Evidence and Practice
This article describes a public engagement project on bereavement
Why you should read this article: • To understand the issues that some people with learning disabilities may experience when using easy-read materials • To be aware of the benefits of using various formats – including audio, video, computer programs and storytelling apps – to provide information to people with learning disabilities • To enhance your practice in the provision of accessible health information to people with learning disabilities Background Providing people who have learning disabilities with accessible information can encourage them to engage with their health and with healthcare services, thereby contributing to reduce the health inequalities they encounter. Aim To examine, with people with learning disabilities, different formats of accessible health information and explore with them which formats they found useful. Method Six focus group sessions were undertaken in which ten people with learning disabilities expressed their views on different formats of accessible health information, including easy-read materials, videos, computer programs and websites. The sessions were audio recorded and transcribed verbatim, and the data were analysed using grounded theory. An easy-read report was submitted to the group to validate the findings. Findings Participants felt valued when provided with information that acknowledged their learning disability and catered for their needs. When developing accessible information, it is important to consider the use of language, images, audio and video. Easy-read materials do not meet the needs of people with suboptimal reading skills, but technology can be used to address this issue. Conclusion The findings of this research project reflect previous research, existing guidance on accessible information and the researchers’ experience, emphasising that it is important to use clear, jargon-free language. Further research into the use of narrative in health information provision would be useful.
Why you should read this article • To familiarise yourself with the principles underpinning cognitive behavioural therapy (CBT) • To identify the role of CBT in treating psychological disorders experienced by people with intellectual disabilities • To understand the challenges of delivering CBT for people with intellectual disabilities Cognitive behavioural therapy (CBT) has become established as a method for treating psychological disorders experienced by the general population, with considerable evidence available to support its efficacy. However, little research has been conducted into its effectiveness in treating psychological disorders experienced by people with intellectual disabilities. This article explores the various factors involved in the use of CBT for people with intellectual disabilities and how healthcare professionals and the multidisciplinary team have an important role in the CBT process. The input of learning disability nurses is also explored, particularly their vital role in supporting CBT and providing information that is concurrent with an individual’s level of understanding. Challenges in the provision of CBT for this population are also examined, for example the prevalence of diagnostic overshadowing, which can make it difficult to distinguish between cognitive impairment and mental health issues in people with intellectual disabilities.
Transforming care: negotiating the complex discharge process
Why you should read this article • To understand how people with a learning disability may be at an increased risk of Helicobacter pylori infection • To increase your knowledge of actions you can take to reduce the risk of spread of H. pylori infection • To learn about how to improve staff knowledge of H. pylori infection, including signs and symptoms Background Helicobacter pylori is a bacterium that lives in the stomach’s gastric mucosa layer. H. pylori is a carcinogen that increases the risk of stomach and duodenum ulcers, gastro-oesophageal reflux disease and stomach cancer. Prevalence rates of H. pylori are higher in people with a learning disability than in the general population; however, despite the increased risk of H. pylori in people with a learning disability there is a lack of literature that applies specifically to this population and their families or carers. Aim To explore issues related to the diagnosis and treatment of H. pylori in people with a learning disability by examining the attitudes, beliefs, experiences and behaviours of staff working with people with a learning disability who are undergoing assessment and/or treatment for H. pylori. Another aim of this study was to understand the barriers to using preventive strategies, completing assessments and treating H. pylori in people with a learning disability. Method Focus groups were conducted with 16 staff members from two learning disability services. Before the focus groups, staff members were sent an information sheet with facts about H. pylori in people with a learning disability. Transcribed focus group discussions were analysed to identify themes. Results Staff reported issues with identifying accurate prevalence figures for H. pylori in people with a learning disability in their services due to the limited number of people who had undergone assessment. Identifying the signs and symptoms of H. pylori was also challenging for staff due to communication difficulties with people with a learning disability, or because the individual had minor symptoms or was asymptomatic. Other staff said that symptoms could be attributed to the side effects of medicines. Staff believed that people with a learning disability should be treated for H. pylori, given the associated risks of the bacterium, but that the lack of guidance on re-testing after treatment meant it was challenging to incorporate re-testing into care planning. Conclusion Little consideration has been given to the presence of H. pylori in people with a learning disability over the past decade, despite the fact it is an important health concern that can be identified and treated. Staff, carers and people with a learning disability should discuss with their GP having a blood, stool or breath test to check for H. pylori. Adding assessment for H. pylori to annual health checks will ensure screening becomes routine and may reduce complications or signs and symptoms, such as reflux and bloating.
People’s experiences can be improved by ensuring a smooth transition to inpatient care
Why you should read this article • Mental health concerns in people with intellectual disabilities can be difficult to identify due to various factors, including the person’s physical health, behaviour and cognition, and formal and informal carers’ skill deficits and attitudes • Knowledgeable and skilled health professionals must be present in the daily lives of people with an intellectual disability to identify and explore emerging mental health issues, make referrals, implement interventions and monitor outcomes • Registered intellectual disability nurses play a vital role in ensuring that the mental health of people with an intellectual disability is addressed and maximised Mental health concerns are prevalent in regard to those with intellectual disability. There are many reasons for this, some of which may relate to the causation of the person’s intellectual impairment. Other extraneous factors, such as the number of significant life events, may also result in compromised mental health. For many people, however, mental health problems may go untreated, which may relate to difficulties in diagnosis or in ascribing the signs and symptoms to other causes. With increasing numbers of people with an intellectual disability making use of regular community health services, and the reported unfavourable nature of such services, mental health problems may not be addressed. Registered intellectual disability nurses have a crucial role to play in ensuring that the mental health concerns of people with an intellectual disability are identified and addressed in an expeditious manner to achieve maximum well-being. This article explores such mental health concerns and, drawing on a brief case study, describes the role of nurses.
Asthma is a long-term condition that requires patient education, support and close monitoring. It is important that individuals are empowered and educated about their asthma and supported to self-manage as appropriate. Self-management is a goal that is recommended as an established and effective approach. However, it can be challenging for many individuals, including those with learning disabilities. Learning disability nurses can support individuals diagnosed with asthma to self-manage the condition and should have the knowledge, skills and competence to do so.
Care should be person-centred, holistic and underpinned by current evidence-based practice
The knowledge and skills required to manage patients with a PEG tube safely and effectively
Many adults with intellectual disabilities require nutritional support as feeding problems are prevalent in this population. While many types of nutritional support are available, enteral feeding tubes, such as nasogastric (NG) tubes, are considered safe and effective. NG tube feeding is a common clinical procedure carried out to maintain patients’ nutritional needs when they have swallowing difficulties or cannot tolerate oral feeding. Insertion of an NG tube provides adequate nutrition and improves positive health outcomes and quality of life, but being fed through an NG tube may alter patients’ perceptions of feeding and mealtimes. Healthcare professionals, including intellectual disability nurses, should not underestimate the social aspect of mealtimes or the physical and psychological effects of NG tube feeding in patients with intellectual disabilities. Demonstrating competence and compassion with regard to insertion and care of an NG tube and applying best practice to ensure patient safety and well-being are critical to supporting patients with intellectual disabilities.
Healthcare professionals who support people who require an inhaler or nebuliser need to know how to use the devices, monitor and assess patients’ inhaler techniques effectively. Often, people have inadequate inhaler techniques, which can lead to poor management of their respiratory condition, increased signs and symptoms, reduced quality of life and increased use of primary/secondary care services and treatment costs. This article explains how to use inhalers and nebulisers appropriately and considers some of the challenges for children and adults with a learning disability. It also describes some devices and assessment tools, and explores assessment/review methods to help ensure people use their inhalers/nebulisers successfully.