How nurses can apply spiritual care to improve the daily lives of people with learning disabilities and their families.

BACKGROUND: Most UK nursing research into spirituality overlooks its daily application in certain specialties, notably learning disability nursing. AIMS: Tz explore spirituality over the lifespans of people with learning disabilities and how spiritual care affects their quality of life. To provide practical examples for nurses on how to apply spiritual care in their daily practice. METHODS: A literature review conducted between January 2002 and July 2022) following recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Thomas and Harden's (2008) approach to thematic synthesis was used to structure 10 full-text articles into three key themes. FINDINGS: The three key themes were: the role of the nurse, the impacts on the individual, and family/carer perspectives. CONCLUSION: The nursing role in using spiritual care encompasses care planning an individual's spiritual activities, facilitating time alone, nurturing values such as self-acceptance, building therapeutic relationships, and advocating for progression in existing social structures and legislation.

Enabling patients with learning disabilities to self-manage lower limb lymphoedema.

Kathryn Taylor, Lymphoedema Clinical Nurse Specialist and Service Lead, Community Lymphoedema Service, Manchester Local Care Organisation (kathryn.taylor3@mft.nhs.uk), was runner-up in the Chronic Oedema Nurse of the Year category in the BJN Awards 2021.

Mediating the interface between voluntariness and coercion: A qualitative study of learning disability nurses' work in medical examinations of people with intellectual disability.

AIMS AND OBJECTIVES: To gain knowledge of prevention and use of restraints in provision of medical care to people with intellectual disability. To this end, we explore how learning disability nurses in community services support the individual through medical examinations when facing resistance. BACKGROUND: Despite increased focus on limiting restraints, there is a lack of knowledge of how restraints are prevented and used in the delivery of physical health care to people with intellectual disability. DESIGN: We used an ethnographic comparative case design (n = 6). METHODS: The study was carried out in Norway. The analysis is based on data from semi-structured interviews, participant observation and document studies, in addition to health sociological perspectives on how to support individuals to make their body available for medical examination and intervention. The SRQR checklist was used. RESULTS: Learning disability nurses strove to ensure that examinations were carried out on the individual's terms, supporting the individual in three phases: preparing for the examination, facilitating the examination and, when facing resistance, intervening to ensure safe and compassionate completion of the examination. CONCLUSIONS: Supporting the person was a precarious process where professionals had to balance considerations of voluntariness and coercion, progress and breakdown, safety and risk of injury, and dignity and violation. Through their support, learning disability nurses helped to constitute the "resistant" individual as "a cooperative patient," whose body could be examined within the knowledge and methods of medicine, but who could also be safeguarded as a human being through the strain of undergoing examination. RELEVANCE TO CLINICAL PRACTICE: The article sheds light on how restraints are used in the medical examination and treatment of people with intellectual disabilities and demonstrates the significance of professional support workers' contributions, both in facilitating safe and efficient medical care and in ensuring the least restrictive and most compassionate care possible.

Learning disability nurse provision in children's hospitals: hospital staff perceptions of whether it makes a difference.

BACKGROUND: In response to multiple United Kingdom investigations and inquiries into the care of adults with learning disabilities, Mencap produced the Getting it Right Charter which campaigned for the appointment of a Learning Disability Liaison Nurse in every hospital. More recent best practice guidelines from the Care Quality Commission included the need for all children's units to have access to a senior learning disability nurse who can support staff and help them manage difficult situations. However, little evidence exists of the extent of learning disability nurse provision in children's hospitals or the nature and impact of this role. Here we report selected findings from a national mixed methods study of hospital care for children and young people with and without learning disabilities in England. The extent of learning disability nurse provision in children's hospitals is described and perceptions of staff working in hospitals with and without such provision is compared. METHODS: Semi-structured interviews were conducted with senior staff across 15 children's hospitals and an anonymous survey was sent to clinical and non-clinical staff with patient (children and young people) contact within these hospitals. The survey focused on six different elements of care for those with and without learning disability, with additional questions concerning identifying and tracking those with learning disabilities and two open-ended questions. RESULTS: Forty-eight senior staff took part in interviews, which included a subset of nine nurses and one allied health professional employed in a dedicted learning disability nurse role, or similar. Surveys were completed by 1681, of whom 752 worked in a hospital with dedicated learning disability nurse provision. We found evidence of limited and varied learning disability nurse provision which was valued by hospital staff and shown to positively impact their perceptions of being capable to care for children and young people with learning disabilities, but not shown to increase staff perceptions of capacity or confidence, or how children and young people are valued within the hospital, their safety or access to appointments. CONCLUSION: Further consideration must be given to how learning disability nurse roles within children's hospitals are best operationalised in practice to have the greatest impact on staff and families, as well as how we monitor and evaluate them to ensure they are being utilised effectively and efficiently. TRIAL REGISTRATION: The study has been registered on the NIHR CRN portfolio 20,461 (Phase 1), 31,336 (Phases 2-4).

Development and implementation of the Steps to Successful Palliative Care programme in residential care homes for people with a learning disability.

BACKGROUND:: For health and social care services to meet the needs of a growing and ageing population they need to respond appropriately. This response is only going to be possible if attention is paid to the individuals within it. This includes those people living with a learning disability (LD). AIMS:: To develop and implement a palliative care programme that would meet the needs of people with a LD, their families and care home staff. METHODS:: A palliative care programme and resource folder was created following a literature review and meetings with LD and specialist palliative care experts, organisations and care home managers. This folder was further developed collaboratively throughout the programme's implementation. FINDINGS:: 39 homes were recruited and 86% completed the programme. CONCLUSIONS:: This programme enabled the identification, assessment and management of the health and social care needs of people living and dying in a care home with a LD.

Increasing participation of people with learning disabilities in bowel screening.

Learning disability nurses have a key role in addressing the health inequalities experienced by people with learning disabilities. People with learning disabilities are less likely to participate in bowel screening than other sectors of the population, despite there being evidence of this population being at an increased risk of developing bowel cancer. There are a range of barriers at individual and systemic levels that impact on participation in bowel screening by people with learning disabilities. Actions to address these barriers have been identified in the literature and learning disability nurses are a key agent of change in enabling people with learning disabilities to participate in the national screening programmes.

An Intervention Supporting the Mental Health of Children with a Refugee Background.

This contribution proposes an intervention methodology that provides improved access to and effectiveness of mental health care facilities in Brussels, Belgium, for children and their families with a refugee and migration background. Migration is a complex process that involves several potential risk factors, and referral to mental health facilities is often ineffective. Consequently, optimal developmental opportunities for refugee children are hampered. The intervention is underpinned by a broad-based contextual perspective that seeks to bring to the surface and tackles the many challenges faced by these families. It takes into account the unique developmental context of refugee children, as well as the interplay with broader systems.

Improving the care of children with learning disabilities in hospital.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses care delivery for children with learning disabilities or autism who require a hospital stay, prompted by the recent Lenehan report.

Making reasonable and achievable adjustments: the contributions of learning disability liaison nurses in 'Getting it right' for people with learning disabilities receiving general hospitals care.

AIMS: To examine the role of learning disability liaison nurses in facilitating reasonable and achievable adjustments to support access to general hospital services for people with learning disabilities. DESIGN: Mixed methods study involving four health boards in Scotland with established Learning Disability Liaison Nurses (LDLN) Services. Quantitative data of all liaison nursing referrals over 18 months and qualitative data collected from stakeholders with experience of using the liaison services within the previous 3-6 months. METHODS: Six liaison nurses collected quantitative data of 323 referrals and activity between September 2008-March 2010. Interviews and focus groups were held with 85 participants included adults with learning disabilities (n = 5), carers (n = 16), primary care (n = 39), general hospital (n = 19) and liaison nurses (n = 6). RESULTS/FINDINGS: Facilitating reasonable and achievable adjustments was an important element of the LDLNs' role and focussed on access to information; adjustments to care; appropriate environment of care; ensuring equitable care; identifying patient need; meeting patient needs; and specialist tools/resources. CONCLUSION: Ensuring that reasonable adjustments are made in the general hospital setting promotes person-centred care and equal health outcomes for people with a learning disability. This view accords with 'Getting it right' charter produced by the UK Charity Mencap which argues that healthcare professionals need support, encouragement and guidance to make reasonable adjustments for this group. LDLNs have an important and increasing role to play in advising on and establishing adjustments that are both reasonable and achievable.

A qualitative investigation into nurses' perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability service.

AIMS AND OBJECTIVES: The aim of the study was to examine learning disability nurses' perceptions of incidents involving physical intervention, particularly factors contributing to injuries sustained by this group. BACKGROUND: This article reports on a qualitative study undertaken within one secure NHS Trust to respond to concerns about staff injuries sustained during physical interventions to prevent incidents of service user violence from escalating out of control. The context of the study relates to increasing debate about the most effective approaches to incidents of violence and agression. DESIGN: A qualitative research design was utilized for the study. METHODS: Semi-structured interviews were undertaken with 20 participants, two from each of the 10 incidents involving staff injury sustained during physical intervention. RESULTS: Four themes were produced by the analysis, the first, knowledge and understanding, contextualized the other three, which related to the physical intervention techniques employed, the interpretation of the incident and the impact on staff. CONCLUSION: Service user violence consistently poses nurses with the challenge of balancing the need to respond in order to maintain the safety of everyone whilst simultaneous supporting and caring for people with complex needs. This study highlights the need for further exploration of the contributory factors to the escalation of potentially violent situations. RELEVANCE TO CLINICAL PRACTICE: Services may have good systems in place for responding to and managing service user violence but appear less effective in understanding the reasons for and developing strategies to prevent violence occurring.

Ethical challenges in everyday work with adults with learning disabilities.

BACKGROUND: Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake. RESEARCH QUESTION: What ethical challenges are discussed among healthcare providers working with adults with learning disabilities? RESEARCH DESIGN: The study had a qualitative and investigative design. PARTICIPANTS AND RESEARCH CONTEXT: The study was conducted in a community institution for adults with learning disabilities. Participants were healthcare providers joining regular focused group discussions. Two groups participated and each group consisted of six participants. The conversations were taped and transcribed. ETHICAL CONSIDERATIONS: The study was reported to Norwegian Social Science Data Services and was approved by the regional ethics committee. FINDINGS: Findings are presented in four themes: (a) feeling squeezed between conflicting actions, (b) being the client's spokesman, (c) searching shared responsibility, and (d) expecting immediate and fixed solutions. The healthcare providers wanted to be the clients' advocates. They felt obliged to speak up for the clients, however, seeking for someone with whom to share the heavily experienced responsibility. Data likewise revealed that the group discussions created expectations among the healthcare providers; they expected smart and final solutions to the problems they discussed. DISCUSSION: The discussion focuses on everyday ethical challenges, the meaning of being in-between and share responsibility, and the meaning of ethical sensitivity. CONCLUSION: Ethical challenges can be demanding for the staff; they might feel squeezed in-between contradictory attitudes or feel alone in decision-making. Frequent conversations about ethical challenges do not solve the ethical problems here-and-now, but they do visualize them. This also visualizes the staff's need for support.

'It's one of the hardest jobs in the world': the experience and understanding of qualified nurses who work with individuals diagnosed with both learning disability and personality disorder.

BACKGROUND: This study examines the experiences of qualified nurses working with individuals diagnosed with both intellectual disability and personality disorder (PD) in a medium-secure forensic intellectual disability setting. Potential training needs are highlighted, as well as other ways in which services could better support staff to work effectively with this client group. METHOD: In-depth, semi-structured interviews were used to explore the nine participants' experiences; the narratives were analysed with interpretative phenomenological analysis (IPA). RESULTS: Four master themes emerged from (i) disorder overriding disability; (ii) resilience; (iii) ambivalence towards label and (iv) knowledge. CONCLUSION: The findings highlight that for these participants, the clients' intellectual disability appeared to be lost under the complexity of the PD diagnosis. The clinical implications are discussed in terms of developing training, supervision and support.

Leadership and learning disability nursing.

Leadership is seen as critical for the transformation of learning disability services and has been further emphasised since the publication of Transforming Care, the Department of Health's response to the review of events at Winterbourne View. What is clear within learning disability nursing and services is the demand for leadership in the quest for improving the quality and effectiveness of services across health and social care. This article discusses the challenges for the undergraduate learning disability nurse with the recommendation to pursue a framework that promotes and focuses on integrating knowledge transfer into services for people with a learning disability. It explores practice change using the Promoting Action on Research Implementation in Health Services (PARiHS) framework, and the example of the involvement of service users in practitioner training on the Mental Capacity Act 2005 and consent and capacity to consent for treatment.

End-of-life training for paid carers working with people with learning disabilities.

People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted.

Show of support.

People with learning disabilities often find healthcare appointments difficult and stressful, and can miss out on preventive services and treatment. A team of nurses at Guy's and St Thomas' NHS Foundation Trust in London support people with learning disabilities to use community and hospital health services.

Nurse support in police stations could help reduce reoffending.

Specialist nurses could hold the key to helping offenders whose learning disabilities often go ignored by police and criminal courts, the RCN says.

Professional boundaries in learning disability care.

Healthcare staff providing care for people with a learning disability often deliver intimate personal care and have access to confidential information about vulnerable clients. Awareness of professional boundaries can help them to avoid either under- or over-involvement with patients and clients. Education and reflection can improve staff awareness of boundaries and help them reflect usefully on their relationships with clients.

Identifying parents with learning disabilities.

People with learning disabilities are likely to need additional support when accessing healthcare and, for those who are parents, receiving support at an early stage may help them to keep their child. Health professionals who have contact with expectant mothers early on in their pregnancies are well placed to identify support needs. Providing timely support may be a challenge, particularly if the mother has not been known to learning disability services. This article discusses whether screening tools may offer nurses a quick, easy way of identifying people with learning disabilities.

Service users' perceptions of student nurses.

BACKGROUND: A group consisting of a lecturer, staff nurses and mentors to student nurses on placement wanted to explore service users' perceptions of student nurses. AIM: To explore service users' perceptions of student nurses and their experience of being nursed by them. METHOD: This research involved a qualitative study of service users' perceptions of student nurses. It involved brief semi-structured interviews where the service users were asked about their experiences. A thematic analysis of their responses was undertaken. RESULTS: In many cases, perceptions of student nurses was positive and service users had fond recollections but some remembered students in a negative way. Many service users remembered student nurses coming and going but considered this to be neither good nor bad--they expressed indifference as they were accustomed to having health professionals change throughout their care pathway. CONCLUSION: This study focused on people with learning disabilities but the findings are likely to apply to all care settings, particularly those that are long stay, where the care environment becomes home. The findings give student nurses and other staff insight into service users' experiences.

What knowledge and attitudes do paid carers of people with a learning disability have about cancer?

The purpose of this study was to explore the knowledge and attitudes of paid carers of people with a learning disability regarding cancer. A questionnaire was utilised to gather information from carers involved in the social care of adults with learning disabilities within the independent sector. A total of 324 questionnaires were returned. Subjects were asked to provide words that they associated with cancer to provide data on their attitude to cancer. Knowledge-based questions examined their knowledge on the possibility of recovery from cancer, the likelihood of cancer (particularly in relation to people with learning disabilities), types of cancer, risk reduction and early signs and detection. Subjects were also asked for their views regarding the adequacy of their knowledge and training needs. The findings indicated that the carers had some knowledge regarding cancer, but strategies for preventing and detecting cancer with adults with learning disabilities were not clearly elucidated.