Our continuing professional development (CPD) articles are designed to assist with your nursing skills and practice.
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.
Keratoconus is a potentially sight-threatening condition in which the cornea distorts and becomes fragile, and without treatment can lead to severe visual impairment. The condition is much more common in people with Down’s syndrome and likely to be more common in people with other types of learning disability. Since the advent of a new treatment, corneal cross-linkage, which is only applicable in the early stages of the condition, early diagnosis has become imperative. However, people with learning disabilities are less likely to complain of poor vision and more likely to have poor vision and astigmatism which can mask early changes, so keratoconus can be missed. It is essential that those caring for and supporting people with a learning disability appreciate the risk of keratoconus and ensure that clients have regular and appropriate eye examinations from the age of ten years. When keratoconus is diagnosed it is important to discuss treatment options and for carers to understand the effects of the condition to minimise sight loss and maximise quality of life. Aims and intended learning outcomes This article describes the progressive eye condition keratoconus and its effect on sight and treatment. The aim of the article is to enable readers to better identify the risk to people with learning disabilities they are supporting, to recognise signs and symptoms of sight loss and to anticipate potentially beneficial treatment. After reading this article and completing the time outs you should be able to: • Describe keratoconus and its prevalence among the general population and people with learning disabilities. • Summarise the effects of the various stages of the condition on sight. • Outline the treatment options and the stages at which they are applicable. • Discuss the importance and challenges of early diagnosis. • Advise families and carers on the importance of regular and appropriate eye examinations. • Appreciate how to support young people undergoing examinations and treatment for keratoconus.
People with Down’s syndrome enjoy a longer life expectancy now than they ever have before, and are therefore at greater risk of developing conditions associated with ageing, including dementia. The evidence base for the effects of dementia on people with Down’s syndrome is much smaller than that for older people generally, which means that learning disability professionals do not always recognise the condition and do not know to talk about dementia with clients who already have cognitive impairments, poor short-term memory or altered communication. As this article describes, professionals must make baseline assessments from which they can monitor changes in people’s behaviours. This involves finding out about clients’ lives in the past and present so that professionals can understand their preferences, how they communicate and what adjustments may be required in the future based on their levels of understanding. In addition, staff in learning disability and older persons’ services need information and education about the care of people with Down’s syndrome and dementia to increase their own awareness, skills and confidence.
This article aims to give readers an overview of the Mental Capacity Act 2005 and its role in supporting the right to autonomy of people who, because of their disability, may unreasonably and unjustifiably be excluded from decisions with which they should and can be involved. The article also considers situations in which people need support in making decisions and how such support can be given. Finally, it outlines the principles to be followed when making a decision on behalf of a person who lacks capacity.
People who care for a family member who has learning disabilities face many of the same challenges as those in other family carer roles, but with distinct differences. Many people with learning disabilities depend on family support all their lives, regardless of where they live, or until the carer dies. This article explores the experiences, challenges and rewards of being a family carer, focusing in particular on what happens when the person with learning disabilities moves out of the family home. Recognising carers’ experience, expertise, involvement and what is important to them can have a positive impact on outcomes.
The role of the nurse is vital in the management of childhood epilepsy. Nurses play a key role in supporting the child and the family and ensuring that important relevant and accurate information is identified, recorded and reported to the team responsible for the medical management.
People with learning disabilities experience health inequalities and are at greater risk than the general population of developing problems associated with an unhealthy lifestyle. Obesity is also higher in this group as are the mortality and morbidity from related conditions. Lack of education, income and medical attention mean that people with learning disabilities are vulnerable to poor nutrition, inadequate physical activity and excessive weight gain. Appropriate training and support for health professionals are essential.