Learning disability nursing is a branch of nursing that tends to be understated. People with learning disabilities are as deserving of our compassionate care as the rest of our patients. Having a learning disability means that a person has a difficulty learning, understanding and acquiring new skills. These may be social, intellectual and daily skills (MENCAP). As a result they may be slower and need lots of help and support with daily tasks. This does not mean that they cannot learn. The existence of this learning impairment means that a different approach needs to be used when delivering care and support to them.
We are told in all the texts to avoid labelling people because every person is unique. The fact that people have learning disabilities does not mean that they are all the same. It does not also mean that a one size fits all approach will be suitable when delivering their care. Nurses need to be mindful during nurse-patient interaction because care delivery must be tailored to suit each patient as a unique individual. Patience, compassion and support should underlie every interaction that nurses enter with each patient especially when they have a unique way of interacting based on the existence of a learning disability.
I was privileged to work on an end of life care ward for people with learning disabilities and mental health. It was surreal to see the elderly experience very life limiting conditions. The learning disabilities they possessed exacerbated the ability of staff to understand their needs. It also affected the extent of tailoring required to keep the care delivered person centred. The level of complexity experienced by the patients due to their severe physical health decline meant that lots of activities needed to be performed to keep the patients safe and comfortable.
As a result, there was a high risk of adopting a blind approach to individualising care. Many of the patients had sensory needs, speech impairments, physical disabilities and mobility needs. The tasks had to be performed in a timely manner to maximise their health outcomes. It appeared as though attempting to personalise care could have made the tasks more cumbersome. It was difficult to support the individual wishes of patients because at times, especially when their mental states declined, it was sometimes nearly impossible to uphold their wishes.
The nurses often experienced dilemmas when attempting to meet the patient’s unique demands. It was difficult to determine if it was really a patient’s desire to be cared for in a certain way when they were not very coherent? Did they fully understand the implications of some of their requests? Were these requests in their best interest? For example balancing the need to support the oral fluid intake of a dysphagic patient when they were declining water.
I was a student nurse with minimal experience within a setting as such. I felt paralysed as I contemplated the enormity of the tasks I was to perform alongside staff. I wondered why my university had decided to send me there. As far as I was concerned, it was too early in my nursing programme to be there. I had only theoretical skills from all we had been taught at university. Surely, a slow admittance into this reality would have been better for me. I had never seen as massive a trolley as I beheld in the clinic room. How on earth was I to know where all the medicines were? Perhaps a ward with fewer patients, less hustle and bustle would have been best. As I came into the placement daily, I was very withdrawn. The more I allowed my inner fears hold me back, the more I sunk psychologically.
I soon began to experience the fight, flight or freeze response. I was sweaty, thirsty and could feel the micturition bells ringing as soon as I arrived at the start of my shift. Luckily, one of the staff noticed my demeanor. With a warm smile, she took me under her wing. I spent the first few days on the side shadowing staff as they delivered this challenging care. I saw that how looking beyond the disease and finding the person shrouded by illness transformed the care. They were able to wait patiently for patients to communicate and valued the smallest non-verbal movements made by each patient.
I saw first hand how all I had learnt at university came to life in practice. I learnt the importance of seeking consent before procedures and respecting patients’ personal spaces. I saw the theory of communication was brought to life. I remembered how McCabe and Timmins (2006) emphasised a lot in their text about how non-verbal communication was as important as verbal communication. For these patients, it was very true. Many of them were non-verbal and for some who could speak, they had varying levels of cognitive abilities, which impacted on their speech quality and content.
In addition, I learnt to value every form of communication including when patients withdrew from communication. Frustration, exhaustion or satiety sometimes explained why patients withdrew from communication. It was important to be mindful of these reasons while accepting patients right to decline interaction, participation or stimulation. The unintentional nature of some forms of communication does not undermine their relevance as communication especially for patients with learning disabilities. I learnt not only to decipher these aspects but to practice different evidence based communication and care delivery techniques.
Today, I am thankful for the opportunity I had within the setting that scared me at first. I now know first-hand that the practice learning opportunity is truly a valuable part of the nurse training. However, it is important that student nurses should take charge of their learning. Participating in care delivery under supervision is one of the ways to overcome the psychological barriers that may keep students from practicing their ability to care for patients.
The demands on services can sometimes mean that students feel pressured to perform activities of care for patients when they do not feel ready. However, care must be taken by students not to allow fear stop the student from seeking out practice experiences (James et al., 2016). McCaughan and Parahoo (2000) propose that seeking out these experiences is one of the ways that student nurses can reduce the inner insecurities that may inhibit their participation.
The practice learning opportunity creates the chance for mentors and experienced staff to provide practical and emotional support to students.(Bath et al., 1996). Heaven et al (2006) also cite clinical supervision as precursor for skills transfer to students.This is an invaluable resource for aspiring nurses because it creates the opportunity for safe trial and minimal errors when practicing clinical skills and care delivery because staff are on hand to provide guidance and support.
Thank you for reading.
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Written by Lauretta Ofulue