“A social constructivist narrative exploration of women with an intellectual disability and nurses in English secure services”

Ridley, Angela (2020) “A social constructivist narrative exploration of women with an intellectual disability and nurses in English secure services”. Doctoral thesis, Northumbria University.

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Abstract

Little research has been undertaken with women with an Intellectual Disability (ID) who have experienced secure services, and there is a similar picture with the registered nurses (RNs) who support them. Secure services (SS) support people with an ID who may have experienced the criminal justice system (CJS), need security and/or have a health need.

The overall aim of this study was to explore the experiences of women with an ID (the women) within secure services and how registered nurses (the nurses) support those women. The principal research question in the research was ‘What are the experiences of women with an intellectual disability within secure services and how do the nurses support them?’

The objectives were to:

1. Develop innovative qualitative methodological approaches in exploratory research with female patients who have an ID and are in secure services.

2. Explore the treatment of women with ID by secure services based on the lived experiences as told by the women and the nurses.

3. Discover, through the stories of women and the nurses, the nature and provision of significant support provided to or accessed by women with an ID in secure settings.

4. Find out what the nurses’ perspectives are about their preparation and practice for working in female ID secure services.

5. To make recommendations for the future with suggestions and guidance for women with an ID in secure services, their families, researchers, staff working in women’s secure ID services, educators, and service provision.

There were two research sites in the study, both located in the North East of England. Women with an ID who have previously accessed or are currently accessing secure services; registered nurses (male or female) who have supported the women in the past or are currently supporting the women in secure services, were eligible to take part. Participants were recruited from both research sites, this included twelve nurses who were all female and eight women (n=20).

This research adopted a narrative approach using semi-structured interviews carried out by the researcher. The study was designed to include participants who required the presence of staff, which may have otherwise thwarted participation in some research studies. The constant presence of staff may have conflicted with the confidential relationship between researchers and participants. Moreover, gathering data from the women with staff present, enabled the researcher to conduct interviews and utilise a blended approach of interview styles. An approach that created a unique and innovative methodological approach to conducting semi structured interviews with participants who have an ID, and staff are required to be present.

The corpus of raw data gathered from the semi-structured interviews was analysed and generated into codes, candidate themes, then themes as adapted from Braun and Clarke’s (2006) model of Thematic Analysis. This was inductive in nature and meant a creative, organic approach to coding and theme development could be taken, likened to Big Q data analysis. The themes were not waiting to be found (as in small q data analysis), the researcher was able to create the themes from generating the data and retain the narrative in its purist form. The analysed data formed overarching themes from all the participants, which in some instances were shared themes from the women and the nurses.

The themes are presented in this thesis chronologically; the past, present and future. The past shows how the participants have had a complex journey with services over a prolonged period of time, which in turn has shaped their identity. The present shows the current experience, relationships, and gender to be existing issues in the lives of the participants. The future highlights the long-term views and aspirations held by the participants.

The recommendations in this research are aimed at women with an ID and their families, future researchers in the field of ID, staff working in women’s secure ID services, educators, and future service provision. This research has produced a unique contribution to the body of knowledge in the field of women with an ID and the nurses who support them. By providing an innovative methodological approach to conducting research with participants who have an ID and may otherwise be excluded from participating in research. This research recommends a blended approach to conducting semi-structured interviews and a new way to hear from women with an ID, which is best described in the acronym INTREPID (interviewing using a narrative approach with a third-party present, for conducting research ethically with participants who have intellectual disabilities.

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