Adults with Learning Disabilities in Acute Care Settings

Article

Bradbury‐Jones, Caroline, et al. “Promoting the Health, Safety and Welfare of Adults with Learning Disabilities in Acute Care Settings: A Structured Literature Review.” Journal of Clinical Nursing, vol. 22, no. 11/12, 2013, pp. 1497-1509.

The paper is a structured literature review which includes articles that were obtained from four main electronic sources including Medline, British Nursing Index and Archive, PyschINFO, Allied Health literature and Cumulative Index to Nursing. The use of the structured literature review as a research method yields highly valid results that can be validated by other researchers by using the described processes. A structured review as a method of research also has other benefits, including the ability to yield a sophisticated theory that can help to improve the understanding of issues in various contexts where they occur. The research article also outlines the quality appraisal that was employed when determining whether various articles would be included in the research, and hence, improves the validity of the outcomes obtained.

Challenges

Individuals with learning disabilities are mainly faced with a lack of adequate care as evidenced in the available literature (Bradbury‐Jones et al. 1500). For example, most of the persons who live with a disability could not have access to a specialized utensil that was necessary for daily needs such as eating and taking fluids. Individuals with a learning disability have more compromised care since they are unable to read and comprehend the menu available in the hospital. In most cases, individuals with a learning disability have issues with time orientation and hence the strict schedules that are evident in the hospital are likely to present them with challenges as they tend to have their food removed before they can eat (Goodley 217). Other challenging written directions including the direction where the toilet was located and convenience pads were also hard to read and thus, the patients could have these needs left unattended by the staff due to the assumption that all persons tend to read simple instructions (Bekkema et al. 497). Another care challenge that is largely evident among the persons with disability is the lack of adequate medication prescription and overlooking some subjective symptoms since most of the individuals with a learning disability are unable to provide this information to the caring team.

Persons with a learning disability are also shown as having challenges with communicating their needs. The issue is further exacerbated when dealing with healthcare professionals as the use of medical jargon tends to further impair communication regarding the care being provided (Bradbury‐Jones et al. 1501). The issue of lack of communication also affects the healthcare providers themselves as they are also unable to understand nonverbal communication as used by the persons with disability (Watson et al. 208). The poor communication is not limited to the lack of understanding between the persons with a learning disability and the healthcare professionals but could be precipitated by other factors such as the lack of adequate time to ensure both parties can include nonverbal cues to enhance their conversation (Emerson et al. 348). Inadequate documentation regarding the patients’ condition could also be a hindrance to effective communication between the patients with a learning disability and healthcare professionals. As demonstrated in most areas of literature, the lack of proper communication between the parties tends to interfere with the provision of adequate care for the patients with a learning disability.

Staff attitudes are also a critical factor when evaluating how to work with persons with learning disability in a healthcare setting. Bradbury‐Jones et al. indicate that there is a widespread discriminatory attitude against persons with learning disability in most care areas (1502). The form of discrimination that is mainly evident towards this category of patients is overt and is seen in the negative comments that the care providers make about patients with learning disability with those who have communication difficulties experiencing the highest level of discrimination. The discriminatory practices are likely to result from the awkwardness that the care providers experience when dealing with persons with a learning disability. For example, nurses dealing with this category of patients indicated that they felt fear and vulnerability (Bradbury‐Jones et al. 1503). The nurses were unable to identify how to refer to the patients with learning disability especially with the many phrases that are available to describe such conditions. Most care providers worry that the patients with a learning disability could present some form of complexity that would be hard to deal with hence exacerbating the discriminatory practices.

On their part, the patients with a learning disability tend to experience an increased level of fear of procedures. They also tend to react with fear whenever they are being addressed by staff members in white coats. Thus, these patients precipitate an environment where discrimination would occur without their knowledge. The care providers in most situation lack adequate knowledge on how to deal with the reactions as exhibited by the persons with a learning disability (Salsgiver 194). These pervasive forms of anxiety exhibited by the care providers could be picked by the persons with a learning disability and cause them to feel agitated and react negatively to the care process.

Best Practice

Notably, there are some best practices regarding care provided to persons with a learning disability. For example, Bradbury‐Jones et al. indicate that when dealing with persons with a learning disability it is paramount that the care providers employ some specialized aid equipment and other aids (1501). The equipment should be placed in an area where they are easily accessed and training should be offered to all persons who provide care to the patients with a learning disability to ensure that they can incorporate the use of these aids in their care process. When assessing pain among the persons with a learning disability, the failure of the patients to the intensity of the pain could be a hindrance to provision of quality care and thus, employing the “Disability Distress Assessment Tool” could help to determine the specific issues that need to be addressed (Bradbury‐Jones et al. 1501). Another best practice approach that care providers should incorporate when working with persons with a learning disability should be the inclusion of relative and carers as part of the team to ensure all issues are addressed effectively and encourage the continuity of care.

The existing literature indicates that there some best practice strategies that can be employed to address the communication challenges when dealing with a patient who has a learning disability. For example, the use of video resources and booklets has been shown as an effective method of ensuring that these individuals can access enough information that they can use when participating in the decision-making process (Bradbury‐Jones et al. 1501). As opposed to just listing out the menu for this category of patients, it would be more effective to use pictures to help them to decide on their meal which is likely going to contribute towards their nutrition and wellbeing during the care process. Other communication devices such as key rings with symbols and sheets can also be used to improve the understanding between the patients with a learning disability and their care providers which in turn contributes towards the quality of the care provided (Anastasiou and Kauffman 456). The assessment of this category of patients should also be carried out while maintaining appropriate care to ensure that the providers can identify the nonverbal communication that could be used by the persons living with a learning disability to express some of the symptoms associated with their illnesses.

When dealing with the discrimination which is directed towards the persons with a learning disability, there are various best practice measures that have been proposed in the existing literature. For example, providing the staff with the knowledge on how to deal with this category of patients has been shown as an effective method of reducing the discriminatory practices (Bradbury‐Jones et al. 1504). The lack of knowledge on how to handle persons with learning disability among the nursing staff has been shown as one of the reasons they are unable to pick up on the cues provided by this group of patients. Most healthcare providers overlook the need for these patients to provide consent to the care provided hence increasing resistance and distrust which then tends to breed fear between the two parties resulting in discrimination (Heslop et al. 893). Communication training for the healthcare staff has also been shown to be effective in enabling them to handle the needs of patients with learning disabilities. Working with the community and care providers can also serve as a learning point for the healthcare providers when handling persons living with a learning disability as these can provide a practical understanding of how to interpret the cues from this category of patients (Emerson and Hatton 278).

Safe-guarding, Policy and Law

Safeguarding the patients with a learning disability is an integral part of their care. One of the methods that can be used to ensure the safety of the patients living with a learning disability is through paying close attention to the environment in which they are placed in when receiving care. Most healthcare settings are alien to patients and the situation may be worse when they have a learning disability as they are unable to evaluate their new environment and familiarize with it is inhibited (Emerson and Hatton 87). For example, these patients tend to fear getting lost in the various rooms in the healthcare facility or even being unable to find basic amenities such as toilets and areas to wash their hands. Therefore, using images rather than written instructions is bound to improve their comprehension of their surrounding and hence increase their safety.

When providing care to patients with a learning disability, carrying out a thorough preadmission assessment is critical in ensuring that they are provided with a secure environment during the care process. The preadmission assessment is a critical approach to ensuring that the healthcare team has a better understanding of the individual needs of the patients with learning disability and helps to identify the existence of communication challenges (Emerson et al. 186). Symbols can also be used as a method of assisting patients with learning disabilities to understand the various instructions that are available in their care settings. Despite using symbols and pictures to enhance the safety of these patients in the care environment, it is paramount that the nurses also discuss the strategy with the patients themselves to ensure that they can comprehend the message being communicated (Emerson and Hatton 431).

The existing policy and regulations regarding the provision of care for persons with a learning disability include similar rights as those that are provided to other patients. However, the care for these has more regulations that include the right to have a family member included in the process of care to ensure that they can help with decisions regarding the care provided (Lowes and Hulatt 180). The carers also play the role of monitoring the process and enhance the accountability regarding the way the healthcare staff can treat the patients with a learning disability. The patients with a learning disability are also entitled to other benefits that are extended by most insurance organisations and hence they need to be identified appropriately to ensure that they access the necessary resources.

Positive Risk-Taking

The concept of positive risk-taking is basically a strategy where one weighs the potential risks that are involved in various actions and employ various resources to minimise the risks. For persons with learning disabilities, most of the regular activities involve an increased amount of risk as compared to what the other patients may experience (Harkes et al. 92). The situation is compounded by the fact that these patients always avoid taking risks as they image the consequences may end up hurting other people. Based on this concept, it is important for healthcare providers to evaluate the risks involved when the person with learning disability engages in various activities. For example, the care provider needs to evaluate what danger would be involved when allowing the patient out of their room to access facilities in the hospital. Based on the risks identified, the health care provider should be able to plan effectively to prevent the occurrence of the dangers as opposed to denying the patient permission to access the facility.

The incorporation of caregivers and supporters is also another strategy that is proposed in the literature as an approach to enhance positive risk-taking. Most patients with learning disabilities have a carer or parents who are willing to remain with them during their stay in the hospital. These carers can enhance communication between the patient and the healthcare provider and hence contribute to the reduction of risks in various activities (Harkes et al. 88). Therefore, if the carers are valued by the healthcare providers, they can help to create a positive association with the patients and increase positive risk-taking with the outcome being enhanced satisfaction with the care provided.

Differences Between My Life and that of Persons Living with Disability

From my field practice, I could identify several ways in which the life experiences of persons that live with a learning disability tend to differ from my life. For example, persons living with a learning disability tend to experience disability hate crime. The concept of disability hate crime constitutes any form of crime that is perpetrated by individuals who are motivated by any form of prejudice towards persons living with a disability or even perceived disability (Burton et al. 263). Some of the actions that could constitute disability hate crime include name-calling, physical assault, having their properties stolen or even intrusion into their personal space. Most of the persons living with a learning disability are likely to be increasingly affected by these occurrences and tend to lack the ability to stand up for themselves as compared to individuals in the general population. Thus, these individuals require extra support to ensure that their rights are observed.

Another main difference that was evident between my life and that of the persons living with a learning disability was that of expressing emotions. For example, taking an example of the case study of Graham, he indicated that he thinks of himself positively whenever he manages to complete levels on his play station. Graham could demonstrate his feelings of happiness and sadness in a manner that allowed other individuals in his environment to have a better grasp of what he was experiencing. It was also encouraging to learn that Graham could identify persons who cared about his welfare. Most individuals with a learning disability tend to value having positive relations that guaranteed them with support which is not necessarily the case for other individuals among the general population.

The realization that individuals living with a learning disability face disability hate crime made me feel that the society was not being sensitive to their needs. The knowledge about the occurrence of disability hate crime made me feel that there is a need to educate the community about the needs of the persons with disability. I was convinced that by providing education regarding how to handle the persons living with a disability would help to improve the communication between these individuals and other people in their community. I also noted that there was a need to establish programs to protect the persons living with a disability beyond the confines of their homes and healthcare setting to ensure that they are safe from harm.

The knowledge that individuals living with a learning disability can comprehend their relationships with other persons and identify persons who genuinely care for them enabled me to learn that they are different from the rest of the population. This understanding was critical in helping me to learn that it is important to demonstrate genuine care for the patients living with a learning disability to ensure that they develop trust towards the healthcare providers which ensures that they can benefit more from their care (Bastable 348). The experiences also helped me to learn that the individuals with a learning disability are also able to express their emotions and as healthcare provided it is necessary to learn to understand these expressions to ensure that a healthy relationship is established.

Conclusion and Implications

From this analysis, there are various issues that have emerged which are critical in informing the implications for practice for health care providers who work with persons living with a learning disability. First, there is a need to adopt a person-centred planning approach when dealing with persons living with a learning disability. In most cases, the inability of healthcare providers to communicate with this group of persons leads to the failure to incorporate them in the process of providing care (Mansell and Ericsson 486). The person-centred planning approach is based on the realization that these individuals can identify their needs and hence need to be supported to make better decisions about how they would prefer to meet these needs as opposed to dictating what activities they should undertake. The adoption of person-centred planning improves positive risk-taking practices and hence ensures that the patients can feel secure and unrestricted in the care settings.

There is also a need to ensure that the rights of the individuals living with a learning disability are observed during all engagements. The legal requirements for working with persons who live with any form of disability indicate that there is a need to respect their privacy and liberty as well as freedom of thought (Farmer et al. 105). Thus, the care providers working with individuals with a learning disability need to observe these rights. When persons who live with a learning disability are not able to understand the different procedures that are included in their care, they are likely to be increasingly agitated and thus face increased discrimination which could compromise their care (Burton et al. 389). The observance of these rights ensures that this category of patients can cooperate with the care providers and feel safer in different settings where they are receiving their care.

When working with persons living with a learning disability it is necessary for healthcare providers to demonstrate that they have a duty of care and avoid any form of negligence. The healthcare providers are required to demonstrate watchfulness, caution, and prudence when working with persons living with a learning disability (Lowes and Hulatt 186). Notably, also, professional healthcare staff have a specific duty of care to their patients and hence their conduct is expected to be within the regulations provided by the regulatory bodies. Therefore, healthcare providers working with persons living with a learning disability should demonstrate a higher level of skills as compared to members of the general population. Negligence resulting from the failure to comply with the professional code of conduct could attract malpractice lawsuits for the care providers working with persons living with a learning disability.

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