Students in adult nursing on a placement at The Dudley Group attend a week-long training on learning disabilities. This initiative won the Learning Disabilities Nursing category in the 2018 Nursing Times Awards
People with learning disabilities often have a poorer experience when in hospital, and receive poorer treatment and care, than people without learning disabilities. This can lead to worse outcomes, decreased quality of life, reduced life expectancy and even premature death. One way to tackle the problem is to make sure hospital staff are well equipped to address the needs of this patient group. At The Dudley Group Foundation Trust, pre-registration students in their second year of adult nursing education attend a one-week training programme designed to improve their knowledge and skills in this field, including via simulation acted out by service users.
Citation: Howells J (2019) Training students to care for people with learning disabilities. Nursing Times [online]; 115: 4, 32-33.
Author: Jacqueline Howells is learning disability liaison nurse, The Dudley Group Foundation Trust.
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- Entries for the 2019 Nursing Times Awards close on 26 April – click here to find out more
- Award category sponsored by NHS England
Admission to hospital can be confusing and stressful for anyone, but is worse for people who find it hard to understand new environments, explain how they feel or describe their symptoms. The problems faced by people with learning disabilities in hospital have been described in the past 15 years in a series of alarming reports from the charity Mencap, the Disability Rights Commission and the Health Service Ombudsman (Giraud-Saunders et al, 2015).
In 2013, the Confidential Inquiry into Premature Deaths of People with Learning Disabilities (CIPOLD) found that men and women with learning disabilities died sooner than those without (by an average of 13 and 20 years, respectively) and experienced a higher number of avoidable deaths from causes related to poor-quality healthcare. Poor staff understanding of the Mental Capacity Act 2005 was cited as one of many compounding factors (Heslop et al, 2013).
Tuffrey-Wijne et al (2013) found that one of the barriers to better, safer care for people with learning disabilities in NHS hospitals was poor staff awareness of the specific vulnerabilities of this patient group. Staff may not always understand the cognitive, health and personal care needs of people with learning disabilities (Giraud-Saunders et al, 2015). More recently, the Learning Disabilities Mortality Review (LeDeR) Programme (2018) has shown that people with learning disabilities still experience deep health inequalities.
The Dudley Group Foundation Trust provides hospital and adult community services for around 450,000 people in the boroughs of Dudley and Sandwell and the districts of South Staffordshire and Wyre Forest. It also provides secondary care services and some specialist services in the Black Country and West Midlands, as well as specialist adult community-based care in Dudley. As the trust’s learning disability liaison nurse, I know the challenges faced by people with learning disabilities and their carers when accessing health services.
Pre-registration students in adult nursing received little education in the field of learning disabilities. Training was usually limited to students completing on their own, over one week, an online workbook. I wanted to improve students’ understanding of learning disabilities in the hope that it would empower them to act in patients’ best interests and, eventually, lead to improved patient experience, better outcomes and fewer instances of poor care.
“This project really makes a difference. It promotes respect through a solutions-based approach and demonstrates authenticity” (Judges’ feedback)
In 2017, I created a one-week training programme for second-year students in adult nursing at the University of Wolverhampton, designed to raise their awareness, improve their knowledge and enhance their communication skills. Part of their allocated practice hours, it includes a simulation exercise developed with Kate O’Connor, simulation lead at the trust, and acted out by service users. This gives students an opportunity to practise their skills in a safe environment.
The programme is designed to:
- Explain what a learning disability is, how it may affect people when using hospital services, what associated conditions they may develop, and what specific treatment and care needs they may have;
- Highlight key legislation, policies and guidelines;
- Raise awareness of the issues encountered at local and national level;
- Prompt students to champion high-quality care for people with learning disabilities.
The programme was piloted in August 2017 with 116 students on placement at the trust. Several sessions taught them about learning disabilities and how care is delineated by legislation such as the Mental Capacity Act 2005, Mental Health Act 1983, Equality Act 2010 and Autism Act 2009. Speakers included Helen Laverty, professional lead for learning disability nursing at the University of Nottingham, and staff from community services and the University of Wolverhampton. Students met service users and carers, hearing about their good and bad experiences of hospital.
At the trust’s simulation centre, two scenarios tackling consent to treatment, communication and pain assessment were conducted four times. Each time, eight students participated directly while all others observed the exercise on video. Each session was followed by a debrief to discuss what had gone well, what had not, and what other strategies could have been used.
The scenarios were acted out by two service users with a learning disability who gave immediate feedback to the group. From Dudley Voices for Choices, a local self-advocacy charity, these service users also co-produced and co-presented the training programme, speaking about their experiences and needs. One session was delivered by parents of service users, who shared their expertise and insight.
Challenges and feedback
Challenges included preparing service users for role play and ensuring speakers and students were available – blocking out a whole week can be problematic. A one-week training programme is resource intensive, but it is crucial to have enough staff present – especially to support those who may be distressed by the issues discussed.
Initially, some students were a little reticent about attending, but feedback after the first day was extremely positive – this continued throughout the week. Students found the interventions by guest speakers and service users inspirational and engaging. They later shared with us that they were applying their newly acquired knowledge and skills in practice.
Where are we now?
The pilot’s success led to other cohorts asking to attend the training. As our trust has two annual intakes of second-year adult nursing students, we now deliver the training twice a year so all can take part. In 2018, we ran it in July and December.
To provide a whole-team approach and improve multidisciplinary practice, we wanted to involve medical students – the first four participated in December 2018. Benefits for them included adapting their communication styles and putting into practice learning about mental capacity assessments gained in their psychiatry rotations.
In future, there will be a session by a consultant psychiatrist in learning disability, who will discuss mental health issues and treatment in people with a learning disability and/or autism.
Nurse training is now governed by the Nursing and Midwifery Council’s (2018) standards of proficiency, which clearly set out the need to take into account the needs of people with cognitive and learning challenges, to “understand and apply the principles and processes for making reasonable adjustments”, and to “facilitate equitable access to healthcare for people who are vulnerable or have a disability”. This is a great opportunity to improve understanding of the needs of people with learning disabilities in all branches of nursing.
Another positive development for nurse training is NHS Improvement’s (2018) learning disability improvement standards for NHS trusts, which state that “all trusts must have the skills and capacity to meet the needs of people with learning disabilities, autism or both by providing safe and sustainable staffing, with effective leadership at all levels”.
Our work at The Dudley Group has been key in driving change locally. Together with these two new sets of standards, it can contribute to a real improvement in hospital care for people with learning disabilities.
Advice for setting up similar projects
- Involve service users – they will provide expert opinion and insight
- Involve practitioners who have a passion for improving patients’ experience of care and students’ experience of learning
- Involve experts in the field to engage and inspire students
- Use real-life simulation to allow students to practise and exchange in a safe environment
- People with learning disabilities experience inequalities when accessing hospital services
- One way of reducing these inequalities is to improve nurse training
- Placements are a good opportunity to teach adult nursing students about learning disabilities
- Simulation can improve students’ awareness of the needs of people with learning disabilities
Giraud-Saunders A et al (2015) Working Together 2: Easy Steps to Improve Support for People with Learning Disabilities in Hospital.
Learning Disabilities Mortality Review Programme (2018) Annual Report December 2017.
NHS Improvement (2018) The Learning Disability Improvement Standards for NHS Trusts.
Nursing and Midwifery Council (2018) Future Nurse: Standards of Proficiency for Registered Nurses.
Tuffrey-Wijne I et al (2013) Identifying the factors affecting the implementation of strategies to promote a safer environment for patients with learning disabilities in NHS hospitals: a mixed-method study. Health Services and Delivery Research; 1: 13.