Comment

All nurses should be prepared to make reasonable adjustments for patients with learning disabilities

Paying attention to a hospital passport can make all the difference when caring for people with learning disabilities.
Hospital passport

Paying attention to a hospital passport can make all the difference when caring for people with learning disabilities

Why are we still failing to train all nurses how to meet the needs of people with a learning disability (LD) when they are receiving healthcare? As a practising LD nurse consultant Im still disappointed to hear horror stories of people with learning disabilities having poor experiences of healthcare.

Many service providers dutifully prepare hospital passports with straightforward explanations of how best to meet the needs of an individual when they are in a healthcare setting. They cover areas such as: how the person communicates, what individual support they need, such as information about their sensory needs, food issues,

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Paying attention to a hospital passport can make all the difference when caring for people with learning disabilities

Why are we still failing to train all nurses how to meet the needs of people with a learning disability (LD) when they are receiving healthcare? As a practising LD nurse consultant I’m still disappointed to hear horror stories of people with learning disabilities having poor experiences of healthcare.


An individualised passport can help people with learning disabilities cope with a hospital
visit – but only if healthcare professionals act on its recommendations.  Picture: Roy Mehta

Many service providers dutifully prepare hospital passports with straightforward explanations of how best to meet the needs of an individual when they are in a healthcare setting. They cover areas such as: how the person communicates, what individual support they need, such as information about their sensory needs, food issues, continence, pre-existing health conditions they have, and what causes them distress or anxiety.

The idea is that the person with a learning disability can take the passport into hospital or an outpatient appointment and those treating them can read it and make the necessary reasonable adjustments when providing care. The problem is that so often this does not happen

Avoiding anxiety triggers

In practice, sometimes passports are read and followed, but often they are seen as optional; something to read if time permits. They are not valued as an indispensable guide to how to get it right. If someone had a nut allergy it would not be acceptable to give them a few cashews. Why then might a healthcare worker think it’s okay to ask someone who is hypersensitive to noise to wait in a crowded waiting from for a prolonged period? 

It can make such a difference when things go right. I supported a patient who was having day surgery. They were able to delay arrival until just before their appointment by waiting in a nearby café, they were seen in a lounge – rather than a room filled with electrical equipment – by hospital staff in ‘normal’ clothes. This made a huge difference to the whole experience – and it was not that hard to organise.

It would seem that there is a fundamental problem. Many nurses still do not see people with a learning disability as part of their core patient group. Why is it that the longstanding stigma that is often attached to this client group will still not go away?

Online guide

The answer may lie in healthcare workers’ core training. Nurses should be trained to see people with a learning disability as part of their ‘normal’ patient group from the beginning of their training.

To help with this, the RCN learning disability nurse forum has developed an online and downloadable guide titled The Needs of People with Learning Disabilities, What Pre-Registration Students Should Know. It outlines ten key areas that all nurses need to know about how to care for someone with a learning disability and has links to key websites that can help.

 It covers: what a learning disability is, communication, capacity and consent, health issues that are more prevalent in this patient group, how to make reasonable adjustments, the causes of and how to cope with challenging behaviour, working in partnership with families, carers and other healthcare professionals, and what it is like to have a profound learning disability.

The guide not only explains these areas but also suggests the types of competencies students need to work with this client group effectively.

My hope is that all students read this guide and seek further advice if they need it – or seek out a learning disability to give them some extra support.


About the author

Simon Jones is chair of the RCN’s learning disability forum and nurse consultant with Lifeways Community Care Group, Moreton-in-Marsh, Gloucestershire

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