviewed, which differs in perspective from the self-reported accounts of the other four.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not interpret these themes as evidence that trauma and orthopaedic care is universally poor for this population, nor as a measure of clinical outcomes. This is a small qualitative study of five individuals' lived experiences and perceptions, not a test of treatment efficacy or a representative sample of all patients.