Discriminatory Practice and Learning Disability

Reflection occupies a significant place in nursing and is actively encouraged to withdraw conclusions, discover new insights, and consider further actions. Reflecting should be purposeful, focused, and should raise significant questions (Nicol and Dosser, 2016). Reflection entails a certain level of mindfulness and can be referred to as the ability to return to initial treatment stages, assess all procedures, and contemplate on the best strategies. Mindfulness opens the room for thought and helps nurses “to develop resilience against the stress of today’s society” (Walker and Mann, 2016, p. 188). Moreover, reflecting on the encounters and experiences in nursing contributes to learning substantially. In other words, reflection is accounting for previous knowledge and integrating new skills to improve practice, which also helps to express feelings and emotions (Relijic et al., 2019). This paper accounts for the experience gained during working in my alternative field of nursing practice, which is working with people with a learning disability.

It is vital to understand what are the best nursing practices in this field, evaluate their influence, and apply the findings to my own field of nursing, which is mental health. Hence, this reflection’s purpose is to deliberate on the connection between anti-discriminatory practices towards patients with a learning disability and the mental health of individuals, using Driscoll’s reflective model. Reflecting and evaluating care is integral to all nursing fields because it helps to continually improve the quality of care, discuss openly, and learn how to cooperate with others (Nursing Time, 2019). Nevertheless, reflection is of particular significance to working with individuals with a learning disability and in the mental health care sector. Within the outlined fields, it helps to develop a better understanding of those who think differently, learn from each other, show less judgmental reactions, create trust and deal with the patients’ emotions (Hem et al., 2018). Reflecting on the anti-discriminatory practices within my alternative field of nursing and connecting it to my primary sector is integral to my learning.

One essential aspect is that there are different types of reflection, which can be viewed as reflection-in-action and reflection-on-action. The primary difference is that a professional is reflecting in action throughout the process of performing any clinical work, which the reflection-on-action occurs after the activity (Roberts, 2015). Although both types of reflection provide their benefits, reflection-on-action can be more structured and systematic. This habit can help practitioners determine gaps in knowledge, encourage evidence-based practice, increase self-awareness, and provide better standards for care (Roberts, 2015). Consequently, this paper emphasizes the reflection after the gained experience and allows conducting rigorous, critical, and systematic thinking.

The first step for the reflection will be identifying Driscoll’s model of reflection (2007) that it will utilize. The concept is based on three questions that entail the experiences’ analysis and learning from them, which include what, so what, and now what (University of Cambridge, 2020). Thus, reflecting on my experience with anti-discriminatory practice towards individuals with a learning disability will start with describing the context of the situation. The next step would be identifying the conclusions from experience and what was learned, followed by the contemplation on what would be the further action based on the results of reflection. In such a way, my reflective account will include several stages that correspond to Driscoll’s reflective model.

The event that this reflection is aiming to assess happened in the department of general surgery. Individuals of different ages were coming there, and there were several patients with a learning disability (LD). I was working closely with a learning disability liaison nurse (LDLN), observing the patients and assessing the struggles that they encountered throughout their stay. Once, there was a patient (Peter – name changed for information security purposes) who was keeping silent and could not answer the questions concerning his physical condition and the symptoms during the screening stage. I was getting very anxious as I struggled to establish a rapport with him, yet I achieved minimal effect. As a result, my supervising nurse decided to conduct another round of orientation, showing all the necessary amenities and services. It helped to establish the bond between Peter and LDLN. I was present throughout the whole procedure, which helped me to establish relationships based on trust with Peter. The next step was taking the patient to a separate quiet room, free of the hospital noises. There, an individual managed to relax, and, started to answer the questions necessary to proceed with the treatment slowly.

LDL has various responsibilities and work not only at direct patient care, but also “to educate staff and, strategically, interpret and enact national policies at the local level” (Sheehan et al., 2016, p. 2). Consequently, I had an opportunity to observe the patients with LD, how the hospital is providing services to them, their reactions, and treatment outcomes. In the process, I realized the importance of the specified experience and the positive effect that it had on my professionalism and the intuitive understanding of patients’ needs. I was delighted to develop a specific approach towards individuals with LD and highlighted the need for creating a calm environment and establishing a bond with them.

Moreover, I recognized how vital it is for a nurse to understand what a learning disability is, which will explain the importance of paying particular attention and designing the work in a specific way. In the UK, learning disability is substitutable with intellectual disability (Green, 2018). This condition is “a significantly reduced ability to be able to understand new or complex information, to learn new skills and to cope independently” (Adshead et al., 2015). Thus, patients with LD can have substantial difficulties in their journey of receiving medical care, and the staff should ensure equality and high-quality delivery. The significant point is that patients with a learning disability are disadvantaged in terms of access to the relevant care services in comparison to the rest of the population (Morton-Nance, 2015). The understanding of LD patients’ concerns filled me with sympathy and allowed me to gain the emotional concern that would, later on, help me to become more empathetic in my nursing approach. It is vital to reflect on the knowledge and information gained throughout this experience, as it focuses on the significance of anti-discriminatory practice to improve the quality of care.

I was thrilled to discover the specifics of managing the needs of patients with LD. Patients must prepare for their stay in the hospital, which includes possessing a healthcare passport. The National Health Service in the UK suggests several aspects for individuals with a learning disability that might facilitate their experience. First, the patients are encouraged to tell about any problems, and the hospital personnel should ask about the preferred way to receive the updates (National Health Service, 2018). The specified element of the process resonated with me particularly strongly since I have always advocated for active patient-nurse communication. Those requirements for the health services were outlined in the Accessible Information Standard in 2016, which aimed to improve the quality of healthcare for people with disabilities (National Health Service, 2017). The patient who had difficulties with describing the symptoms had his healthcare passport, which eased the process for the nurse. Nurses must fulfill the standards and do their best to offer an equal opportunity for receiving information. It can be related to one of the strategies to reduce discrimination because it strives to provide fair access to the info for everyone, despite any condition.

Applying the gained experience to the first step in Driscoll’s model, the “what” question, I was curious to learn that the situation included the instance when Peter (the patient) faced difficulties sharing and comprehending the info, which required a particular approach from LDLN. In other words, I did my best to help this individual with LD in the general surgery department, who had troubles in understanding the given information about the recommendation in the pre-operation stage and providing the needed information.

The next step in the used reflective model is the “so what” aspect, which emphasizes the knowledge gained from experience. I quickly realized that the first crucial issue is the nurses’ compliance with all the standards and regulations, which was directly connected to the overall patients’ experiences and the quality of care. Nursing and Midwifery Council (NMC) designed the specific competencies for the field of learning disability nursing. The regulations include compliance to the legislation, promoting autonomy, supporting the carers or families, practicing professional advocacy, and recognizing individuals with LD as full and equal citizens (Nursing and Midwifery Council, 2019). Thus, I recognized the necessity for nurses to engage with local authorities to affect nursing policies so that the existing regulations could support the specified function. Following the described competencies is directed to ensure that individuals with learning disabilities feel like full-fledged members of society who receive the same opportunities and services of an equal level.

The described experience showed the significance of stressing particular attention to this field and finding the best ways of assistance and understanding. The NMC highlights the need to implement ongoing training, which would be more efficient than separate sessions (Stephenson, 2019). I felt that this request was vital for the future of health care in England because it involved a substantial part of the population and worked towards equality. The proposals of the Department of Health and Social Care outline the need for skills to support target individuals and provide quality care, as learning disability affects their lives (Stephenson, 2019). I am genuinely convinced that these recommendations represent the urgent need to address the rights of people suffering from LD.

I encountered several situations similar to the one described above, which led to the conclusion that further work has to be done. In such a way, it is the liability of the legislation and distinctive services to ensure the provision of specialized education and training for healthcare professionals. One of the conclusions withdrawn from my experience is that every nurse should possess knowledge about patients with a learning disability, which is the first step towards reducing discrimination. In this case, discriminatory activities do not imply different attitudes or the reduction of the care quality, but rather the lack of training and regulations to ensure equal opportunities for different patients. Nevertheless, I concluded that people with LD face misconceptions and negative stances, and insecurity in other spheres of their lives (Scior and Werner, 2015). Thus, there is a need for additional training for the nurses, so that they will be prepared in any situation and will be able to help the patients with LD feel included and equal.

After applying the findings from the experience to the second stage of Driscoll’s reflective model, I discovered that there was a need for action within the field of learning disability care. I researched further to learn that one of the most significant directions was focusing on implementing anti-discriminatory practice towards patients with LD because there is a need to address the rights and opportunities for the described individuals. A sufficient supply of learning disability nurses plays a critical role in eliminating discrimination within this sector. I found out that there was a significant fall in the number of individuals who applied for learning disability courses, which was an obvious problem (Maguire, 2019). The situation with a patient who had troubles with providing the information required substantial time from the LDLN. There is a lack of awareness about learning disability nursing, which leads to an insufficient number of students applying for this field (Merrifield, 2018). This experience answers the “so what” question in a way that every patient with LD requires an individual approach and human and time resources, not to face any discrimination.

The final reflection stage is answering the “now what” question, which implies determining the possible recommendations and strategies to be utilized in the field. All nurses should comply with the Equality Act that provides “a legal framework to protect the rights of individuals and to promote a more equal society” (Barr and Gates, 2018, p. 488). Thus, I feel that it would be appropriate to suggest recording the work of learning disability nurses through the Health Equality Framework, which addresses the health inequalities experienced by patients with LD (Duff, 2016). In such a way, it provides a more exceptional picture of what might happen and how to act in case of communication difficulties.

Another integral aspect that I was exhilarated to draw from the experience is focusing on leadership in learning disability care. The Department of Health that created the National Skills Academy for Social Care designed the Leadership Qualities Framework for the social care field (Jukes and Aspinall, 2015). All healthcare employees should carefully follow this framework, along with the competencies of the NMC mentioned above. Besides, the Health and Social Care Act 2012 sets out the obligations on NHS and Clinical Commissioning Groups to work towards eliminating inequalities in terms of access to health services (Heslop et al., 2018). The reflection shows that complying with the regulations and recommendations from the legislations mentioned above is vital to providing high-quality care for patients with LD. If my supervising LDLN did not have proper training, there could have been more severe consequences, and it would be impossible to get the information from the individual.

Moreover, I found it very useful to reflect on this experience since it highlighted the necessity to look at the long-term plan concerning learning disability care, to understand the objectives, and observe what can be done. I learned that the NHS established a long-term strategy that focuses on the commitment to people with LD. The plan entails various aspects, including respecting and protecting rights, personalizing care, engaging patients and their families, and providing a sufficient workforce (Blair, 2019). To reduce discrimination, I would also recommend the integration of special objective structured clinical examination (OSCE) stations (Conway et al., 2019). This implementation can facilitate the process of keeping information about the patient and make it more organized.

It is possible to say that reflecting on the occurred situation using Driscoll’s model opened up the significance of particular focus on the learning disability care field for me. Providing more training and ensuring compliance with the regulations is directed towards improving the quality and equality of services for patients with LD. Guaranteeing equal rights, treatment, and attitudes to individuals with LD leads to a lower risk of negative experiences among them, which can reduce the likelihood of severe mental health problems’ development. Organizing effective care, promoting coordination and communication among the personnel, stipulating training and supervision, and involving the patients are practical measures to prevent mental health issues (Allan and Crossland, 2017). In conclusion, I found this reflection model a useful method of contemplating the experience, gaining new skills and knowledge, and assessing potential solutions for both the alternative and own fields of nursing.


Adshead, S., Collier, E. and Kennedy, S. (2015) ‘A literature review exploring the preparation of mental health nurses for working with people with a learning disability and mental illness.’ Nurse Education in Practice, 15(2), pp. 103-107.

Allan, R. and Crossland, T. (2017) NICE guidelines: mental health problems in people with learning disabilities. Web.

Barr, O. and Gates, B. (2018) Oxford handbook of learning and intellectual disability nursing. 2nd ed. Oxford: Oxford University Press.

Blair, J. (2019) How to tune into a person’s frequency: the past, present, and future of learning disability nursing. Web.

Conway, C., Poon, K., Hollén, L., Blythe, A. and Rai, D. (2019) ‘Delivering a learning disability OSCE station–challenges and solutions.’ Education for Primary Care, 30(5), pp. 309-311.

Duff, H. (2016) ‘Health Equality Framework shows promise in improving service users’ well-being.’ Learning Disability Practice, 19(7), pp. 30-36.

Green, J.L. (2018) ‘Peer support systems and professional identity of student nurses undertaking a UK learning disability nursing programme.’ Nurse Education in Practice, 30, pp. 56-61.

Hem, M.H., Molewijk, B., Gjerberg, E., Lillemoen, L. and Pedersen, R. (2018) ‘The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.’ BMC Medical Ethics, 19(1), pp. 54-68.

Heslop, P., Read, S. and Dunwoodie Stirton, F. (2018) ‘The hospital provision of reasonable adjustments for people with learning disabilities: findings from freedom of information requests.’ British Journal of Learning Disabilities, 46(4), pp. 258-267.

Jukes, M. and Aspinall, S.L. (2015) ‘Leadership and learning disability nursing.’ British Journal of Nursing, 24(18), pp. 912-916.

Maguire, D. (2019) Does learning disability nursing need the maintenance grant back? Web.

Merrifield, N. (2018). Exclusive: learning disability nurse shortage needs ‘real’ action. Web. 

Morton-Nance, S. (2015) ‘Unique role of learning disability liaison nurses.’ Learning Disability Practice, 18(7), pp. 30-34.

National Health Service (2017) Accessible Information Standard specification. Web.

National Health Service (2018) Going into hospitals: learning disabilities. Web.

Nicol, J.S. and Dosser, I. (2016) ‘Understanding reflective practice.’ Nursing Standard, 30(36), p. 34.

Nursing and Midwifery Council (2019) Learning disabilities nursing: field specific competencies. Web.

Nursing Times (2019) NMC highlights importance of nurses’ ‘reflection’ on practice. Web.

Reljić, N.M., Pajnkihar, M. and Fekonja, Z. (2019) ‘Self-reflection during first clinical practice: the experiences of nursing students.’ Nurse Education Today, 72, pp. 61-66.

Roberts, M. (2015) Critical thinking and reflection for mental health nursing students. London: SAGE Publications, Inc.

Scior, K. and Werner, S. (2015) Changing attitudes to learning disability. London: Mencap.

Sheehan, R., Gandesha, A., Hassiotis, A., Gallagher, P., Burnell, M., Jones, G., Kerr, M., Hall, I., Chaplin, R. and Crawford, M.J. (2016) ‘An audit of the quality of inpatient care for adults with learning disability in the UK.’ BMJ Open, 6(4), pp. 1-7.

Stephenson, J. (2019) NMC calls for protected nurse training time on learning disabilities. Web.

University of Cambridge (2020) Reflective practice toolkit. Web.

Walker, M. and Mann, R.A. (2016) ‘Exploration of mindfulness in relation to compassion, empathy and reflection within nursing education.’ Nurse Education Today, 40, pp. 188-190.