Learning_Disability

Fundamental changes to services for people with learning disabilities have been evident in the United Kingdom due to policy reviews such as Valuing People (Department of Health [DoH], 2001) and Fulfilling Promises (Welsh Assembly, 2001) claims Gates (2007). However nurses who do not possess adequate knowledge of learning disability often lack the confidence of working with such individuals which often means individuals with learning disabilities do not gain access to adequate and appropriate health care services (Davies 2008). The purpose of this assignment is to produce a case study of an individual with a learning disability in which factors that influence the health and health choices of the individual will be examined. Health education, lpromotion and relevant legislation will be explored along with the challenges faced in meeting the needs of different people with varying abilities. The term learning disability will be explored together with what it means for healthcare providers. Each of the topics will be addressed from a theoretical perspective then linked to the patient. To maintain confidentiality the patient’s name has been changed to a pseudonym, in order to conform to the Nursing and Midwifery Council (NMC) Code of Conduct (NMC, 2008). The patient who will be used for the basis of this case study is Mr Jones a 62 year old gentleman with severe learning disability who was met in practice in a rehabilitation unit whilst recovering from a cerebrovascular accident. Whilst Mr Jones had a long history of accessing health and social care services because of his learning disability the main reason for his need to access health services on this occasion was his stroke. As in the past Mr Jones was reliant upon others to recognise that he needed help with his health problems and it was these individuals who got him seen by a doctor who then referred him to the hospital for treatment and rehabilitation The Department of Health (2001) defined learning disability as being a significantly reduced ability to understand new complex information and learn new skills with a reduced ability to cope independently which started before adulthood and which has a lasting effect on development. According to Holland (2011) severe learning disability is when an individual has an intelligence quotient scoring in the range of 20 to 35. Health providers need to be aware that such individuals may require additional support and care such as help with communication needs compared to individual without learning disabilities (Davies, 2008). Mr Jones’ learning disability was identified whilst he was a young child when it was recognised that he had communication difficulties that included difficulty speaking and understanding information given to him. Limited cognitive abilities were reflected in him being unable in the main to read and write. As a result of his learning disability Mr Jones spent most of his early childhood in a long stay institution where in his early years he was labelled as having a “mental handicap” and shared facilities with people who also had mental health illnesses. It was not until 1959 when he was around ten years of age that a distinction between “mental handicap” and mental health was made (Holland, 2011) and care and treatment of people with a learning disability began to change significantly as a result. Admission to such long stay mental handicap institutions could be at the family’s request or petitioned by a group of people that needed to be sanctioned by two doctors. Gates (2007) is of the view that the diagnosis and compulsory certification used according to the Mental Health Act 1913 was done using tests that for many such as Mr Jones meant institutionalised care was an inevitability . The Jay Committee 1979, when looking into the care of people with mental handicaps concluded that many people in long stay hospitals experienced living in squalid and devaluing conditions (Gates, 2007). Following these reports and better understanding of the damage that institutional care could have upon a child’s development led to calls for the care and treatment of children and adults with a learning disability to be significantly changed. Principles of normalisation were adapted in the UK by O’Brien and Tyne (1981) cited by Emerson (1992). These five service accomplishments included respect, choice, community presence and participation as well as developing competence of service users with learning disabilities. Following the government’s introduction of the NHS and Community Care Act 1990, service provisions were tailored to the needs of the individuals and community care assessments were introduced. These changes lead to health professionals and services seeing people with a learning disability as unique individuals with potential and rights that merited protection rather than as individuals with few rights (Holland, 2011). Following the closure of the long care hospital in which he had been raised Mr Jones moved into a residential home for adults with learning disabilities as it was recognised that he was unable to live independently and needed continuing support from others to meet his daily living needs (DoH 2001). Whilst living there he attended a local authority run daycentre five days a week and began to learn some skills that would increase his ability to live more independently. He finally was able to move in with his mother who became his main carer. He relied upon his mother to prompt him to attend to his personal hygiene needs and with her support and guidance he was able to perform most household tasks. Holland (2011) identifies that by the use of the right person centred approaches people with learning disabilities can be supported to use and develop their social functioning skills. Unfortunately for Mr Jones his mother’s health deteriorated and she died leaving him alone and unable to manage to live independently in the family home, he was once more placed in an institutional setting. Walker and Walker (1998) claims that the life expectancy of people with learning disabilities has significantly improved therefore making it increasingly more likely that they outlive their parents. Hubert and Hollins (2000) agrees stating that this leads to more people with learning disabilities living in supported accommodation elsewhere such as in Mr Jones’ case. The Mental Capacity Act 2005 was introduced to protect people who cannot make decisions for themselves or lack the capacity to do so (Department for Constitutional Affairs, 2005). Mr Jones was already in contact with the Community learning disability team through which an assessment of his mental capacity was done which established that he did not have the capacity to make the decision of where to live at that particular time. The Independent Mental Capacity Advocate (IMCA) service which was created under the Mental Capacity Act 2005 was instructed then consulted and they worked with Mr Jones, supported him and represented his views to those who were working out his best interests on where he could live and level of support he needed. Mr Jones was placed in a community supported living scheme were he shared the accommodation with another individual with a learning disability. He was encouraged to be as independent as possible and had a choice of accessing the local community when he wanted as he had his own support worker during the day. This encouraged him to develop a range of activities and meaningful friendships and relationships which is necessary for an individual to lead a fulfilling life (DoH, 2001). The scheme was significantly different from the institutions he had been placed in before. This is a reflection on better understanding and lobbying of charities to treat people with learning disabilities as human beings who must be valued, respected and given the same opportunities in life (Mencap, 2011) Along with charity campaigns and legislation, the government strategies Valuing People and Valuing People Now has seen a radical change in how people with learning disabilities are viewed and treated. The strategies have four key principles namely, rights, choice, independence and inclusion for people with learning disabilities. It reinforces the fact that legislation such as Disability Discrimination Act 1995 and the Human Rights Act 1998 confer to all citizens (DoH, 2001 and 2009). It is important for nurses to be aware and familiarise themselves with such legislation as it affects their work and patients’ outcomes. Nurses must act as advocates for the patients in their care (NMC, 2008) with an awareness of the inequalities in health provision for people with learning disabilities (Tyrer et al, 2007). Following the death of his mother Mr Jones became withdrawn and carers reported that it was becoming increasingly difficult to communicate with him. In order to enable communication with him various means of communication to aid to his speech such as the use of pictures and “object of reference” were used. Following his admission to the rehabilitation unit Mr Jones at times demonstrated an aggression towards those working with him as well as his own regular carers who continued to maintain contact with him. His carers whilst reporting that he had had a history of aggression and challenging behaviour in the past noted that this was unusual for him and that he had not presented with any of these behaviours for several years. Assessing him holistically enabled the nurse to understand possible reasons for his behaviour. Holistic healthcare approach acknowledges that individuals function as a whole rather than as separate systems (Berg et al, 2005). The grief of losing his mother, the changes to his health and environment as well as the frustrations of people not understanding him would alter his behaviour (Worden, 1991).