Intellectual disability, hate crime and other social constructions: A view from South Yorkshire.

The category of hate crime is a recent legislative response to the increasing levels of antisocial, criminal and discriminatory behaviours and practices that target a wide spectrum of individuals on the basis of their identification within certain minority sociological subcultures. People with intellectual disability are often targeted for this kind of behaviour. Here, we report on an evaluation of one English city's efforts to instigate a street-based scheme to offer some security and protection to its intellectually disabled citizens. The physical location of the premises and the engagement of the staff employed therein have some bearing on their potential to be effective in offering shelter and support to distressed individuals. But even where premises are well situated with positive staffing, the absence of local records to list the uptake of the scheme leaves room for doubt about its overall effectiveness.

Evaluation of a mental health liaison team. Part 2: the themes and their effect on practice.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, part two of two on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, focuses on the perceptions and experiences of the MHLT participants, and explores three sub-themes derived from the interview data. The article considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital.

Evaluation of a mental health liaison team. Part 1: background and literature review.

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Management of these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. In April 2015, a mental health liaison service was introduced in Rotherham Hospital as part of a two-year pilot scheme. The aim was to provide assessment and treatment of adults with mental health problems admitted to the hospital. An evaluation of the new service was undertaken to assess the effects of the service. This article, part one of two, reviews the literature, as well as outlining the background to, and method of, evaluation. Part two, which will be published in December, examines the themes revealed by analysis of the service participants' responses.

'How families live ' - the views and experiences of parent-carers who provide family placements to intellectual disability nursing students.

AIM: We aimed to learn about the value of family placements from the perspective of parent-carers who provide them to nurse students via a Scottish university Family Placement Scheme. METHOD: Qualitative interviews were conducted with seven parent-carers who provided a family placement over two academic years. Descriptive data was analysed, organized into themes and subject to content analysis: parents' descriptions of caring; their perceived value of family placements; and their views and experiences of participation in intellectual disability nurse education. RESULTS: Family placements are beneficial to nurse students and families with children with an intellectual disability. Description of wider aspects of caring was provided, offering insight into learning experiences of students on placement. CONCLUSION: This model of learning provides opportunities for students to appreciate the reality of caring for a relative with an intellectual disability at home. Students develop their practice skills for working in partnership with family carers.

How do people with learning disability experience the city centre? A Sheffield case study.

The use of city centre spaces by people with learning disability is not much debated in the literature. Here we include the thoughts and opinions of groups of people with learning disability as we undertook some guided walks through Sheffield city centre. We found that few of the participants had independent access to the city centre. Many cited concerns over personal safety and the most, on few occasions when they did visit, did so with family and/or paid staff for pre-planned purposes, usually linked to shopping. The need for appropriate support figured prominently. There is also a need to re-assess what we mean by social inclusion for this cohort.

Recognising and respecting patients' cultural diversity.

AIM: To explore nursing students' experiences of caring for patients from different and often unfamiliar cultural backgrounds. METHOD: Focus group discussions were conducted with nursing students from mental health, learning disability and adult nursing in one university, to obtain qualitative information about areas of difficulty in providing culturally competent care. FINDINGS: Nursing students expressed difficulties and challenges meeting the cultural needs of patients, with particular focus on issues related to language, food and gender. CONCLUSION: Nursing students need to prepare for work in a culturally diverse healthcare setting and should receive education and training in this area to ensure ongoing personal and professional development.

Breast cancer information and support needs for women with intellectual disabilities: a scoping study.

OBJECTIVE: To examine the compass and nature of relevant research and identify gaps in the current evidence in order to determine the priority of future research about breast cancer and intellectual disability (ID). METHODS: A scoping study that comprised of a consultation exercise with a wide range of key stakeholders (n = 26) from one northern city (Sheffield) within the UK. RESULTS: This study identified numerous gaps in the current evidence base. It highlighted a dearth of research that focuses specifically on the information and support needs of women with IDs (and their carers) across the breast cancer patient pathway. Within the interviews, whilst 'reasonable adjustments' were being made and there was evidence of good practice, they were neither strategic nor systematic. Participants suggested that future research should focus on devising protocols to advise on the legal, ethical and clinical imperatives so that clinical governance in this area is assured. CONCLUSIONS: There remains a dearth of research or practice guidelines at every stage of the breast cancer care pathway for women with ID. This may arguably lead to late diagnosis, suboptimal treatment and management and overall survival rates for this group. Further research is needed to understand the specific information and support needs of both women with ID (and their formal and informal carers) through the breast care pathway and to identify appropriate protocols, strategies and interventions in order to address these.

Exploring placement pathways in nurse education.

As community-based care has developed in line with current policy towards integrated care, some hospital placement capacity for student health professionals has been lost as a result of service reorganisation. However, student nurses and allied health professionals need to gain a broad range of experience to prepare them for the complex and rapidly changing environments they will be entering as qualified professionals. Placement pathways constitute a means of offering the knowledge and skills to enter the profession in challenging times. This study explored, by means of a literature search and interviews with key stakeholders, the challenges and opportunities offered by placement pathways. The findings are presented and the work being done as a result, including an the introduction of an electronic placement pathway tool, are discussed.

Dr. Tulp, I presume: intellectual disability and ethnicity in Rotherham.

In this article, we report on that aspect of our ongoing simulation project which focuses on the cultural needs of a 'virtual' young man living with profound and multiple intellectual disabilities, who is British Asian and receives care in a residential setting. We describe our involvement with a local agency who support families from black and minority ethnic populations and who have children with a variety of intellectual disabilities. We then go on to detail the focus group we attended and how we incorporated the data generated into a more comprehensive story for our 'virtual' young man, Ahmed.

Dr. Tulp attends the soft machine: patient simulators, user involvement and intellectual disability.

Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from 'real' people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

Intellectual disability, consumerism and identity: to have and have not?

Here we consider the consumer society as it currently exists in the UK and examine its relationship and relevance to the population of individuals with intellectual disability. We do this through a reading of the associated literature on theories of shopping and consumption which we then contrast with research evidence as it applies to the lives of people with intellectual disability. By brining together these two perspectives we hope to shine some light on ideas around identity and choice. We then transfer these arguments to the health and social care sector. Here we ask whether an economic model which has been exposed as divisive and exclusionary should be used in the administration of social secutity benefits of the kind accesed by people with a range of disabilities. We conclude that the unchallenged advance of marketisation within health and social care may benefit those who are financially able but for those who are economically disadvantaged the choices offered are illusory at best.

Contemporary issues in the training of UK health and social care professionals--Looking after people with a learning disability.

The health and social care of people labelled with 'learning disability' has historically been a disputed territory for those individuals working within the nursing and allied health professions. In recent times this situation has seen public debate as instances of poor care and avoidable deaths have received a high profile in the popular and professional presses. Here we report on a local initiative where students can study for a joint honours award which allows them to practise as a generic social worker and a learning disability nurse. We believe that the inter-professional perspective improves their ability to manage the increasingly complex aspects of health and social care that this client group demands. Furthermore, we suggest that if a similar model were to be applied at a foundation module level to the training of ALL health and social care professionals, then the results would be a win/win situation for all parties. This would also go some way to meeting the recommendations of Sir Jonathan Michael's report, Health Care for All (DH, 2008).

The anatomy lesson of Dr Nicolaes Tulp: what can it teach us today?

We report on the use of a high fidelity patient simulator (SimMan) within a clinical lab setting to teach learning disability nursing students about epilepsy management. We had previously prepped the students with verbal discussions on epilepsy management and, when the simulator began to undergo a seizure, small groups of students managed the unfolding scenario. We received written feedback from the students on the experience, and with reference to this and to the wider literature we consider the benefits of this approach to patient care. We surmise that lessons learned here will be applicable to trainee professionals from other parts of the register and in other fields allied to healthcare. We anticipate that this will improve care for people with intellectual disability in line with recommendations in Health Care for All (2008).

A problem with inclusion in learning disability research.

People with severe learning disability are particularly difficult to include in the research process. As a result, researchers may be tempted to focus on those with learning disability who can be included. The problem is exacerbated in this field as the political agenda of inclusion and involvement is driven by those people with learning disability who are the higher functioning. To overcome this we should first detach the notion of consent from ideas about autonomy and think instead of it as a way to avoid wronging others; this fits the original historical use of consent in research. This allows us to think in terms of including participants to the best of their abilities rather than in terms of a threshold of autonomy. Researchers could then use imaginative ways to include the least able and to ensure they are not wronged in research or by exclusion from it.

Become a role model for good practice.

Handwashing is a vital part of the job yet not everyone does it.

"Riding the bumpy seas": or the impact of the Knowledge Skills Framework component of the Agenda for Change initiative on staff in intermediate care settings.

This paper explores the compatibility of the recently modernized NHS pay structure, "Agenda for Change" (AfC) with the workforce flexibilities arising within intermediate care services in the NHS in England. The findings reported here were an unanticipated outcome of a larger, Department of Health (England) study which explored the impact of workforce flexibility on the costs and outcomes of older peoples' community-based services. The research coincided with the introduction of AfC, and, as such pay modernization was a strongly emergent theme from focus groups that involved 11 teams as part of the larger study. In principle, it appears that both intermediate care and AfC should support the concepts of interprofessional working, blurring of role boundaries and role substitution, however the findings from this study suggest otherwise. In particular, intermediate care was described as a largely non-hierarchical service structure where staff roles expand horizontally to take on a broad plethora of generic tasks. In contrast, AfC promotes a hierarchical framework for career progression that recognizes and rewards defined skills, expertise and responsibility. From this perspective, AfC was seen to reward specialization rather than skill sharing, and had difficulty differentiating between and rewarding staff with broad generalist roles.

People with intellectual disabilities as bloggers: what's social capital got to do with it anyway?

The concept of social capital, the socially constructed category of intellectual disability and the social practice of blogging may appear initially to be unconnected. In this study we report on an attempt to link the three as we examine the consequences of giving a group of people with intellectual disability supported access to the Internet and specifically to that section of cyberspace known as the ;blogosphere'. Using the Social Capital Question Bank as a framework, we interrogate the data in an attempt to discover whether the qualities associated with successful inclusion within society might be available via the blogging community. Along the way we touch on issues related to policy, daily life and who or what counts as a friend.

Language, labels and diagnosis: an idiot's guide to learning disability.

The phrase 'learning disability' is just one in a long succession of descriptors applied to those people in our society who are categorized by a matrix of psycho-medical assessments, marginalized by compromised intellectual function, characterized by increased health needs and excluded from the mainstream on the basis of reduced social opportunity. But what exactly is 'learning disability'? Is there an empirical basis to the label, or is it just another example of bureaucratic language objectifying individuals in a process of medicalization? Historical examples will be used to illustrate the origins of the taxonomy that has subsequently formed the basis of the labelling process. The more recent words of individuals labelled with learning disability too will be introduced to offer some grounding to the debate. Any apparent problem belongs to language more than science. Narrative approaches to understanding are suggested as a useful alternative to traditional scientific inquiry.

Lights, camera, education! The potentials of forum theatre in a learning disability nursing program.

Learning disability nurse education, with a current emphasis on inclusive practice and a history of listening to the person with the disability, is well placed to take advantage of more 'experimental' forms of classroom teaching. In this article we argue for the use of forum theatre as a method of addressing topics from practice within an educational setting. Based on our emergent and exploratory work with students we detail at length the theoretical background that supports such an approach and contextualise the issues with reference to a short piece of drama we have used successfully with different student groups. We feel that the success of this method is due to the involvement of students in directing their own education as well as the inclusion of individuals labelled with learning disability as an integral part of the process.