My job

How I make the emergency department less daunting for people with learning disabilities

Lauren Johnston describes her work in a pioneering nursing role

Lauren Johnston describes her work in a pioneering nursing role

Learning disability nurse Lauren Johnston

For patients with learning disabilities and/or autism, visiting a hospital’s emergency department (ED) can be an especially frightening experience. To address this issue, a Merseyside trust has become one of the first in the UK to introduce a new nursing post to support vulnerable patients when in the ED.

‘Our department is busy and noisy, and sometimes people wait several hours to be seen. That’s distressing for all of us, but especially for someone with additional needs who requires time to collect their thoughts and realise that people are there to help them,’ says Lauren Johnston, a newly qualified learning disability nurse working exclusively in the ED at the Royal Liverpool Hospital, part of Liverpool University Hospitals NHS Foundation Trust.

Making the emergency department a positive experience

Since taking up the new role in September, her goal has been to make the experience a positive one for patients and their carers. ‘I want to break down those barriers and make it more comfortable for these individuals,’ says Ms Johnston.

‘For those who are older and perhaps living in institutions, coming here is the worst thing they can imagine. I’d like to think I can help reduce some of those anxieties and change their opinion.’ 

I was determined to work in learning disability nursing

Ms Johnston completed her final placement at the hospital while studying learning disability nursing at Edge Hill University. ‘I always wanted to work with people who have learning disabilities, but I thought I wasn’t clever enough to become a nurse,’ she says.

‘I did some research into it and then thought, what have I got to lose by applying? It’s the best thing I could ever have done.’

Throughout her life, Ms Johnston has helped to care for Michael, who has Down’s syndrome. He first came to stay with her family for respite care when Ms Johnston’s mother was pregnant with her, and he has been holidaying with them every year since.

‘He’s been a large part of my life, influencing my decision to become a nurse,’ she says.

Being there to support vulnerable patients

Around a year ago, she attended another hospital’s ED with Michael when he needed treatment. ‘He has a huge fear of hospitals and anything clinical,’ says Ms Johnston. ‘But the experience he had was fantastic and we were in and out in just over an hour.

‘It made me realise how fortunate we are that he has people around him who are able to say what he needs. There are many patients with learning disabilities who don’t have anyone. Now I think if he were to come into hospital again, what kind of support would he need? I try to offer that for every single one of my patients.’

Ms Johnston works with people who are either recognised immediately as vulnerable, or who are spotted by staff who ask for her expert view. In some cases, she is identifying people for the first time.

‘With the cold weather, we’re getting a lot of people coming in who haven’t been known to the service before,’ she says.

Supporting people through their care journey

Alongside delivering awareness training to other staff members, Ms Johnston’s role involves providing information that is easy for patients to understand. She supports them through their care journey, including accompanying them for scans, and can move someone to a quieter area if they are finding the noise and bustle too much to bear.

‘It gives the staff reassurance because they can focus on someone’s physical health needs,’ she explains.

Improving the information that patients receive

Shaun Lever. Picture: David Gee

Spotting patients who may otherwise have got lost in the department’s fast turnover is among the key attributes of the role, says the Liverpool trust’s dementia and learning disabilities lead Shaun Lever.

‘When any of us go through the ED, there’s just a small window of opportunity to get things right,’ he says.

In contrast, getting it wrong can cause long-term difficulties: ‘If people have a bad experience, it can set up real barriers, especially for those who may need multiple visits. It can be hard to rebuild trust and confidence, and to alleviate all of their fears.

‘Now these patients get better information, with a specialist service looking after them, which reduces their risks.’

Award-winning service helps to attract patients to the trust

Earlier this year, Mr Lever’s team won the Learning Disability Nursing category of the RCNi Nurse Awards 2019, in recognition of the trust’s ‘standout service’. The organisation was praised for halving the average length of hospital stay, and producing training and information packs used by 12 trusts and primary care services in Cheshire and Merseyside.

Click here to enter or nominate a colleague for the RCNi Nurse Awards 2020

‘Patients and carers have an improved experience,’ says Mr Lever, ‘and we know we’re attracting more patients with learning disabilities to come here because they’re hearing good things about us.’ 

The nursing post has been such a success that discussions about a further specialist role are now taking place. ‘We’re talking about what it might look like from a dementia perspective,’ says Mr Lever. ‘The clinical benefits and business case are being put together, and hopefully we’ll be able to demonstrate how fantastic it can look.’

Lynne Pearce is a health journalist 

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