Career advice

Mind your attitude

The Francis and Winterbourne View inquiries revealed significant concerns about nurses’ attitudes and behaviours towards vulnerable people.

Healthcare professionals are duty-bound to examine their attitudes towards people who have a learning disability

Picture credit: Neil O’Connor

While one would expect nurses to have positive attitudes towards patients, this is not always the case – particularly when patients have a learning disability.

Attitude is a complex construct that has fascinated researchers, particularly nurses, for years.

Attitudes are characterised by three dimensions:

Cognitive: what we think the object of our attitude is like

Affective: how we feel about the attitude entity

Behavioural: how we act or respond towards the attitude entity

The consequences of negative attitudes towards people with a learning disability are immeasurable. They undoubtedly contribute to deficits in care, as people with learning disabilities experience higher levels of ill health and their need to access mainstream services is higher than in the general population.

There is worrying evidence that people with a learning disability encounter negative attitudes when they present to hospital services for their care, which means that an already marginalised group can be further alienated.

There are several layers of action to be considered when providing care for people with a learning disability:

Nursing students, irrespective of discipline, should undertake a learning disability placement during their undergraduate programme. Increasing contact with people who have a learning disability is a key component in addressing the cognitive and affective components of attitudes. This ought to be complemented by a theoretical foundation on the causes of learning disability.

Organisations have a duty to provide meaningful education that modifies professionals’ attitudes towards people with a learning disability. Influencing the cognitive and affective components of attitudes can be achieved through teaching sessions, role modelling, involving individuals with learning disabilities themselves, and through exposure. Positive cognitive and affective components of attitudes are a good predictor of positive behaviour.

Health professionals have a responsibility to examine their own attitudes towards people with a learning disability. This can be achieved by reflecting on the 6Cs and the degree to which they measure up while asking: how do I think (cognitive), feel (affective) and act (behavioural) towards people with a learning disability?

Overall, there has been progress and there are examples of good practice in some health services, although unacceptable inequalities persist. The creation of liaison learning disability nursing posts in acute hospitals is welcomed but more attention should be paid to spreading good practice widely.

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