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Innovation

Caring for inpatients with learning disabilities

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An education programme raised hospital employees’ awareness of the needs of people with learning disabilities when they are admitted to hospital

 

In this article…

  • Setting up a learning disabilities awareness programme
  • An evaluation of the training sessions
  • The impact of the programme on staff awareness and on care

 

Author

Dee Buchanan is community learning disability nurse Bath Locality Team, NHS Bath and North East Somerset.

Abstract

Buchanan D (2011) Caring for inpatients with learning disabilities. Nursing Times; 107: 32/33, early on-line publication.

People with learning disabilities are more than twice as likely as the rest of the population to experience ill health, yet their health needs are often poorly met.

This article describes the implementation and evaluation of an education project, led by community learning disability nurses, to improve the care of patients with learning disabilities in hospital.

Keywords: Learning disabilities, Acute care, Awareness training

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article

 

5 key points

  • People with learning disabilities are more than twice as likely as the rest of the population to experience ill health, and four times more likely to die from preventable causes
  • Awareness training for acute staff can significantly improve the hospital experience of these patients
  • Hospitals need to work with community learning disability nursing teams to improve the care of these patients
  • A link nurse for each ward means at least one member of the ward team will know about caring for patients with learning disabilities
  • Awareness training can improve staff confidence, increase referrals from the hospital to community teams and improve patient experience

 

People with learning disabilities  are more than twice as likely to experience ill health than the rest of the population, and four times more likely to die from preventable causes. They also experience extreme and multiple health inequalities, and poorly met health needs (Disability Rights Commission, 2006; Hollins et al, 1998).

In 2007, Death by Indifference, a report from the charity Mencap, stated there was institutional discrimination in the NHS against people with learning disabilities (Mencap, 2007). This was echoed by the Six Lives report, which said a lack of knowledge was contributing to poor healthcare for this group (Abraham, 2009). The Michael (2008) report and the Department of Health’s (2009) Valuing People Now paper called for these inequalities in care to be addressed.

This article discusses an education project aimed at raising staff awareness of the needs of people with learning
disabilities, and improving the care of these patients when they are admitted to hospital.

Background

In 2010, a Care Quality Commission inspection found our local hospital was struggling to meet the standards required for caring for patients with learning disabilities. This prompted the hospital to request support from the local learning disability service to help improve the care of these patients. Through the Access to Acute Hospitals Network (www.a2anetwork.co.uk), the community learning disability nursing team worked with the hospital to raise staff awareness of best practice when caring for these people in hospital.

Trueland (2010) stressed the importance of educating hospital staff about reasonable adjustments that could be made when treating patients with learning disabilities. She highlighted how information given to staff about different communication methods and basic awareness training could help transform the hospital experience of these patients.

Learning disabilities awareness programme

Two community learning disability nurses worked with a local service provider and a service user with a learning disability to compile and deliver a two-hour training session to a multiprofessional group. At this pilot session, people learnt about learning disabilities, had opportunities for discussion and heard stories from people with learning disabilities about their hospital experiences.

After feedback from attendees and the hospital’s director of nursing, the session was reduced to 30 minutes as it was felt more likely that staff would be able to attend shorter sessions.

These sessions could be delivered on wards to promote attendance and discussions within teams. We developed a training plan, which included the 30-minute session (Box 1) and an information pack for the ward. The pack included some of the content from the two-hour session that could not be given in the shorter time, as well as information on health conditions and “hospital passports” – documents that provide staff with information about a patient, enabling them to provide more person-centred care.

 

Box 1. Teaching session content

  • Mencap’s (2007) Death by Indifference report
  • The Six Lives report (Abraham, 2009)
  • What a learning disability is
  • The Mental Capacity Act, including the best-interest checklist (DH, 2005)
  • Consent and health issues
  • Admission and discharge
  • The role of the hospital link nurse
  • The patient’s hospital passport
  • Top tips and the Getting it Right checklist (www.mencap.org.uk)
  • Role of community teams and learning disabilities nurse

Two sessions were run every month at a time convenient to ward staff. Initially, eight sessions were planned over four months with the aim that 10-12 staff would attend a session. Staff were only required to attend one session. To ensure staff had contact with a trainer with a learning disability, half-day sessions open to all staff were organised twice a year. Seven training sessions have so far been delivered to 78 staff, mostly nurses.

Evaluation

Staff completed a questionnaire (Box 2) before starting the training, which gave an overview of their confidence about working with patients with learning disabilities, and their knowledge and experience. 

Box 2. questionnaire before training

1. What do you understand by the term learning disability?

2. Have you had any experience of nursing someone with a learning disability?

3. Briefly describe the experience, highlighting any concerns/problems

4. What would have helped?

5. Do you feel confident about supporting someone who has a learning disability?

6. If the answer to question 5 is no, what would improve your confidence?

7. Do you know who to contact for support and information relating to someone with a learning disability?

The pre-training questionnaire and post-training discussion identified changes in knowledge, especially around confusion between mental health, dyslexia and learning disabilities. After the session, staff could differentiate between terminologies they had previously found confusing.

We used staff feedback on the awareness sessions to identify trends, strengths and weaknesses. The only weaknesses related to the venue, not the sessions’ content. Most staff found the training useful and relevant; only one said their knowledge had not improved as a result of it.

Staff also said they appreciated having contact details for the local community learning disabilities team and felt less anxious about working with people with learning disabilities. Just under half of those who attended training expressed interest in becoming a link nurse. 

Impact of training

Evaluation indicated the nurses’ knowledge improved as a result of the awareness session. Eight link nurses have now been recruited for the wards, training has been provided, and there has been an increase in referrals from the hospital to the community team when a patient with a learning disability is admitted.

The community nurses have been given access to the care records of inpatients with a learning disability, and a new nursing role has been created. The sister in quality improvement mental health and learning disabilities is developing protocols and care pathways with community learning disabilities team nurses to further improve services.

Anecdotal evidence from service users and carers shows the awareness sessions have improved patient experiences. On admission, more staff have been asking service users for their hospital passport. 

Discussion

In a hospital with more than 4,000 staff, time constraints are a problem when organising training. However, having link nurses for each ward means at least one person on the ward will have some knowledge of caring for patients with learning disabilities and links with the community team.

Community nurses have taken part in a peer review since the sessions began, with the following results:

  • Links have been made with the clinical lead for training who will take over the programme’s administration, and several wards have requested training;
  • There are plans for staff induction to include learning disabilities awareness training, given with members of the community team, and the hospital plans to accredit the training;
  • A seminar is planned, in which people with learning disabilities will talk about their experiences, and the hospital intranet has a learning disabilities page;
  • The community team and the hospital will continue to work together to evaluate the impact of the training.

Conclusion

The willingness of the hospital to try to improve the way they support people with learning disabilities has been impressive. It demonstrates that community  learning disabilities team nurses can offer support to acute services to improve care for patients with learning disabilities, their families and carers. Staff have been very enthusiastic about the training, and the community nurses have gained a greater understanding of the pressures faced by colleagues in acute care.

The project aims have been achieved, and partnership working continues to bring improvements in acute care services for people with learning disabilities. 

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