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