Using Nursing Intervention Classification in an Advance Practice Registered Nurse–Led Preventive Model for Adults Aging With Developmental Disabilities

Key wordsAdvanced nursing practice, gerontology, health disparities, health promotion, health education, developmental disabilitiesAbstractPurpose: To describe the most frequently reported and the most central nurs- ing interventions in an advance practice registered nurse (APRN)-led in-home preventive intervention model for adults aging with developmental disabilities using the Nursing Intervention Classification (NIC) system.Methods: A descriptive data analysis and a market basket analysis were con- ducted on de-identified nominal nursing intervention data from two home visits conducted by nurse practitioners (NPs) from October 2010 to June 2012 for 80 community-dwelling adults with developmental disabilities, ages 29 to 68 years.Results: The mean number of NIC interventions was 4.7 in the first visit and 6.0 in the second visit and last visit. NPs reported 45 different interven- tion types as classified using a standardized language, with 376 in Visit One and 470 in Visit Two. Approximately 85 % of the sample received the Health educa- tion intervention. The market basket analysis revealed common pairs, triples, and quadruple sets of interventions in this preventive model. The NIC nurs- ing interventions that occurred together repeatedly were: Health education, Weight management, Nutrition management, Health screening, and Behavior management.Conclusions: Five NIC interventions form the basis of an APRN-led pre- ventive intervention model for individuals aging with lifelong disability, with health education as the most common intervention, combined with interven- tions to manage weight and nutrition, promote healthy behaviors, and en- courage routine health screening. Less frequently reported NIC interventions suggest the need to tailor prevention to individual needs, whether acute or chronic.Clinical Relevance: APRNs employing prevention among adults aging with developmental disabilities must anticipate the need to focus on health educa- tion strategies for health promotion and prevention as well as tailor and target a patient-centered approach to support self-management of health to promote healthy aging in place. These NIC interventions serve not only as a guide for planning preventive interventions, but for designing nursing curricula to re- duce health disparities among people with varying learning needs.Nearly 60 million people in the world live with lifelong developmental disabilities (International Association for the Scientific Study of Intellectual Disabilities, 2002). In the United States, an estimated 850,600 individuals with developmental disabilities are over 60 years of age, and by 2030, this number is expected to be 1.4 million (Fac- tor, Heller & Janicki, 2012). The term developmental disability, as used in this study, "refers to a severe and chronic disability that is attributable to a mental or phys- ical impairment that begins before an individual reaches adulthood. These disabilities include intellectual disabil- ity, cerebral palsy, epilepsy, autism, and disabling con- ditions closely related to intellectual disability or requir- ing similar treatment" (California Department of Devel- opmental Services, 2013, para. 1)Growing older with a developmental disability is seen in the context of increased recognition of health dispari- ties faced by persons with developmental disabilities over their life course (Iirahn, Hammond, & Turner, 2006) and in aging (Haveman, Heller, Lee, Maaskant, Shooshtari & Strydom, 2010). This includes being less likely to re- ceive health promotion and preventive screening services (Owens, Kerker, Zigler & Horowitz, 2006). Persons ag- ing with developmental disabilities compared to persons aging without developmental disabilities experience in- creased health complexities, multimorbidity, and depen- dence on others (McCarron et al., 2013).Multidimensional assessment tools show promise in reducing health disparities by identifying unmet health needs and putting in place routine screening services to reduce health risks and health disparities (Robertson, Roberts, Emerson, Turner, & Grieg, 2011). …