The concept of learning disability nursing now is different to what it was over 20 years ago. There are over 1.4 million people in the UK that have a learning disability (LD) and they make up approximately 2.16% of the total adult population in the UK (Mencap, no date). Their population has been increasing over the years according to Public Health England (2016) but the reasons for this are unclear. It could be due to a greater recognition and understanding, therefore more people are being diagnosed or it could be that people have better access to health care, so mortality rate is lower.
For whatever the reason may be, this increase shows that LD nurses are needed more now than ever before; however, according to Nursing Times (2018), therell be a 35% decrease in numbers by 2020 unless action is taken. Learning disabilities have different levels of severity and affect the way a person understands information and how they communicate (National Health Service (NHS), 2018). The reason why we need LD nurses is because theyre specialised and can act in a way that general nurses couldnt.
Their role also includes being an educator, a counsellor, a therapist and an advocate (Baldwin and Birchenall, 1993).
Furthermore, the four Ps of nursing are crucial to the professional role of an LD nurse. The first one is prioritising people; an LD nurse needs to ensure that the service users care and safety are their main concern, whilst recognising that each person has different needs which require different actions.
They also must act in the persons best interest, whilst respecting their choices and upholding their rights, to preserve their dignity and enable them to have a voice. The second one is preserving safety. As a professional, you need to work within the limits of your competence and be able to ask for help from another professional when a procedure falls outside of your own capabilities; this ensures service user safety as well as the publics. Any concerns need to be raised immediately where a service user may be considered at risk either to themselves or others, and therefore, the nurse should take appropriate action where necessary to deal with those concerns as part of their role. Next, is promoting professionalism and trust. Here, it is always important to uphold the reputation of your profession and to present a personal commitment to the standards of practice. Its also crucial to be a model of professionalism that others can aspire to be, leading to a level of trust and confidence from service users, as well as, fellow professionals. The final one is practicing effectively. This is vital to the nurses professional role as they need to assess the service users needs, then either deliver or advise them on treatment. Accurate records should be kept of everything that occurs and knowledge should be shared where appropriate to protect the service user from harm. Its also important to reflect, and then act on any feedback given to develop your professional role as a nurse. This allows you to look at what you have done, so you can then think of ways to improve yourself the next time a similar situation arises (Nursing and Midwifery Council (NMC), 2015). Moreover, when developing your professional role, its imperative to look at your communication skills and how they differ from person to person. Everyone communicates in different ways, not just people with learning disabilities, so its great to know what resources you can access to ensure a person understands what you are trying to communicate. A common way of communicating is by using Makaton, which is a simplified version of Sign Language that can be personalised to an individuals needs and used at a suitable level for them. It involves using signs and symbols to help people communicate, and is designed to accompany spoken language; therefore, if a person begins to develop their own speech, they can easily drop the signs (Makaton, no date). In addition, two resources that can be used to simplify spoken language are Books Beyond Words and the Communication Jargon Buster. Beyond Words are an organisation that provide books and training to support people who find pictures easier to understand than words. The books are designed to clarify complicated ideas, such as diabetes and how to examine yourself (Books Beyond Words, 2011). The Communication Jargon Buster contains alternative phrases to commonly used medical terms along with visual prompts; this is essential when trying to explain a complicated idea (General Medical Council, 2018). Thus, advanced communication is fundamental to a nurses professional role. It allows a service user to feel valued as you show that you are willing to listen and understand how they are feeling, whilst putting them at ease. It also helps them feel in control as they may feel helpless once in the healthcare system, but good communication can avoid this and enables the person to know they still have a say (Royal College of Nursing, no date).
In relation to people with learning disabilities, a fundamental aspect is ensuring they feel prioritised. According to Learning Disability England (LDE) (2018), people with an LD and/or autism are to be included as one of the top priorities for the NHS over the next ten years. In the month of September 2018, there was seven meetings held by NHS England and LDE to discuss what work had occurred so far to make health services better and to put plans in place for what would need to happen next. These meetings were open to the public, so service users could attend and have their opinion heard on what they thought would improve health services. It was chosen to be one of the four clinical priorities as evidence showed that people with an LD had significantly worse physical and mental health than the general public and were at greater risk of dying earlier (Gifford. B, 2018). This highlights that they werent prioritised, instead they were discriminated against due to their LD. Heslop et al. (2014) suggests that premature deaths of people with an LD compared to the general population has been identified since the 1970s, and those with more severe learning disabilities are recognised as having an even shorter lifespan. In addition, Heslop et al. (2014) reports that 38% of people with an LD die due to avoidable causes, compared to only 9% of the general population. This is further evidenced by Glover and Emerson (2013) who report that health professionals lack of training could be contributing to these avoidable deaths. According to the Equality Act 2010, healthcare professionals are to make reasonable adjustments to the care of someone with an LD as part of their legal duty to ensure a persons needs are met. If a professional hasnt received any training, a persons needs may go unrecognised due to diagnostic overshadowing; this is where a professional may assume that a persons medical symptoms are a consequence of their LD (Jones, Howard and Thornicroft, 2008). To ensure diagnostic overshadowing is reduced in the future, Mencap are working to ensure that no healthcare professional can enter a hospital without having some form of training on how to care for people with learning disabilities (Mencap, 2018).