Discuss how a day in the life of a registered nurse (learning disability nurse) might be different today from 1980.
Historical Content of Learning Disability Nursing Role from 1980's
Learning disability (LD) can be understood as a lowered intellectual capacity and an increased challenge dealing with day to day activities like household work, socializing or finance management, and it affects the individual lifelong (Maki, Burns and Sullivan 2017). The UK National Careers Service describes Learning Disability Nursing as a career that promotes the wellbeing, health and independence of individuals living with learning disabilities, and to assist and support their families and careers. The Learning Disability Nurses helps in the providence of specialist healthcare and enables the individuals living with Learning Disability to live a meaningful and fulfilling life (Health Careers 2017). Studies have shown that children with learning disability are now living longer and having a fulfilling and better quality of life, and learning disability nursing have played a vital role in the improvement of their health and care (Nationalcareersservice.direct.gov.uk 2017). The main tasks involved in learning disability nursing are: improvement and maintenance of the physical and mental health; helping them to overcome the barriers to live life independently; providing support to live a fulfilling and meaningful life; helping them to acquire skills needed to find jobs.
The purpose of this essay is to understand how the job roles and responsibilities of a nurse working with learning disability have evolved over the years, to become a multidisciplinary approach. In this essay, the key elements leading to the change in the role of LD nurse will be identified, with respect to the nursing practice in the 1980’s. The essay will also identify key aspects, skills and responsibilities of the modern day LD nursing practice that ensures the providence of care to patients.
The Study of Healthy Study as a domain of nursing education started in 1976, and United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) becomes the regulatory body for nursing by 1983 (Nursing in the 1980s and 1990s--a challenge for managers. - PubMed - NCBI. 2017). The UKCC along with four national boards had the responsibility of setting up standards and guidelines for the education of the nurses and ensuring that the quality is maintained. During the same time, the first professional code of conduct for professional practice in healthcare and nursing was published that covered the ethical and practice standards that a practitioner is required to meet. The Griffiths report (1983), published by Roy Griffith during the same period recommended the replacement of the clinical managers in the NHS, by general management from independent sectors, and led to the introduction of performance indicators (Stephenson and Ford 2008).
Current Role of Learning Disability Nursing
During this time, the nurses were more involved in the general care of the patients, like taking care of the hygiene needs, and giving bed-baths, as well as being involved in taking care of the nutrition and hydration needs of the patient and specialist nursing roles did not evolve then. The Parkinson Report (1979) that was published in 1981 also recommended community care for patient suffering from mental health issues, and a move away of asylum based care. Mental health nursing in the 1980’s did not promote dignity, personalized care and wellbeing of the patients (Stephenson and Ford 2008). French (2017) points out that the nursing curriculum back then was not patient centered, and the training practices did not foster personal development in critical analysis, and self confidence in problem solving skills. Instead the general practices restricted specialized care for the patients, especially those with special needs, likes individuals with learning disabilities. Mental health issues during this time had two opposing views: biological view that considered mental health due to biological causes and considered physical treatment for these problems and psychological view that considered mental health problems due to psycho-social factors (Hashem 2017).
The nursing practice during the 1980’s was much more dependent on the primary healthcare service while liasoning activities similarly were also limited to family members and caregivers, and involved only some of the healthcare professionals, like physicians, or clinicians. Usage of computers and technology was also limited, and most of the information were collected and shared manually (Donabedian 1988; Malloch and Porter-O'Grady 2010).
Since the 1980’s a lot of increase in knowledge occurred in the fields of neurobiology, and healthcare for mental conditions. The nursing guidelines and code of conduct was aimed to ensure the provision of better care and equality to individuals with learning disabilities or other mental health conditions, providing a more personalized approach for treatment, than a generalized one.
The Seebohm Committee Report (1968) led to the set up of Social Services Department. As a result, training centers and hostels were made. A white paper titled “Better Services for the mentally handicapped” by the Department of health (1971) highlighted the importance of rehabilitation, while noting the deficiency in the service provided. It also recommended against overpopulation or over admittance in hospitals. In 1974 three bodies were formed: National Development Group (NDG) for assisting the policy development, National Development Team (NDT) for policy implementation and Enquiry Committee for mental handicap. By the next year, the idea of normalization theorized by Wolfensberger (1972) and the evaluation system proposed by him called Program Analysis of Service Systems (PASS) were implemented. Such policy changes allowed the diversification of LD nursing roles to include secondary care, rehabilitation and provide support to individuals with learning disabilities or other mental health conditions, instead of the job just ending after the patients step out of the hospital, and provide a comprehensive care for the patients.
Modern nursing practices for Learning Disability are based on the value of human dignity and consider the patient as a central part of the treatment, and require specific skill sets and qualifications to deal with and treat individuals with learning disability disorders (Arnold and Boggs 2015). The activities of the LD nurse can include liaisoning with staff from the hospitals in case of admittance or discharge; planning for activities, events, and day-offs; arranging for home visits or clinic appointments, and monitoring and sharing patient progress report with the doctors and care giver; arranging group activities on problem solving, stress and behavior management, and healthy lifestyle; providing support for other staff or caregivers. The nurses are also required to provide assistance to run tests and diagnosis for the patients, as well as document the observations and help to infer information from the tests. In addition, awareness of mental health issues, and its psychological effects can also be spread by the nurses, which can increase the understanding of the challenges of the mental health issues by the caregivers and family of the patient. LD nurse also needs to be able to identify the following attributes like complex emotional needs, dementia, long term conditions, legal rights and cultural sensitivities of the patients.
The nurse needs to operate within the legal parameters, access and responds to the requirements and inputs from the caregivers and family members of the patients. They should also be able to analyze the deficit in the current knowledge, thereby helping its improvement and updates, and using research based evidences in practice. Identifying own level of competence also allows working within the limitations, and thus prevents incompetent action.
The qualifications necessary to become an LD nurse in the UK are set by the Nursing and Midwifery Council (NMC) includes the completion of pre-registration program in nursing in NMC approved institution, with Pediatric, Mental Health, Adult Health, or Learning disability as one of the discipline of knowledge (Nmc.org.uk 2015).
The skills required to become an LD nurse can involve team work- This allows the nurse to work as a part of a bigger team, constituting of social welfare workers, primary healthcare professionals, support workers, caregivers and family members (Oldknow et al. 2014). Empathy is also necessary as this allows the nurse to fully comprehend the complex requirement of the patient, and form an emotional bonding, and trust with the individuals (Lovell and Bailey 2017). Compassion should exist in the nurses on a genuine level, to be able to fully understand their situation to help them properly (Hutchison et al. 2016). Adapting to those requirements allows a more personalized care being provided. Assertiveness is needed towards the treatment plans, can foster courage and help faster recovery. Excellent communication allows better interaction with the patient or with the care giving team. Proper sharing of information is essential for a coordinated plan being executed. Emotional Resilience allows dealing with setbacks or failures, and prevents de motivation or disappointments. Since the treatment plan is often lifelong, the nurse needs to be able to cope up with setbacks, and keep moving ahead, while learning from previous experiences (Lovell 2017). Patience can allow the nurse to follow the long drawn time table for treatment, and dealing with challenges of the job (Shwartz and Kramer 2017).
Care provided by LD nursing can include children, adolescents, adults, elderly, people with difficult emotional requirements, residential/ day care centers, rehabilitation centers, geriatric care, family care. The knowledge that a modern day learning disability nurse needs possess includes the nature of work and ethics related to nursing practice that guides the basic activities of patient care, and ensure maintenance of nursing standard. General and specialized knowledge of medicine also will allow the nurses to understand the actions of medications, and monitor/review medications prescribed for the patient. Additionally, an understanding of the bio-psycho-social factors of mental health and learning disabilities can help the nurse to realize the complex interplay between the social, psychological and biological components of mental health. Understanding of more basic sciences like physiology, anatomy, genetics, and neurology can be effective to equip the nurse with an enhanced understanding of how biological factors can affect psychological health. Such diversification of knowledge was not deemed necessary early in the 1980’s as the nurses then were responsible for the providence of generalized care for the patients.
Modern day LD nurses have the responsibility of providing a holistic care for the patients, encourage independency of the patients and provide them with appropriate treatment, therapy, and support. Education is also a big part of the work, helping on everyday activities, family education, mentoring support givers. This enables the care givers to be better equipped with knowledge to help the patients.
An LD nurse might work in schools, home, residence or community health centers. The work can be strenuous and tiring but equally rewarding. An LD nurse needs to deal with different service users each with specialist medical/ healthcare requirement. The special need can be due to the complex nature of their medical issue. The nurse can also act to facilitate the support of the service users from other healthcare professionals. Maintaining case logs also helps monitoring the progress of treatment, and determining immediate and future objectives. Arranging workshops allows the knowledge to be effectively transmitted to new professionals. Working as a mentor, an LD nurse can enable students to combine their theoretical knowledge with practical experience, and using them in practice. It includes finding of opportunities, critically discuss and reflect upon the knowledge gained, and identify any obstacles for training (Birks et al. 2016). The work comprises of domains like: professional values, skills in communication & interpersonal interaction, practice & decision making, and leadership, team work and management.
As Gates and Mafuba (2014), pointed out that Learning disability nursing needs to include the ability to assess the complex needs and be able to plan interventions (Townsend 2014). Knowledge about conditions like diabetes, challenging behavior and epilepsy, and understanding of palliative and geriatric care are important in supporting people in the learning disability spectrum. In the modern structure of Nursing for the learning disabled, the inclusion of disability nursing liaison services tended to improve communication and promoted holistic care for their patients (Castles et al. 2014). Majority of Learning Disability nurses are employed one of the following practice areas: Health facilitation (that supports mainstream access), specialist roles (in community team setups), and inpatient service (like assessment, secure service and treatment). The activities primarily undertaken in the fields of Health promotion (working with teams dealing with health promotion) (Eldredge 2016), Health facilitation (co-working with community healthcare professionals, primary caregiver team and secondary healthcare delivery teams (Hinkle 2014), Teaching (which allows a large number of staffs, social service workers, and workers of independent sector to be more familiar and comfortable with people who have learning disability and meet their health needs and Development of Service (contribute any knowledge on health issues to the planning process.
Routine Health Checks allows continued monitoring and assessment of treatment progress (Robertson et al. 2014). The procedure can involve the following steps: Inviting the patient for a health checkup, providing the required explanation, appointment time or time choice, and helping the setup of the appointment. Corresponding with the patient and doctors, keeping in mind the difficulties the patient face while learning, and ensuring that does not delay or prolong the process. It can mean the allotment of about three to four weeks for the arrangement of appointment slots. Ensuring that the patient is fully aware and consents the treatment plans, and the confidentiality of the information be made clear. If the consent is not given, discussion with the patient and the caregivers must also follow, to understand or identify any barriers in the treatment. Risks or consequence that might follow due to treatment not done also needs to be clarified to the patient. Approaches that are for the best interest of the patient must be advocated and acknowledged. Ensure routine health checks are done by healthcare professionals and obtaining any recommendations when necessary. Adding the information obtained by the health checkup into a database. Ensuring an action plan is implemented based on the information, after the health facilitator is identified. Health Action Plan (HAP) based on health check can be made, and include clear set actions and their agreed timescales. Integrating the report with the medical records, and involving support workers, family members of caregivers whenever appropriate. Ensuring the action plans are implemented by practicing recall systems, and sharing the results with patient/ caregivers.
An overview of the change in LD nursing practice since the 1980’s have shown a significant diversification of the role of the nurse in patient care. A significant development is marked by the departure of LD nursing practice from being a subsidiary of primary healthcare practice to a more specialized and comprehensive care for the patient and service users based on a patient or consumer centric approach. This has increased the involvement of the LD nurses in the healthcare outcomes that have shown significant improvement over the last two decades. The LD Nurses now have the capability to act as advocates for the individuals under their care, and act as social service workers, upholding their rights, dignity, and independance. Considering how learning disability severely affects the cognitive abilities of the individuals, the LD Nurses, acts as teachers for these individuals apart from being their advocates. Additionally, they also would liaison with other agencies and providers, to facilitate the healthcare for the individuals, ensuring minimum hassle for them. This has resulted in a much better quality of lives experienced by the individuals, and thus an overall better care. Improving the capacity of the individuals with Learning Disability through their life, to acquire skills to find jobs, improves their employability, and helps to reduce the burden of the disease (by enhancing in employability of the LD individuals).
The job literally transcends above just the provision of healthcare to the learning disabled, but allows their successful assimilation to the society, helping the affected individuals to be productive and self-realized/ self-actualized, and that these individuals are not discriminated or stigmatized or their vulnerabilities, not exploited. In effect, these roles enable the nurses to uphold some of the most integral values of humanity and ensuring both health and social care for the affected (Munn-Giddings and Winter 2013).
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