Abstract
Aotearoa New Zealand’s Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 (IDCCR Act) provides an alternative to imprisonment for people with intellectual disability who engage in serious offending. Instead of incarceration, the Act enables care and rehabilitation within hospital-based secure facilities. These settings are predominantly staffed by nurses, whose practice is guided by the professional, ethical, and legal standards of the Nursing Council of New Zealand. This study sought to develop a theoretical framework that explains how nursing practice shapes, and is shaped by, the care of individuals subject to the IDCCR Act.
Using an interpretive constructivist grounded theory approach informed by symbolic interactionism, the study explored the experiences of nurses working in secure care settings that care for people who come under the IDCCR Act. This methodology supported the co-construction of meaning between researcher and participants, with reflexivity and constant comparative analysis guiding the interpretation of interviews, memos, and literature. Nineteen nurses were recruited through purposive, homogeneous sampling based on their specialised experience. Data collection included semi-structured interviews, memo writing, and theoretical sampling.
Three key categories emerged from the data: Creating a Space of Safety, Protecting Nursing Identity, and Navigating Ethical Tensions. These themes culminated in the central insight that Being There is Not Enough. This emergent theoretical model reflects the evolving nature of nursing roles under the IDCCR Act and highlights the impact on both care recipients’ human rights and nurses’ professional identity. Participants expressed a desire to be meaningfully present—not merely physically present—in their roles.
The study revealed critical gaps in how care and rehabilitation are defined and delivered under the IDCCR Act. Participants emphasised that containment alone does not equate to safe or therapeutic care and, if poorly managed, may contribute to harm. The continued placement of individuals with intellectual disability in mental health units was identified as a practice that must end, aligning with recent OPCAT reports from the Office of the Ombudsman.
Findings identify the need to formally recognise nurses as essential contributors to care under the IDCCR Act. Their expertise is vital to delivering ethical, high-quality care and upholding the rights of care recipients, in line with Article 25 of the United Nations Convention on the Rights of Persons with Disabilities.