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Nurses admit skills gap on treating patients with learning disabilities


A third of nurses believe that people with a learning disability receive a poorer standard of healthcare than the rest of the population, according to a survey by charity Mencap.

The survey results were announced on Monday to coincide with the launch of its “Getting it right” campaign, which calls on trusts to sign up to a nine point charter on improving standards of practice when dealing with people with a learning disability, their families and carers.

It follows a warning last week by the Royal College of Nursing that gaps in nurses’ knowledge often contributes to the deaths of patients with learning disabilities while in healthcare settings (news, page 2, 15 June).

The warning itself followed Basildon and Thurrock University Hospitals Foundation Trust being fined £50,000 after the death of Kyle Flack, who was asphyxiated when his head became trapped between his hospital bed and the bedrail.  

The Mencap survey, which involved 417 hospital nurses and 223 primary care nurses, revealed that a third of respondents said they had personally witnessed a patient with a learning disability being treated with neglect or a lack of dignity or receiving poor quality care.

The results also revealed that 33 per cent of primary care nurses and 30 per cent of hospital nurses said they had not been trained in how to make reasonable adjustments for patients with a learning disability.

Additionally, 74 per cent of primary care nurses and 65 per cent of hospital nurses said they needed specific guidelines on how care and treatment should be adjusted to meet the needs of those with a learning disability.

Mencap chief executive Mark Goldring said: “The fact that so many healthcare professionals recognise the gaps in their own training and the need for specific guidelines for treating people with a learning disability, shows the need for urgent action before more people suffer.”

Royal College of Nursing chief executive and general secretary Peter Carter said the college fully supported the launch of the campaign.

He said: “It is deeply concerning to hear that nurses are witnessing one of the most vulnerable groups of people being let down by the health service.

“Learning disability nurses have the specialist knowledge and training to provide the best possible care for these patients. Worryingly, despite an increase in the number of people with learning disabilities, there are now a third fewer learning disabilities nurses than in 1996.”


Readers' comments (8)

  • First of all, is MENCAP really an unbiased party to conduct this research?

    I have said this in a recent post, but I will repeat it here as I believe this story is not only misleading, but unfair to adult nurses.

    Isn't this the reason we have seperate branches?

    I am an adult Nurse, I am good at what I do and I am responsible for the medical care of a wide range of illnesses and injuries in adults. I admit my knowledge in Childrens and Mental Health Nursing is basic, but why should it be anything but? I am a specialist in my area, just as they are specialists in theirs. We cannot be expected to know everything, even though I think that expectation is made on us sometimes.

    If we are to have these specialties, where Nurses are branched off into seperate groups (which I believe is a good thing), then wouln't a better system - instead of blaming general nurses - be to make sure that general wards who recieve patients with mental health patients, have access to mental health Nurses?

    I mean on any given ward or general area, we will recieve patients with anything from schizophrenia to senility, bipolar disorder to autism, etc etc etc.

    Few Adult Nurses have the training or specialist knowledge to deal with the vast amounts of MH and LD patients that are on the wards daily, and nor should we be expected to. If adult Nurses are expected to treat MH and LD patients, then maybe MH and LD Nurses should be on the wards with those patients whilst we treat them medically. That would create not only the staff and resources needed to deal with what are often highly demanding patients time and attention wise, but also bring the specialist knowledge that is required to treat them holistically.

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  • I agree with Mike and, as a children's nurse, I did my recent dissertation on the ability of nurses in my field, who aren't LD trained, to cater for the sometimes very complex needs of the child and family, in the acute setting. It seems very rare that even If the right support network is set up in the community, that any meaningfull liaison can be facilitated to support the nurse/child/family. And, as can sometimes be the case, parent's can find it very difficult to stay with thier child. In these circumstances even the most basic communication can be a huge challenge, meaning the child can be literally truamatised by procedures such as toiletting, carried out by strangers who are not versed in their usual habits and routines. There is not enough time in a nursing course to be proficient in LD or MH care but the support should come from those fields, into the acute setting, when necessary.

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  • I accept what Mike says to some extent but not being a specialist in learning disabilities or mental health is not an excuse for poor treatment. People should not die in hospital because nurses do not know how to assess them or how to treat them because they are not considered the 'norm'. Providing a second class service to someone because it is just too hard to communicate with them or because they are a 'nuisance' is not acceptable either.

    Having mental health or LD nurses holding the hands of general nurses is like asking for an interpretor to be sent along, they know little about the physical needs which are obviously the over riding problem otherwise the person wouldn't be on the ward. So what is their role? Should the question not be to improve understanding and communication so that nurses feel better equipped to carry out assessments. Also have someone review and develop more appropriate assessment tools that make allowances for communication difficulties.

    Also there is an expectation that MH & LD nurses have a basic knowledge and understanding of medical process ie assessment and treatment of UTI/Chest infections/peg feeds/IV drips etc so is it really too much to ask for adult nurses to have a better understanding of LD problems and improved communication techniques?

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  • As an LD nurse working with special needs children, I was expected to undertake PEG feeds, suction, treatment of wounds, etc, etc - I was trained by the Paediatric nurses who worked on the same unit as there was a mix of both nursing disciplines. I loved this - it not only ensured my ability to do the job but it proved extremely valuable when I moved posts.

    This mix of expertise & specialism should be happening in all health care settings if necessary but what gall's me most is the fact that some nurses only refer to themselves as an 'adult' nurse or a 'mental health' nurse & so on - we all train as nurses in whatever branch we choose BUT what is wrong with nurses from one branch learning the skills and knowledge from another?? Whilst i'm not saying every nurse should be trained in every discipline, being a nurse is about providing the care & support to patients as individuals despite what difficulties they may present.

    I got sick of Paediatric nurses asking why, as an LD nurse, I'd been given a post in a special needs children's unit - I often just shook my head in contempt of such people who, when faced with a child with autism who proved challenging when facing an injection or a down's syndrome child who required alternative communication methods other than speech, they always passed such kids over to me. And yes, I gave the injection!!!

    What would be ideal is an LD nurse employed & based within each general hospital - and let's not forget, an LD nurse often has extensive experience of mental health issues which often go hand in hand with learning disability, may also have worked with special needs children & their learning disabled mothers AND possess the practical skills & knowledge from treating the long standing chronic diseases their learning disabled patients have presented.

    I've done all of this & I'd gladly jump at the chance of such an opportunity

    I think it's what's called in the trade transferable skills & knowledge!!

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  • krystal hemingway, I don't think for one second that I suggested that I or any other Nurse would give 'second class' care or poor treatment because of lack of specialty. To suggest otherwise is insulting to all Nurses who work their arses off trying to give the best care they can.

    You said 'Also there is an expectation that MH & LD nurses have a basic knowledge and understanding of medical process ie assessment and treatment of UTI/Chest infections/peg feeds/IV drips etc so is it really too much to ask for adult nurses to have a better understanding of LD problems and improved communication techniques?'. Like I have said I and many other adult Nurses DO have this basic knowledge, but we do not and should not be expected to have specialist knowledge, otherwise what is the point in having specialties? You even said yourself that 'they know little about the physical needs which are obviously the over riding problem otherwise the person wouldn't be on the ward.' A bit of a contradiction there?

    I come across MH and LD patients all the time in an acute adult setting. I give as much care and attention as I do to every one of my patients, and whilst I may have enough basic knowledge to get by, I certainly am not versed in the nuances or specialist knowledge that they require for their care, whereas a MH or LD Nurse would be able to spot things or react to behaviour in ways that I would not know how. Just as in the same way I would not expect a MH or LD Nurse to be able to (for example) know the best practice of treating a gunshot wound or spot the advanced clinical signs of change in this instance, as I can as an adult Nurse with an interest in emergency trauma.

    What is needed is more LD and MH Nurses employed in an acute setting. If the patients are there, why aren't the Nurses?

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  • In response to your question Mike, the nurses are not there because acute trust do not invest any money in employing any other discipline. You only have to look at the National Dementia Strategy to identify the savings that such nurses within the acute sector,could make and yet we have so few. As for insulting adult nurses, your comments may be very true about yourself but like everything else you are not in a position nor am i, to generalise for the rest of the nursing profession. There are obviously some nurses not providing basic care otherwise we wouldn't have had 'Death by Indifference' and we wouldn't have PCTs employing Strategic Health Facilitators.

    On a professional and pesonal level I have witnessed the poor care recieved by patients who do not fit 'the norm' and if you care to read some of the reports by the likes of the Alzheimer's Society and look at your own hospitals length of stay for older people with dementia and their outcomes then you may begin to understand why people become upset.

    To add to this the spotlight should not only be focussed on acute nurses but medics and community services also, who make no reasonable adjustments and then threaten to ban people with severe dementia from surgeries for being disruptive.

    Also in the current economic climate we are likely to see a scaling down of expensive specialist nurses and a greater emphasis on education, training and collaborative working.

    As a final note i would add to Mike that in some cases you do have the specialist to hand, there is no-one better placed to assist you then the carer, don't ignore a valuable resource.

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  • I work on a busy medical admissions unit. We have everything medical you could imagine come through to us, including patients with learning disabilities and mental health issues, including overdoses, self harm etc, and transfers from our local mental health hospital.

    We have access to two mental health nurses who work across the whole trust (one for over 65s and one for under 65s). Patients referred to the team can take days, there is no cover when either is off sick or on annual leave. The mental health hospital does everything it can not to send a member of staff over with their patient and very often, there is no funding for carers to come sit with patients with a learning disability (it has to come out of a different pot according to the carers I have spoken to).

    I have very little training in these areas. I'm an adult nurse. I don't understand why we can't have access, 24 hours a day, to mental health nurses, even if we perhaps shared with a&e. It wouldn't cost anymore than employing an adult nurse, they are not specialist nurses in the sense of the diabetes nurse or paliative care nurse, they have just trained in a different area to myself and the other nurses with whom I work.

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  • tich x

    seems to me as if mike & one or 2 others have been spot on. i also agree totally with most comments on another recent article on LD. to carol... its fantastic that you can do peg feeds, suction, etc; but to me its because these are skills you use on a daily basis. i dont expect you carol to be very good at looking after patients on ventilation or setting up machines, syringe pumps/ drivers etc as i do. in the same way i dont expect myself to be very good in interpreting ECGs or setting up TPN feeds as i work in respiratory unit.

    the main point is that you are most likely going to be a master of one branch, or jack of all trades but master of none. how does someone for instance who work in surgical ask and get time to go for a study for something they dont do on daily basis?

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