Nursing patients with learning disability

Principles of care 974 Communication 975 Consent to treatment 976 Maintaining patient safety 978 Networks of support 980 A learning disability is a lifelong condition where the person has a reduced ability to understand new and complex information or to learn new skills, and has a reduced ability to cope independently. This has a lasting effect on the individual’s development....

2018 ◽  
Vol 28 (10) ◽  
pp. 278-282
Author(s):  
Sue Wilkinson

Patients should be at the heart of everything we do. The aim should always be to achieve healthcare outcomes by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone: ‘no decision about me, without me’ (DH 2012). This article details a plan of care for an 18 year old male patient with a moderate level of learning disability who was scheduled for a tonsillectomy at a local NHS trust hospital. It focuses on the management of the patient’s anxiety, nausea and pain. In accordance with the Health and Care Professions Council’s code of confidentiality (HCPC 2014) the location and individual names of places and people concerned will not be disclosed. The patient presented at the pre-assessment appointment as having a learning disability consistent with a diagnosis of being on the autistic spectrum. More specifically, he had cognitive impairment which affected his ability to understand complex information. This, combined with a reduced ability to cope independently, formed the rationale for the attendance of a carer throughout his perioperative journey. According to the National Autistic Society (NAS) there are approximately 700,000 people with autism spectrum disorder (ASD) in the UK ie more than 1 in 100. Autism is a part of daily life for 2.8 million people (NAS nd).


2004 ◽  
Vol 9 (2) ◽  
pp. 11-17 ◽  
Author(s):  
Tracy Carlson ◽  
Annette Hames ◽  
Sue English ◽  
Caroline Wills

1999 ◽  
Vol 23 (9) ◽  
pp. 522-524 ◽  
Author(s):  
John Hillery ◽  
David Tomkin ◽  
Adam McAuley

Health care professionals in Ireland are concerned about the effect of L v. Bournewood Community and Mental Health Trust ex parte L (1998). Despite Ireland's distinct legal system and different service provision, this case has highlighted existing concerns about the treatment of patients with a dual diagnosis of learning disability and mental illness.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S36-S36
Author(s):  
Thomas Leung ◽  
Lina Zariddin ◽  
Emma Megoran

AimsPsychiatric hospitals are well equipped to manage patients with complex psychiatric needs, however due to their community setting when a rare medical emergency occurs it is not unusual for a small delay whilst staff search for equipment on the ward or even go to other wards for equipment. The aim of this audit is to ensure that our psychiatric wards in Carseview Centre are well equipped to respond to patients becoming medically unwell and put our nurses and doctors in a position to safely stabilise the patient until furthur help arrives.MethodWe collected data from 3 inpatient adult wards, 1 intensive psychiatric care unit and 1 learning disability unit and compared their resuscitation trolley equipment with local NHS Tayside Emergency Equipment Protocol in January 2020. Following data collection we fed back to the wards about our results and discussions were held between doctors, charge nurses, pharmacists and resuscitation officers to determine whether missing equipment were neccesary in the community setting and to see if there were updates that required for our local protocol to better reflect current practices as it had not been reviewed since 2012. Following multiple meetings we amended our local protocol to better reflect what was . A list of recommendations was also made to improve patient safety.We then collected data again in January 2021ResultFolloing our first data collection we found that the resuscitation trolleys tended to not have ligature packs and masks were generally not by the oxygen cylinders. Hypoglycaemic dextro-tablets were also not readily available. The Learning disability units also did not have an emergency resuscitation trolley.Following our discussions and amendment of the protocol this was finalised in November 2020 and was dissemindated towards the wards and we waited 2 months for the changes to take effects and recollected our data. There continued to be equipment that was incomplete/missing on each individual ward, but none that were consistent throughout the whole hospital site. All the recommendations that were made for the 1st data collection had been done.ConclusionOverall we felt that the emergency trolleys were better equipped in line with the updated protocol compared to the previous audit cycle. The overall pattern of missing equipment was inconsistent and the recommendation was for staff to copmlete checks to address missing/incomplete items when found. Our local protocol also recommends that all ward should stock ‘additional items’ (nebuliser masks and non-rebreather masks), which majority had however were difficult to locate, which could delay patient care.We will continue to repeat data collection cycles and feedback to our wards to ensure patient safety is not compromised.


1999 ◽  
Vol 29 (6) ◽  
pp. 1367-1375 ◽  
Author(s):  
K. ARSCOTT ◽  
D. DAGNAN ◽  
B. STENFERT KROESE

Background. People with a learning disability are increasingly being encouraged to take a more active role in decisions about their psychological and medical treatment, raising complex questions concerning their ability to consent. This study investigates the capacity of people with a learning disability to consent in the context of three treatment vignettes, and the influence of verbal and memory ability on this capacity.Methods. Measures of verbal ability, memory ability and ability to consent to treatment (ACQ) were administered to 40 people with a learning disability. The ACQ consisted of three vignettes depicting a restraint, psychiatric or surgical intervention. These were followed by questions addressing people's ability to understand the presenting problem; the nature of the proposed intervention; the alternatives, risks and benefits; their involvement in the decision-making process; and their ability to express a clear decision with a rationale for treatment.Results. Five people (12·5%) could be construed as able to consent to all three vignettes; 26 (65%) could be construed as able to consent to at least one. The questions that were most difficult to answer concerned a participants' rights, options and the impact of their choices. Verbal and memory ability both influenced ability to consent.Conclusions. This study introduces a measure that may enable clinicians to make more systematic assessments of people's capacity to consent. A number of issues surrounding the complex area of consent to treatment are also raised.


1994 ◽  
Vol 18 (11) ◽  
pp. 691-693 ◽  
Author(s):  
Jenny Curran ◽  
Sheila Hollins

For those people who have the cognitive and social impairments described as a learning disability, personal choice is more often than not a limited experience, (Mencap, 1989). Simple choices may be usurped by the preferences of carers, and more serious decisions may be correctly or incorrectly deemed beyond their capacity. We will address two questions which repeatedly face clinicians working with adults with learning disabilities. First, how do we ascertain a person's level of competence to give consent in relation to medical treatment? Second, in the case where a person with learning disability is considered unable to give informed consent to treatment, how do we proceed to make a decision regarding treatment?


2020 ◽  
Vol 29 (4) ◽  
pp. 1783-1797
Author(s):  
Kelly L. Coburn ◽  
Diane L. Williams

Purpose Neurodevelopmental processes that begin during gestation and continue throughout childhood typically support language development. Understanding these processes can help us to understand the disruptions to language that occur in neurodevelopmental conditions, such as autism spectrum disorder (ASD). Method For this tutorial, we conducted a focused literature review on typical postnatal brain development and structural and functional magnetic resonance imaging, diffusion tensor imaging, magnetoencephalography, and electroencephalography studies of the neurodevelopmental differences that occur in ASD. We then integrated this knowledge with the literature on evidence-based speech-language intervention practices for autistic children. Results In ASD, structural differences include altered patterns of cortical growth and myelination. Functional differences occur at all brain levels, from lateralization of cortical functions to the rhythmic activations of single neurons. Neuronal oscillations, in particular, could help explain disrupted language development by elucidating the timing differences that contribute to altered functional connectivity, complex information processing, and speech parsing. Findings related to implicit statistical learning, explicit task learning, multisensory integration, and reinforcement in ASD are also discussed. Conclusions Consideration of the neural differences in autistic children provides additional scientific support for current recommended language intervention practices. Recommendations consistent with these neurological findings include the use of short, simple utterances; repetition of syntactic structures using varied vocabulary; pause time; visual supports; and individualized sensory modifications.


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