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  • 11 May 2023
  • 10 min read

Caring For Patients With Learning Disabilities

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    • Laura Bosworth
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“To treat them with the same dignity as any other patient, we need to be open-minded and see the person for who they are and their health needs outside of their learning disability.”

In this helpful and empathetic video, Laura guides us though how to provide humanised care for patients with learning difficulties, and the importance of raising awareness through education.

My name is Laura, and today's video aims to help nurses outside of the learning disability specialism to better care for patients with learning disabilities (LDs).

I am an adult nursing student, and alongside my studies, I work as a support worker for people with a mixture of complex learning disabilities. The things I talk about in this video are not targeted at any group but reflect what I have witnessed and researched, aiming to raise awareness and give guidance.

The Impact Of Negative Attitudes Towards Patients With LDs

As nurses, we are taught to give humanising person-centred care to all patients without judgement or discrimination. However, as seen in the news and on social media, I have witnessed a general discriminative, dehumanising and negative attitude towards patients with learning disabilities, noticeably those whose disabilities are more profound and complex.

To me, this is the result of general ignorance and a lack of education regarding learning disabilities, contributing to poor care and 1200 avoidable deaths yearly. As a nursing community, we need to do more.

The NMC code states that all patients should be treated as individuals with respect and dignity, highlighting how humanised care is central to nursing education and practice.

However, this patient group is still marginalised, as shown during the COVID–19 pandemic. This is stressed in the Learning Disability Mortality Review, stating that people with learning disabilities are dying at 3.6 – 6 times the general population's rate.

As a result, 1.5 million people in the UK are continually being let down due to the lack of training given to nurses to meet their health needs. Why is this happening?

The Education Gap

Despite patients with learning disabilities being vulnerable due to their lowered capability to defend themselves from harm, they are not viewed as such. Thus, they are not placed in a separate group highlighting their different health needs to the general population.

This results in insufficient training and education being provided. This education gap is highlighted in a Freedom of Information request sent to NHS Trusts and Universities.

The results show that 47% of hospitals do not incorporate learning disability information into staff training. Additionally, 22% of universities did not offer training on reasonable adjustments for people with LD.

Making reasonable adjustments falls under the 2010 Equality Act. So, as professionals, we are accountable for ensuring these adjustments are made to avoid discriminating against patients with learning disabilities.

But how can we do this if we have yet to be trained?

The NMC code states that all patients should be treated as individuals with respect and dignity, highlighting how humanised care is central to nursing education and practice.

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Aiding The Provision Of Humanised Care

Todres and peers developed a framework that aids the provision of humanised care, which can be used to guide nurses and education providers in providing better care for patients with learning disabilities:

Practice Embodiment

The first pillar in this framework is embodiment and reductionism. Nurses can easily subject these patients to reductionism by viewing them with a narrow mind, only recognising them for their disability. Reductionism can also occur when nurses assume that people with learning disabilities lack capacity.

To provide humanising care, we need to practice embodiment, where we encourage the person's dignity and values by not making assumptions and treating them with the same respect and dignity as any other patient.

It is also important that when you receive a patient with a more complex learning difficulties into your care that you complete the necessary mental capacity assessment without presumption.

To treat them with the same dignity as any other patient, we need to be open-minded and see the person for who they are and their health needs outside of their learning disability.

Communicate & Promote Agency

Humanisation also occurs when a patient's agency is promoted. Patients with learning disabilities are often pacified when nurses remove their choice due to the assumption of capacity or communication challenges.

It is important to remember that many of these patients face communication difficulties, and it is down to you, as their nurse, to encourage their agency by finding an appropriate communication method.

Poor communication and lack of choice are isolating for the patient. Using the correct communication aids also enables embodiment, allowing the patient to be involved in their care, maintaining their dignity and choice.

Create A Comfortable Environment

Additionally, a patient's sense of place can be easily removed when nurses do not advocate freedom and comfort by not being aware of physical and communicative needs.

For many patients with learning disabilities, the familiarity and security of an environment play a significant role in their psychological well-being. The effects that environmental factors, such as noise levels, temperature, familiarity, and sensory inputs can have on a patient can lead to distressing emotions and behaviours.

When a nurse cannot understand why a patient reacts to the environment in such ways, the patient is viewed as a nuisance. Disruptive behaviours are often dealt with incorrectly, again causing dehumanisation.

By using objects of comfort and familiarity, using correct communication methods and being aware of environmental factors that may be overstimulating, nurses can help patients develop their sense of place.

If a patient cannot understand their sense of place, their sense-making abilities can become impaired. Again, this can stem from ineffective communication between staff and the patient.

As a result, the patient's sense-making also becomes impeded as they have been incorrectly aided in finding meaning in different things, leaving them estranged in an alien environment. This can be another trigger for distressing emotions and behaviours.

When nurses don't attempt to understand why these emotions and behaviours occur, the patient is often wrongly used as a scapegoat. This lack of education and understanding causes unwarranted negative attitudes and prejudice against patients with learning difficulties, especially when they exhibit behaviours that challenge or behave in a way that is seen as a nuisance.

To treat them with the same dignity as any other patient, we need to be open-minded and see the person for who they are and their health needs outside of their learning disability.

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Discrimination & Objectification Within Healthcare

During the COVID–19 pandemic, blanket DNARs of people with learning disabilities disregarded the future lives of thousands of people. This took away the humanising practice of treating a patient's past, present and future.

Because patients with learning disabilities often have more complex health needs than the general population, we as nurses should aim to preserve their quality of life.

Unfortunately, problems with the provision of advanced healthcare planning, including planning and adjustments as needs change, alongside the provision of services, can all contribute to premature deaths.

This loss of personal journey is widespread because patients with learning disabilities are often labelled as hard work or a nuisance. This allows nurses to use them as a scapegoat, leading to poor care and outcomes.

Poor care outcomes are also associated with objectification when people with learning disabilities are viewed narrowly as a diagnosis or number. By being labelled, objectified or stigmatised by the system or healthcare professionals adds to the frustration, stereotyping, embarrassment, and exclusion often encountered by patients with learning disabilities.

Nurses must resist homogenisation to prevent inadvertently dehumanising patients.

Why Education Is Vital

Due to inadequate education and experience, some nurses are under-skilled and provide insufficient care for this patient group.

Providing mandatory training should be at the forefront of nursing education. Especially as revolutionary shifts in how we care for this patient group have given them a higher life expectancy.

As a result, it is estimated that by 2030 there will be 1.2 million people with a learning disability aged 60 years or older. These statistics show the need to care for this patient group will rise. Nurses will be expected to lead the care for this patient group, yet we have very little education and training provided for us to do this.

Therefore, implementing specialised training, policies, and awareness from local trusts must occur rapidly.

How Can Nurses & Trusts Adapt To This?

As nurses, we can start at the basics and utilise the knowledge given to us by carers and through hospital passports as a grounding point for individualised care.

Local trusts need to make learning disability training mandatory for all staff, and it should be refreshed annually to keep up to date with changes in best practices.

However, the NMC is ultimately responsible for the quality of the nurses on their register. The NMC has allowed the quality of care for this patient group to fall by not incorporating enough training into the courses of Student Nurses.

If we are not taught about learning disabilities during our training, how can we adequately meet their health needs as qualified nurses?

Mencap has already brought forward this call for adequate education and training to the government with the ‘Treat Me Well’ campaign. I believe this campaign also needs to be brought forward to the NMC and local trusts, calling for them to require all Registered Nurses to receive training on learning disabilities.

I cannot understand why education regarding learning disabilities is repeatedly overlooked, especially when so much training has been put in place for other equality and diversity subjects.

Thank you for watching.

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About this contributor

Hi I’m Laura and I’m a student nurse studying adult nursing. I have recently joined the nurses.co.uk team and look forward to creating content in the coming months. I have an interest in learning disabilities and an amazing opportunity to complete an international elective in summer.

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