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STUDENT EDITOR BLOG

'Do nurses need specialist training?'

  • 8 Comments

After spending time on a general ward, Claire questionned whether nurses should be trained in specific branches.

Claire Harries_SNT

Do we really need our nurses to undertake training in the specific fields of adult, child, mental health and learning disabilities, or should it be more of a “one nurse fits all” set-up?

I was thinking about this recently after working a shift as a healthcare assistant in a hospital. On this particular ward, there were a variety of patients including those with dementia and learning disabilities – all being cared for by adult trained nursing staff.

For me, it doesn’t matter what type of nurse provides the care as long as patients’ needs are being met. I’m sure this sentiment would be echoed in the feelings of both patients and their families.

However, when I spoke with the nurse on duty that night, she mentioned how it is always in the news that hospitals are often failing to provide adequate care for vulnerable patients. She went on to say that when she had completed her nurse training she wanted to care for people who were physically unwell and make them better. She hadn’t “signed up” to work with people with mental health problems or learning disabilities and in many respects, she is right.

In the UK, the number of people with learning disabilities is on the rise. Patients with learning disabilities are likely to have communication difficulties that result in them being less likely to report symptoms and understand the information given to them by hospital staff.

Combine this with around one in four hospital beds already occupied by a person with dementia, having more readmissions and longer stays than those without dementia, and what are you left with?

Well, if every adult nurse felt they didn’t want to care for these patients, we would need a great deal more mental health and learning disabilities nurses on our wards.

Thankfully, many general nurses do have the skills to help identify patients with dementia and learning disabilities and have an understanding of the additional needs they may have.

I am also aware that many health boards are offering training to raise awareness among their staff. This is of particular importance as it is often the most basic of needs that are over-looked if vulnerabilities are not identified and acknowledged.

NHS Wales has developed and trialled a “care bundle” that will help health boards and trusts be alerted to and thus be more able to respond to the needs of people with learning disabilities. This was launched in January of this year.

The care bundle details several steps to be taken at various stages of the hospital admission. Within the first four hours, the next of kin or primary carer must be notified, along with the care manager and specialist learning disabilities services. A hospital passport for the person must be requested. On a daily basis (regardless of length of stay), a named nurse is to be identified to the patient and their family, the care plan communicated with the ward staff and the patient-centred plan reviewed and updated.

Within seven days of admission, a full multi-agency discussion is to be held with input from family and carers, with the aim of reviewing progress and planning discharge. 

With effective communication between staff, patients and their families or carers, a dignified and person-centred hospital stay should be achieved and instances of diagnostic overshadowing should be reduced.

Although I am unsure if there have been similar developments in the rest of the UK, I look forward to seeing how this will improve patient care for people with learning disabilities in Wales.

Back to my original question, do I think nurses should have specialist training?

Yes, I do.

There are many aspects of care that can be provided by any trained nurse but there are often far more that require the more in-depth knowledge and experience that comes from field-specific trained nurses. Perhaps if our wards were staffed with nurses from all branches, there wouldn’t be the need for the creation of such care bundles as nurses would be able to share their skills and talents.

 

Claire Harries is Student Nursing Times’ learning disability branch editor

  • 8 Comments

Readers' comments (8)

  • Can someone enlighten me as to why the number of people with learning disability is increasing?

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  • Hiya, It's simple, more people are surviving due to improvements in healthcare, specialist services, medication etc. Many people who would have historically died in infancy are now reaching adulthood. LD services need to grow now in order to keep up with the demand in the future. This is why it is important that those working in general hospital settings have an understating of the additional requirements people with learning disabilities may have - particularly around communication, access and nutrition. Have a look at the Death by Indifference report (Mencap,2007) or the Confidential Inquiry into the Death of People with Learning Disabilities (2013). It's shocking.

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  • There's probably a whole bunch of other reasons, but I'm just a student so will have to find out haha

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  • I am a mental health nurse and feel I would benefit from additional training/experience of physical health conditions. I did not get any placements other than mental health during my training or subsequently.
    Not having the basic skills to assess wounds, identify physical health problems and carry out simple "general" nursing tasks results in having to access primary and secondary generic services to deal with problems that either could have been prevented or could have been carried out by mental health nurses with an additional level of training.
    Accompanying patients to their GP or A+E departments highlights the divide between specialities in that often Nurses trained in general health appear to lack the communication skills to effectively with people suffering active psychosis and my own deficit in knowledge about general nursing skills and chronic conditions.
    I think there should be a greater emphasis on widening the skill base of nursing staff whilst maintaining nurses specialist branch skills.

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  • michael stone

    'For me, it doesn’t matter what type of nurse provides the care as long as patients’ needs are being met. I’m sure this sentiment would be echoed in the feelings of both patients and their families.'

    Spot on Claire - it is simply a case of being sufficiently well-trained/experienced, to competently perform whatever job/task you are faced with.

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  • I'm a learning disability nurse & I have nursed children as young as 2 through to the elderly with numerous health conditions. Children/adults with severe learning disabilities caused by brain trauma at birth or through injury/illness have associated physical health needs such as tracheostomy, PEG feeds, epilepsy, mobility problems, etc, etc.

    Yet I am amazed that as an LD nurse I am not entertained within general nursing because of the branch I am trained in! I have often made queries about general nursing roles but as soon as they hear what my nursing qualification is, I am often told that I would not be considered despite me detailing my extensive general nursing experience. Whatever happened to transferrable skills & knowledge??

    LD nurses do not just cater for those with behavioural or communicational difficulties or those that need a wee bit of shopping doing or taking to the pub for lunch - we do the whole caboodle because let's face it, people with learning disabilities DO suffer from health problems, conditions, & diseases, more so than those without a learning disability.

    in my opinion, every branch could learn something from the other if only the branches weren't so strictly segregated

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  • I'm a learning disability nurse & I have nursed children as young as 2 through to the elderly with numerous health conditions. Children/adults with severe learning disabilities caused by brain trauma at birth or through injury/illness have associated physical health needs such as tracheostomy, PEG feeds, epilepsy, mobility problems, etc, etc.

    Yet I am amazed that as an LD nurse I am not entertained within general nursing because of the branch I am trained in! I have often made queries about general nursing roles but as soon as they hear what my nursing qualification is, I am often told that I would not be considered despite me detailing my extensive general nursing experience. Whatever happened to transferrable skills & knowledge??

    LD nurses do not just cater for those with behavioural or communicational difficulties or those that need a wee bit of shopping doing or taking to the pub for lunch - we do the whole caboodle because let's face it, people with learning disabilities DO suffer from health problems, conditions, & diseases, more so than those without a learning disability.

    in my opinion, every branch could learn something from the other if only the branches weren't so strictly segregated

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  • hie

    Very interesting question, am working at a neurological unit and have observed that if the lead nurse is a RGN,we experience a lot of challenging behavior. Learning Disability nurses have got their beautiful way of communication. They carry the 6c's.

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