1 Introduction

The United Nations Convention on the Rights of People with Disabilities (UN Convention on Rights of Persons with Disabilities, 2007) recognises the importance of principles and policy guidelines for equalising the opportunities for people with disabilities to mainstream their needs. It also affirms that discrimination against any person with a disability violates the inherent dignity and worth of the person as a human. Despite this, people with disabilities still encounter many barriers to participation as equal members of society (UN Convention on Rights of Persons with Disabilities, 2007). People with intellectual disabilities (IDs) should be afforded a healthy life and well-being without facing inequality resulting from their disability (UN Convention on Rights of Persons with Disabilities, 2007). The United Nations' third Sustainable Development Goal (SDG) emphasises the imperative of promoting and securing good health and well-being for all individuals (United Nations, 2015). In parallel, SDG 10 endeavours to minimise societal disparities and inequalities (United Nations, 2015). The Australian Government adheres to the principles outlined in the Disability Discrimination Act of 1992, which serves as a guiding framework in combating discrimination based on disabilities (Disability Discrimination Act, 1992).

Over half a million Australians (around 3%) have an ID (Australian Bureau of Statistics, 2012; Australian Institute of Health and Welfare [AIWH], 2008). The majority (60%) have a severe or profound disability in meeting their own daily needs and require a significant amount of support from family, caregivers or health professionals, especially nurses (AIWH, 2008; Australian Bureau of Statistics, 2012). The prevalence of ID is more than double in First Nations Australians compared with the general population, 5.9% compared with 2.5% (AIWH, 2015). However, there is still a significant disparity in the access to health care for people with disabilities. The care needs for people with disabilities are dynamic and variable, escalating in complexity where multiple disabilities exist exponentially, for example, with co-existing psychological and behavioural conditions, higher risks for heart disease, hypertension, obesity and respiratory conditions (O'Reilly et al., 2018; Wilson, Howie, & Atkins, 2019). Poor health literacy, inadequate healthcare services, low utilisation of screening and preventive services, misdiagnosis, discrimination, communication barriers and limited nurse education contribute to a higher risk of diseases (Cashin, Buckley, et al., 2022; Furst & Salvador-Carulla, 2019; Jaques et al., 2018; Trollor et al., 2018; Wilson, Howie, & Atkins, 2019). Studies have reported poor hospital experience, discrimination and lack of confidence in nurses in providing adequate care and increased reliance on caregivers for care (Hemsley et al., 2011; Jaques et al., 2018; Lacono et al., 2014; Lewis et al., 2019). Furthermore, in addressing the needs of First Nations People and Closing the Gap, priority reforms should concentrate on strengthening the workforce to deliver complex care to individuals with IDs, given the existing issue of overrepresentation (Australian Government, 2020).

It is known that people with IDs experience poorer health outcomes overall, compromised physical health and well-being and limited access to health services. Statistics demonstrate that individuals with IDs experience 38% of preventable deaths, compared with 17% in the general population. (Trollor et al., 2018; Wilson, Howie, & Atkins, 2019). Furthermore, this population has a 26-year gap in life expectancy compared with the general population, which is contributed by increased risk for lifestyle diseases, oral health issues and respiratory diseases (Wilson, Howie, & Atkins, 2019).

In Australia, national policy and public funding shifts resulted in the formation of a National Disability Insurance Scheme (NDIS) in 2013 (Buckmaster, 2017). This individualised general insurance funding model fundamentally changed the delivery mode of disability health and social care from institutionalised care services to a new community care delivery model (Buckmaster, 2017). A further implication arising from the introduction of the NDIS was an alteration in the makeup of the ID workforce, particularly a dynamic shift in the nature and activity of the nursing workforce, where the speciality of disability nursing has stalled (Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). The nature of complex health conditions associated with ID frequently increases the health demands for people with disabilities, who often need high levels of health care from hospital and community health services. Despite the high care needs of many people with IDs, nursing preregistration programmes do not adequately include ID care within the nursing curriculum (Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). As a result, nurses feel unprepared, without suitable education and training to deliver safe care in this context (Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019).

The absence of a specialised field in disability nursing has overlooked the health care, recovery and well-being needs of people with IDs. There has been a resultant pause in disability nursing advocacy within the health, social care and education sectors and a lag in leadership arising following the adoption of a national nursing curriculum (Furst & Salvador-Carulla, 2019; Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). The absence of leadership and advocacy has meant that the needs of people with IDs have been generally overlooked in the nursing discipline (Furst & Salvador-Carulla, 2019; Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). With 3% of the population impacted, nurses will likely encounter people with IDs at some point in their practice in any setting. Therefore, our nurses must be adequately educated to care for this priority population.

A National survey among Australian nurses revealed a high percentage of older (M = 52.31, SD = 10.05) and female nurses (n = 78) working in the disability sector (Lewis et al., 2020). This age is higher than the average age of all nurses working in the UK, USA, Canada and Australia. This is concerning because this aging workforce with specialised training in ID will continue to decrease in number and may not be replaced by nurses qualified to care for people with IDs. Lack of interest in joining the ID workforce is primarily contributed by the absence of an ID nursing speciality, lack of ID content in undergraduate programmes and absence of clinical placement opportunities in the ID area (Lewis et al., 2020).

This is significant because governmental policy changes related to the public care of people with IDs inherently affect the quality, quantity and safe delivery of care provided in hospital and community settings. Later sequelae from these changes result in a reduction in the supply chain of suitably prepared nurses to carry out the specialist healthcare needs of people with IDs, with university nursing schools opting to squeeze out ID nursing knowledge from the comprehensive curriculum to make room for other topic areas (Furst & Salvador-Carulla, 2019; Lewis et al., 2019; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). Previous reviews, including studies by Jaques et al. (2018), Taua et al. (2012) and Lewis et al. (2019), which focused on the roles and experiences of nurses in caring for people with ID, along with research by Lacono et al. (2014) exploring hospital experiences of individuals with ID, have provided valuable insights into specific aspects. However, despite these contributions, there remains a significant gap in understanding the nuanced factors related to care quality and nursing education within the context of IDs. In contrast to prior literature reviews that mainly concentrated on global sources, our review adopts a focused strategy, specifically analysing Australian literature within a defined time frame following the 2012 move to national registration of nurses and the associated shift to accrediting preregistration nursing courses nationally. This focused strategy enables us to comprehensively grasp the contextual evolution of disability nursing within a specific timeline.

2 Definitions

Intellectual disability (ID), as defined by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2022), is a neurodevelopmental disorder characterised by intellectual and adaptive functioning deficits across conceptual, social and practical domains. These deficits typically manifest during the developmental period and are marked by limitations compared with individuals of the same age, gender and social-cultural background (DSM-5). The DSM-5 criteria for ID are illustrated in Figure 1.

3 Methods

4 Search Strategy

We followed the PRISMA framework (Page et al., 2021). Table S1 contains the completed PRISMA checklist for reference. Integrative literature was selected because it included a wide range of literature, study types and any relevant reports that would inform the review question. Theoretical and policy articles and reports were also included in the review. Opinion and discussion papers were excluded from the review. Because of the paucity of literature on ID nursing, the search was supplemented with hand-searching of reference lists. Five electronic databases were systematically searched: CINAHL, MEDLINE, PsycINFO, Scopus and Cochrane Library. The search terms can be found in Table 1.

The search inclusion criteria included peer-reviewed English articles published between January 2010 and August 2023. The period is aligned with the 2012 move to national registration of nurses and the associated shift to accrediting preregistration nursing courses nationally.

A total of 28 articles were located and retrieved from the combined databases. Figure 2 provides a PRISMA flow chart (Page et al., 2021) of the search process. A total of 28 articles were reviewed and were independently considered relevant by an experienced team of researchers. Each article was read in-depth, and data were extracted following a format developed for the study (Table 2). We then coded this data systematically, using descriptive labels to categorise and organise similar information across studies. Through an iterative process of review and refinement, we identified overarching themes that emerged consistently across the included literature. These themes were carefully defined, named and described in detail, with supporting evidence from the original studies. Finally, we interpreted these themes about our research question, synthesising the findings to draw meaningful conclusions and insights.

5 Results

An integrative literature review examined the state of disability nursing practice in Australia following the implementation of the National Disability Insurance Support (NDIS) scheme. A total of 28 articles were considered eligible for inclusion in this study.

Table 2 presents a comprehensive overview of the relevant articles included in the review. Because of the limited availability of literature on this topic, all types of articles were included, following the methodology of an integrative literature review. The dataset comprised literature reviews (n = 5), qualitative studies (n = 8), descriptive and correlation studies (n = 7), mixed-method research (n = 1), web searches or document analyses (n = 3), audits (n = 3) and one report (n = 1). Details of the studies are included in Table 3.

Interestingly, the Australian literature review has focused on international collective findings (Jaques et al., 2018; Lacono et al., 2014; Lewis et al., 2019). A literature review from an Australian perspective relies more on international literature (Jaques et al., 2018; Lacono et al., 2014; Lewis et al., 2019).

The primary subthemes identified in qualitative studies revolve around the experiences of families and children (Douglas et al., 2016; Hurley & Hutchinson, 2022; Lacono et al., 2014; Mimmo et al., 2022). In addition, there is a blend of other themes encompassing workforce development (Goddard et al., 2010; Hemsley et al., 2011, 2012), including professional standards (Wilson, Wiese, et al., 2019). Lastly, there is a focus on the needs of adults with IDs and the palliative care requirements of individuals with IDs (Foo et al., 2021; Lewis et al., 2019).

The primary themes found in quantitative studies encompass workforce development and practice standards (Cashin, Buckley, et al., 2022; Cashin, Pracilio, et al., 2022; Lewis et al., 2020; Wilson et al., 2020; Wilson, Lewis, et al., 2019). Furthermore, these studies delve into curriculum-related aspects, emphasising nurturing attitudes within an educational context (McKenna et al., 2012; Williams et al., 2015). The studies also explored nurses' attitudes as a key theme (Desroches et al., 2021; Williams et al., 2015).

The audits and document analyses primarily focused on examining nursing curricula, disability content, competency standards and participant experiences (Edmonds et al., 2016; Furst & Salvador-Carulla, 2019; Lewis et al., 2019; O'Reilly et al., 2018; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019). Although mixed-methods studies were relatively scarce, one study specifically delved into primary care within the context of the COVID-19 pandemic (Desroches et al., 2022). This study specifically explored the challenges faced by specialist ID nurses in primary care settings while providing care to individuals with IDs during the pandemic (Desroches et al., 2022).

The reviewed literature identified three main themes, including (1) workforce development and professional standards, (2) hospital experience and support needs of individuals with IDs and (3) nursing curriculum and ID. Table 4 summarises themes, subthemes and the corresponding studies.

6 Theme 1: Workforce Development and Professional Standards

An Australian national survey reported that the education of nurses working in the disability sector is fragmented; it varies between vocational qualifications and postgraduate education (Lewis et al., 2020; Wilson et al., 2020). Most of the nurses in the sample (n = 33) had an undergraduate (n = 33), postgraduate (n = 31) or hospital-trained qualification (n = 25), and some were with vocational qualification (n = 12). Only half of the nurses in the disability sector had a further acquired specialist qualification in ID-specific contexts. Around 12 people had a mental retardation nursing certificate discontinued in 1985, and a few (n = 7) had a Certificate IV qualification in disability studies (Lewis et al., 2020). This explains the challenges faced by nurses in caring for people with IDs reported in different studies in Australia (Foo et al., 2021; Hemsley et al., 2012; Jaques et al., 2018; Lewis et al., 2019; Taua et al., 2012; Wilson et al., 2018, 2020).

It was reported that nurses face challenges communicating with people with IDs in acute care settings (Lacono et al., 2014). In particular, a communication problem was evident where the capacity for the person (or guardian) to agree with informed consent could have been more apparent, and this was an area where nurses described themselves as unprepared (Lacono et al., 2014). Hence, nurses are cautious about the need to depend on paid or unpaid caregivers for communication when caring for people with IDs (Hemsley et al., 2011; Lewis et al., 2019). The effort to communicate with people with IDs was limited by insufficient time, which forced the nurses to rely on communicating with family or paid caregivers (Hemsley et al., 2011). Paid care providers play an essential role in supporting people with IDs, meeting activities of daily living and communicating and advocating (Hemsley et al., 2011). Nurses encounter difficulties in comprehending the requirements of individuals with IDs and struggle to accommodate their unique conditions. (Lacono et al., 2014). It is further complicated by the poor attitude of nurses towards people with IDs (Lacono et al., 2014). This highlights the need for proper training and educational preparation for nurses working in the disability sector.

A national survey (Cashin, Pracilio, et al., 2022) in Australia has revealed significant deficiencies in the knowledge, preparedness, confidence and comfort of nurses when caring for individuals with IDs (Cashin, Pracilio, et al., 2022). The survey found that the vast majority of nurses lack postgraduate qualifications related to ID, and a significant proportion have not received continuing professional development (CPD) in these areas. This highlights the need for improved knowledge and confidence among registered nurses in addressing the needs of individuals with IDs. Nurses reported the least confidence in specific skills, such as referring caregivers to resources, nonverbal communication and managing escalation behaviours. Additionally, many nurses were unfamiliar with reasonable adjustment plans, the NDIS and their role within NDIS support services. Clinical placements improved nurses' confidence and preparedness, but there remains a clear need for enhanced education and training in this critical healthcare area.

A qualitative study conducted in Australia among staff working in palliative care explored their experience with death and dying with people with IDs and reported that nurses, doctors and occupational therapists found it difficult and stressful to communicate with people with IDs (Foo et al., 2021). Most of the time, there is no direct or no conversation; conversation is purely based on the perceived capacity of the patient to understand the concept of death and dying, communication ability and ability to cope with discussions. They expressed the need for a different approach when communicating and the lack of knowledge and familiarity in caring for people with IDs. It was reported that staff training in ID were more likely to talk to people with IDs about death and dying (Foo et al., 2021). This further strengthens the argument for including ID content and training for nurses in the disability sector.

The literature indicates that individuals with IDs often fear hospital visits due to concerns about nurses' ability to deliver safe and suitable care, insufficient knowledge and skills among hospital staff, negative attitudes and system failures to accommodate their changing needs and over-reliance of staff on family or paid caregivers (Lacono et al., 2014). Parents of young children, especially those less than 1 year of age, require extensive support from nurses. They need assistance adjusting to the ID diagnosis, information on supporting their child's daily needs and development, and connecting to other parents of children with IDs with similar needs (Douglas et al., 2016).

A study by Wilson et al. (2018) found that nurses have varying understanding of professional practice standards for intellectual and developmental disability nursing but recognise their importance. However, these standards are separate from national competency standards (Edmonds et al., 2016). Existing practice standards can inform the development of new standards for disability nurses (Wilson, Lewis, et al., 2019; Wilson, Wiese, et al., 2019). Unfortunately, there is a lack of evidence to guide practice, guidelines and policies for ID nurses (O'Reilly et al., 2018; Wilson, Wiese, et al., 2019), resulting in health disparities for individuals with IDs. This highlights the ongoing demand for nurses with expertise despite policy changes. When caring for children or young people with IDs, no specific policies or procedures are currently in place. Policies are needed to support the use of family centred care in their health care (Mimmo et al., 2022).

Theme 1 highlights that nurses are generally insufficiently prepared for effective communication and care of people with IDs and their families. They lack the skills to meet the complex care needs of people with IDs. The shift towards community-based care for individuals with IDs has highlighted the need for specialised disability nursing. This finding directly relates to the research questions by shedding light on the gaps in nursing education and practice concerning ID care, prompting the call for clear practice standards and policies to enhance healthcare access and quality of life for individuals with IDs.

7 Theme 2: Hospital Experience and Support Needs of Individuals With IDs

Research on the hospital experience of people with IDs in Australia is scarce. Only three studies were identified in this review (Douglas et al., 2016; Lacono et al., 2014; Mimmo et al., 2022). The hospital experience for children were similar to that of adults with IDs in terms of communication barriers. Parents require assistance understanding their child's ID diagnosis, obtaining knowledge and information and connecting with other parents (Douglas et al., 2016). Communication barriers were also identified in the literature, with nurses relying on parents or carers for information and daily care. A 2022 study (Mimmo et al., 2022) on nurses' perceptions of providing good care to children and young people with ID who were hospital inpatients highlighted the importance of forming partnerships, communication and continuity of care to enhance the patient experience. Establishing rapport through play, involving parents, seeking guidance from experienced colleagues, and demonstrating empathy made children feel safe and comfortable during their hospital stay. Time constraints were identified as barriers, with nurses prioritising clinical requirements over the child's needs. The study recommended the inclusion of child life therapists to address the child's needs (Mimmo et al., 2022).

Individuals with IDs from culturally and linguistically diverse (CALD) backgrounds face unique challenges (Lewis, 2021). With a significant percentage of Australia's population (21%) speaking a language other than English, effective service delivery is significantly impacted (Lewis, 2021). Accessing and utilising services becomes complicated due to cultural and social barriers, further exacerbated by Australia's fragmented delivery of services. This situation creates inequities, particularly for people from CALD backgrounds (Lewis, 2021). It has been observed that children with ID from CALD backgrounds are less likely to access therapy services compared with people not from CALD counterparts and require more referrals to access the NDIS. It is clear that the challenges faced by individuals with IDs from CALD backgrounds directly impact their hospital experience and support needs. These issues highlight the critical need for healthcare systems to address cultural competence and inclusivity in service delivery, ensuring that individuals with IDs from CALD backgrounds receive appropriate and equitable support during their hospital stays.

Interestingly, children from CALD backgrounds are more likely to receive diagnoses of gross developmental delay (GDD), intellectual and developmental disorder (IDD) and autism spectrum disorder (ASD) (Lewis, 2021). Delayed access to services and interventions due to delayed referrals is a concern, as early intervention is crucial (Lewis, 2021).

Overall, the literature review provided insights into the challenges faced by individuals with IDs during hospital stays, particularly in communication, partnership-building and addressing cultural and linguistic barriers. These findings contribute to understanding the quality of nursing care and educational preparedness for ID nursing practice in Australia, aligning with the aim and questions of the integrative literature review.

8 Theme 3: Nursing Curriculum and ID

Nurses with appropriate education and expertise are required to care for people with IDs; despite this, nursing curriculums in universities in Australia are not providing adequate educational preparation for nursing students (Edmonds et al., 2016; Furst & Salvador-Carulla, 2019; Lewis et al., 2019; O'Reilly et al., 2018; Trollor et al., 2016; Trollor et al., 2018; Wilson, Lewis, et al., 2019). There is an inconsistent inclusion of content on ID in the training programme for nurses, which is mainly implemented as a part of professional development rather than an educational pathway (Cashin, Buckley, et al., 2022; Furst & Salvador-Carulla, 2019; Trollor et al., 2016).

A survey (Cashin, Buckley, et al., 2022) of 711 registered nurses' educational experiences and self-perceived capability to care for people with IDs and autism reported that 68.5% (n = 475) did not have any education and training in ID/ASD in their undergrad nursing curriculum. In total, 31.5% who received it was a single unit of study (n = 142, 61.5%), and only 17.9% (n = 39) had content embedded in the entire curriculum. Furthermore, 80.8% (n = 560) received no clinical placement opportunities caring for people with intellectual or ASD. Participants registered as a nurse between 1971 and 80 were more likely to receive a clinical placement in intellectual or ASD care when compared to nurses registered between 2011 and 2020 (28.5% vs. 10.5%). Only 55.7% reported they are somewhat knowledgeable, and 60% reported they are confident in caring for people with IDs. They also reported that their nursing education did not prepare them to care for people with IDs. Nurses felt confident discussing disability with other health professionals, developing therapeutic relationships, establishing treatment procedures and communicating; however, they were not confident in the specific health needs of people with IDs (Cashin, Buckley, et al., 2022).

Several studies conducted in Australia (Cashin, Pracilio, et al., 2022; Foo et al., 2021; Furst & Salvador-Carulla, 2019; Lewis et al., 2020; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019) have established that Australian universities are failing to deliver content to prepare nurses to care for people with ID. Across 15 universities that offer content on ID, lectures (82%) were the primary mode for teaching and learning experiences, followed by tutorials (59%) and workshops (26%) (Trollor et al., 2018). Only one nursing school involved a person with a disability in the unit delivery. A person with IDs participated in the role plays with the students, which helped them to build communication skills. ID content was delivered by only some teachers who specialised in ID in almost 80% of the universities (Trollor et al., 2018). Over half of the universities offered no ID content in the curricula, and those who taught dedicated 3.6 h per unit to ID content. Clinical assessment skills, ethics and legal issues were the most frequently covered sessions, but human rights issues and preventative health could have been better represented (Trollor et al., 2016).

Goddard et al. (2010) conducted a study in Australia among undergraduate students to assess the effectiveness of a functional clinical placement model in a regional community for caring for children with IDs and their families. Five families of children with IDs, nine nursing students and two nursing academics were involved in the study. A family focused health promotion intervention was administered to promote wellness and prevent illness. The study demonstrated increased awareness and valuing of the health needs and increased level of competency of student nurses in caring for people with IDs (Goddard et al., 2010).

In one study, nurses had more positive attitudes towards adults with physical disabilities than IDs (median = 634 vs. 567, Z = −5.473, p = 0.000) (Desroches et al., 2021). However, the two conditions have no difference in positive and negative emotion scores (Desroches et al., 2021). Nurses caring for adults with IDs experience more positive emotions than mainstream nurses (median = 180 vs. 153, U = 941.5, p = 0.013). There are no significant differences in attitudes or negative emotions between ID nurses and mainstream nurses (Desroches et al., 2022).

A study by Williams found that female nurses exhibit more positive attitudes towards people with IDs than male nurses (Williams et al., 2015). Heidke found that recorded interviews of people with IDs have been shown to improve attitudes of nursing students (Heidke et al., 2018), and clinical placements are beneficial for gaining insight and improving attitudes (Doody et al., 2020). A study (McKenna et al., 2012) among undergraduate nursing students found high empathy towards people with IDs, regardless of year of study, age and gender. This level of empathy is similar to student nurse attitudes towards terminal illness, chronic pain and acute mental illness (McKenna et al., 2012).

Finally, Theme 3 sheds light on healthcare professionals' attitudes and emotions concerning IDs. Notably, nurses appear to hold more positive attitudes towards adults with physical disabilities than those with IDs. However, nurses caring for individuals with IDs experience more positive emotions than their mainstream counterparts. Furthermore, the influence of gender on attitudes is evident, with females exhibiting more positive attitudes towards people with ID. Encouragingly, undergraduate students, regardless of their year of study, age or gender, demonstrate high levels of empathy towards individuals with IDs, akin to their attitudes towards other health conditions. This finding underscores the importance of targeted education and training initiatives within nursing curriculum and professional development programmes. By addressing misconceptions, stereotypes and biases, these initiatives can lead to improved attitudes and enhanced care delivery for individuals with IDs. Integrating modules or courses specifically focused on ID within nursing education can foster empathy, understanding and positive attitudes among future healthcare professionals.

In summary, fostering positive attitudes and emotions among healthcare professionals and students towards individuals with IDs is vital for providing inclusive and empathetic care. These insights highlight the importance of education, exposure and ongoing training to create a healthcare environment that values and respects the diverse needs of all patients, including those with IDs.

9 Discussion

Insufficient knowledge and training regarding IDs among nurses have been well-documented in scientific literature. Several studies (Cashin, Buckley, et al., 2022; Furst & Salvador-Carulla, 2019; Goddard et al., 2010; Trollor et al., 2016, 2018; Wilson, Howie, & Atkins, 2019) emphasise the lack of educational content on ID in university curricula in half of the universities. Consequently, the nursing workforce's ability to provide comprehensive care to individuals with IDs has been severely compromised, further exacerbating the growing healthcare demand for this population. The study's research questions, focusing on understanding the nursing care needs of individuals with IDs and assessing nursing education's preparedness in this area, are directly informed by the documented knowledge gap highlighted in the scientific literature. The lack of explicit ID content in university curricula, as evidenced by multiple studies, underscores the urgency of addressing this issue to enhance healthcare professionals' ability to provide safe and effective care to this population.

The life expectancy of people with IDs is increasing, and their health issues are complex with advanced age (O'Reilly et al., 2018; Wilson, Howie, & Atkins, 2019; Wilson, Lewis, et al., 2019). The physical care needs may be similar for people with or without IDs. However, skills in communication, advocacy and person-centred care differ from the general population (Jaques et al., 2018). Ideally, nurses working with people with IDs should develop a clinical skill set focusing on building relationship pro-activeness and reasonable adjustments in communication, which incorporate increased patience and resilience (Jaques et al., 2018; O'Reilly et al., 2018).

The low levels of self-reported knowledge and confidence of nurses working in the public mainstream care environment are significant, as it raises the question of to what degree nurses are meeting their responsibilities as outlined in the UN convention relating to the rights of people with disabilities (United Nations, 2015). Considering that people with ID present more frequently to the ED have more extended stays in acute hospitals and have more readmission rates when compared to the general population, the reported low levels of knowledge suggest that education programmes about ID for this cohort of nurses are an urgent priority. The identified lack of knowledge underscores the urgent need for education programmes focused on ID within this nursing cohort, highlighting the imperative of ensuring safe and effective care for individuals with these conditions.

To address these gaps, Weise et al. (2017) propose implementing a comprehensive national strategy to ensure nondiscriminatory access to health care for individuals with IDs. Nurses play a crucial role in interdisciplinary collaborations facilitating the transition of individuals with IDs between different healthcare settings, such as from paediatric to adult healthcare services or moving from hospital care back to community-based care. Community health centres are particularly suitable settings for nurses, given their scope of practice. Nurses specialising in intellectual and developmental disabilities should have the necessary skills to assess individuals and fulfil the support and training needs of people with IDs and their caregivers. Additionally, nurses should acquire adequate communication skills tailored to the unique requirements of individuals with IDs.

10 Limitation

A publication bias not to include papers about ID may exist in the nursing literature as an artefact of its absence in nursing curriculum and health settings with the advent of the NDIS sector. Because of the dearth of literature about the specialised nursing field for people with IDs originating from Australia, all studies were included. Hence, the quality of the individual studies was not formally assessed. Critical studies might have been published in languages other than English, which would have been missed in our search strategy. A limited number of studies identified the unique roles of ID nurses in Australia.

11 Recommendations

The literature reveals a gap in knowledge regarding the nursing educational preparedness for nurses working with individuals with IDs. Further research is recommended to investigate the quality of health service delivery to this population, especially in light of the introduction of NDIS in Australia. Additionally, research is needed to support leadership and advocacy activities undertaken by nurses for the welfare of individuals with IDs.

There is a clear need for the inclusion of introductory units on ID within undergraduate nursing curricula, alongside the availability of postgraduate courses to facilitate specialisation in ID nursing. The absence of specific registration standards for ID nursing in Australia represents a significant oversight, as it fails to address the unique needs of individuals with IDs. This underscores the urgent requirement for workforce development in this crucial area. Literature highlights the negligible number of studies done in various contexts, such as palliative care, emergency care and primary care. Both undergraduate and specialist postgraduate programmes in ID nursing exhibit notable gaps, particularly concerning mental health literature, where there is a surprising lack of studies addressing the mental health needs of individuals with IDs—a population mental health nurses often engage with.

The establishment of a recognised specialty in disability nursing and the improvement of nursing education and curricula demand a solid evidence base derived from research. This initiative offers a clear career path for experienced clinicians to provide competent care to individuals with IDs. Practical recommendations include the integration of mandatory disability nursing units into preregistration nursing programmes, ensuring that all nursing graduates in Australia possess a foundational knowledge of disability nursing, and promoting collaboration between nursing schools and the Nursing and Midwifery Board of Australia. To deliver high-quality health care to individuals with IDs, the adoption of a coordinated care model, such as intellectual liaison nurses' care coordination, is crucial. This model necessitates a highly skilled workforce capable of addressing the complex needs of this population.

12 Conclusion

The literature emphasises the necessity of educational preparation for nurses and the inclusion of ID content in nursing curricula. Specialised areas of nursing practice are crucial for equipping nurses to provide quality care to individuals with IDs. The findings of the review recommend reintroducing a disability nursing specialty to cater to the complex requirements of these patients. Furthermore, the review suggests incorporating dedicated study units and clinical placements focusing on IDs in undergraduate nursing curricula.

13 Relevance to Clinical Practice

The findings from a national survey among Australian nurses underscore the relevance of clinical practice in the ID sector (Cashin, Pracilio, et al., 2022). The survey highlighted a significant proportion of older and predominantly female nurses working in this field, indicating an aging workforce with specialised training in ID care (Cashin, Pracilio, et al., 2022). However, this workforce is at risk of decreasing due to various factors such as the absence of a dedicated ID nursing specialty, limited ID content in undergraduate programmes and insufficient clinical placement opportunities in this area. These issues contribute to a reduction in the supply of adequately trained nurses capable of addressing the complex healthcare needs of individuals with IDs. The implications of these findings suggest a critical need for prioritising ID nursing education, fostering interest among nursing students and ensuring comprehensive clinical training to support quality care for this vulnerable population.

The study underscores the pressing need to integrate ID education into nursing curricula at all levels to enhance nurses' readiness for comprehensive care of individuals with IDs. The absence of specific registration standards for ID nursing is a crucial gap that must be addressed to recognise the essential role of these nurses in health care officially. Additionally, addressing care gaps across various healthcare settings, including palliative, emergency and primary care, is vital for clinical improvement and ensuring the delivery of high-quality, person-centred care for individuals with IDs.

The dearth of research on the mental health of individuals with IDs is particularly concerning, as mental health nurses frequently engage with this population. It underscores the need for comprehensive mental health support and specialised training to address the unique challenges faced by these individuals. The under-representation of First Nations people and CALD populations reveal significant deficiencies that demand a more inclusive and culturally sensitive approach to care.

Conflicts of Interest

Prof Rhonda Wilson is an Editorial Board Member of the International Journal of Mental Health Nursing.