The application of Kitwood’s theory
Our clinical nursing articles aim to inform and educate nurse practitioners and students. This is achieved through the publication of peer-reviewed, evidence-based, relevant and topical articles.
Why you should read this article: • To enhance your understanding of the functional needs of people with complex physical impairments • To increase your awareness of challenges and the benefits of environmental control systems • To appreciate the role of occupational therapists in the assessment of people’s occupational functioning Environmental control systems (ECSs) are a form of assistive technology that can enable people with complex physical impairments to operate a range of appliances and devices by remote control, therefore enabling them to maintain a higher level of independence. The functional independence and improved communication abilities afforded by ECSs can, in turn, increase people’s confidence, self-esteem and feelings of self-worth.
Why you should read this article: • To understand the importance of writing for publication • To familiarise yourself with the role of peer review • To be aware of the differences between continuing professional development articles and research articles There is an expectation that nurses should use evidence to inform practice but having access to this evidence requires other nurses to write about and publish their work to generate a new evidence base. There is also an expectation that nurses should publish to improve knowledge, although for some the thought of writing can seem challenging. This article presents a reflection on the author’s experience of writing, from her first attempt at publishing through to becoming a published author, and then publishing continuing professional development articles. It provides insight into the work involved in becoming a published author.
Why you should read this article: • To understand the disparity in health between people with learning disabilities and the rest of the population • To familiarise yourself with the effects of health inequalities on people with learning disabilities • To enable you to improve your practice by developing relationships across health and social care to support people with learning disabilities The disparity in health between people with learning disabilities and the rest of the population is well established. Many of the health inequalities experienced by people with learning disabilities can be avoided through the provision of appropriate and timely assessment, diagnosis and treatment. Addressing health inequalities has become a focus for services in Scotland, and the Health Equalities Framework (HEF) is being used as a tool to record the effect of services in addressing these challenges. To explore how moving from a care home setting to other living arrangements affected the determinants of health inequalities for 19 people with learning disabilities. A total of 19 residents with learning disabilities at a care home in Scotland were required to find new accommodation as a result of their care home closing. The residents were moved into different types of accommodation. A HEF assessment was completed for all residents before the closure of the care home and a follow up HEF assessment was completed between 12 and 16 months after their move to new accommodation. Reductions in overall HEF scores were found following the move, along with significant reductions in the social and lifestyle determinants. To the authors’ knowledge, this is the first time that the HEF has been used in people with a learning disability to determine the effect of changing accommodation on exposure to determinants of health inequalities. After moving from a geographically isolated care home setting to other community-based care settings, the participants experienced a statistically significant reduction in the exposure to determinants of health inequalities in the social and lifestyle behaviour determinants of care.
Why you should read this article: • To enhance your awareness of the effects of stigma on children with a learning disability • To familiarise yourself with the concept of ‘double discrimination’ and how this can affect children with a learning disability • To understand whether therapeutic interventions can improve self-esteem in children with a learning disability Background Children with a learning disability can experience stigma in several ways, for example through abuse or barriers such as social rejection that limit their opportunities. The level of awareness of stigma can vary from person to person; however, those who perceive themselves to have a stigmatised identity have been found to have reduced aspirations and self-esteem. Research suggests that children with a learning disability have lower self-esteem than their typically developing peers. Aim To explore whether having more than one potentially stigmatising characteristic or attribute (‘double discrimination’) influences the self-esteem of children with a learning disability; and to understand whether therapeutic interventions could improve self-esteem. Method Data collected by teachers, including self-esteem scores for 20 children with a learning disability, were analysed to explore whether double discrimination was related to lower self-esteem, and whether receiving a therapeutic intervention in the form of input from a clinical psychologist, and/or participating in a gardening group, influenced self-esteem. Results The pilot study found that those children who experienced double discrimination had significantly lower self-esteem than those who did not. Those in the therapeutic intervention group had increased self-esteem scores compared with baseline, while the scores of those in the control group and who received normal schooling fell slightly, although the difference was not significant. Conclusion The results may assist nurses to develop interventions that improve the self-esteem of children with a learning disability.
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
Evaluating a functional assessment for people with an LD and behaviour that challenges