Addressing Health Inequities for People with Intellectual and Developmental Disabilities in the Hospital through Partnerships in Nurse Training

People with intellectual/developmental disabilities (IDD) deserve the same access to quality healthcare yet are at increased risk of medical and/or psychiatric conditions as compared to the general population. Patients with IDD have less health satisfaction, shorter life expectancy, less access to preventative care, higher chronic health conditions, overuse of certain medications, and increased mortality. This population and their caregivers report high levels of dissatisfaction with emergency/inpatient care. Nurses also express frustration with lack of training, limited resources, and competing priorities. We developed the Advancing Supportive Care through Education for Nurses on Disability (ASCEND) Program, to build the capacity of inpatient/Emergency Department (ED) nurses to understand the medical, social, environmental, and mental/behavioral health needs of disabled people. Tier 1 included five didactic modules that were integrated into the online learning platform for a major regional hospital: Attitudes and Barriers to Care, Adapted Nursing Care, Medical Comorbidities, Mental Health, Managing Crisis. Tier 2 included simulations with specific scenarios relevant to IDD presentations, barriers, and biases. Participants included nurses in pediatric and adult inpatient and ED units who participated in Didactics (n = 1,250) and Simulations (n =250). They completed measures at baseline (T1) and immediately after training (T2) capturing the following dimensions: disability knowledge, disability healthcare attitudes, clinical comfort, organizational climate, and training satisfaction (n = 280). Analyses included descriptives on nurse demographics and group comparisons across scores pre/post training. Analyses showed that there were statistically significant differences between T1 and T2 domains of Clinical Comfort, Clinical Knowledge, and Organizational Climate. Nurses reported higher clinical comfort following training (p < .001), more knowledge (p < .001), and better organizational climates (p < .01). There was no statistically significant difference in Disability Attitudes domain scores between T1 and T2 surveys (p = 0.07561). The success of initial development and pilot deployment suggest the feasibility of the ASCEND model. Pre/post data will indicate preliminary efficacy of the tiered system of training. Scale-up and sustainability are planned, and next steps for the ASCEND program are discussed.