Institutionalised cultures and imbalances of power have been identified within the literature as risk factors for the abuse of adults with intellectual disability living in residential services. Governments in the Republic of Ireland and internationally continue to support person-centredness as a framework of care that can promote cultural change within disability services as a safeguard against abuse. However, there is limited research which seeks to explore if person-centredness as a framework of care has had much impact on changing cultures within disability services as a protective factor against abuse. This study aims to explore how adults with intellectual disability living in residential services and staff experience the professional caring relationship and the framework of person-centredness. The study was based on a phenomenological approach using thematic analysis which enabled six adults with intellectual disability and six staff to participate through one-to-one interviews. The thematic analysis resulted in three main themes: (1) Conflict within the relational dynamic between service users and staff. (2) Challenges to delivering person-centred care. (3) Shared needs. Participants reported that there was conflict within the relationship between service users and staff influenced by relational and cultural issues. Participants also experienced challenges in delivering person-centred care within the service. This study revealed that as a result of wider organisational and cultural influences, person-centred cultures, which are vital to underpin changes in power imbalances, were often undermined. This research highlights that it is not enough to have a system of quality of care guided by the principles of person-centredness alone to ensure a shift in culture and safeguard against abuse of adults with intellectual disability. Rather, consideration of the relational and cultural factors that impact their lives also needs to be built into the values and practices of services offered to adults with intellectual disability.

中文翻译：

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关系和权力：爱尔兰智力障碍服务中以人为本的探索

文献中已将制度化文化和权力失衡确定为居住在寄宿服务机构中的智障成年人遭受虐待的风险因素。爱尔兰共和国和国际上的政府继续支持以人为本作为一种护理框架，可以促进残疾服务中的文化变革，作为防止虐待的保障。然而，很少有研究试图探索以人为本作为一种护理框架是否对残疾服务中不断变化的文化产生很大影响，作为防止虐待的保护因素。本研究旨在探索居住在住宿服务和工作人员中的智障成年人如何体验专业的关怀关系和以人为本的框架。该研究基于现象学方法，使用主题分析，使六名智障成年人和六名工作人员通过一对一访谈参与。主题分析产生了三个主要主题：(1) 服务用户和员工之间关系动态中的冲突。(2) 提供以人为本的护理的挑战。(3) 共享需求。参与者报告说，受关系和文化问题的影响，服务使用者和员工之间的关系存在冲突。参与者在服务中提供以人为本的护理方面也遇到了挑战。这项研究表明，由于更广泛的组织和文化影响，以人为本的文化常常被破坏，而这种文化对于改变权力失衡至关重要。这项研究强调，仅以以人为本的原则为指导的护理质量体系不足以确保文化转变并防止智障成年人受到虐待。相反，对影响他们生活的关系和文化因素的考虑也需要纳入为智障成年人提供的服务的价值观和实践中。