Lessons from a Learning Disability Nurse

By Colette McKeown, Learning Disability Nursing, Qualified LD Nurse within the NHS

1.5 million people in the UK have a learning disability. The need for LD nurses is huge as sadly in the UK there are still barriers to equal healthcare for people with learning disabilities. In this article, I will discuss my experiences in the field and the future of LD nursing, which I believe to be one of the most rewarding careers you can do.

My experience

I am a qualified learning disability nurse since 2017, after qualifying from Glasgow Caledonian University. Before university I had never even heard of LD nursing and only discovered it while going through the university prospectus for some inspiration. I think this is still the “forgotten” type of nursing and certainly throughout my time at university and after I am continuously faced with comments and questions about learning disability nursing and if it is “real” nursing. After I qualified and started working in the field, I found that most, if not all, of my colleagues have faced those questions time and time again. I am passionate about my job and advocating for people’s rights to ensure equal and fair access for all.

Owing to the range of skills that LD nurses develop, there are lots of career opportunities available with some working within prisons, community, hospitals and many other settings. Since I qualified my first job was in a care home and then I moved to the NHS to work in an assessment and treatment centre for people with learning disabilities. My current job is working with children with additional support needs in specialist schools. In my experience, I have observed a lack of understanding about learning disabilities within general hospitals and thus people not getting the care they need. This may come from a lack of teaching at a university level. Sheehan (2016) found that people with a learning disability were not getting the proper care in general hospitals, however, services including a learning disability liaison nurse had a better rate of success and treatment.

History of the profession

Learning disability nursing has changed and progressed quickly over the past few decades and I think it will continue to do so. Many of the old long stay institutions in the UK have now closed and society has begun to have a better understanding of the rights of people with learning disabilities. People with a learning disability are now actively encouraged and supported to stay in the community. There is now an emphasis on inclusion and choice, (Reid et al., 2020) however I am sure many would agree there is still a while to go for inclusion.

The Winterborne view scandal displayed the systematic issues and abuse that needed addressing. Death by indifference (2007) also examined cases where individuals with a learning disability died due to failings in the NHS, such as poor communication, delays in diagnosis and failure to recognize pain in individuals who were unable to communicate this.

The shift to community living has certainly come with challenges and there is still a necessity for assessment and treatment centers. The Transforming Care Programme, (NHS England, 2015) was devised with the aim of supporting people with a learning disability transitioning from hospitals into the community.

Skills of an LD nurse

Many would argue for the need for learning disability nurses as they learn and use a lot of different techniques and skills in the job and are the experts at working with individuals with the most complex of needs, both physical and mental. Learning disability nurses have patience like no other professional and their communication skills are one of the most important skills they bring to the role. LD nurses are skilled at handling challenging situations, diffusing high tensions, and communication where many of our patients are non-verbal

The lives of people with learning disabilities are now longer and of a higher quality than a few decades ago, however there is a long way to go. There continues to be discrimination and barriers to healthcare. Even though the role of the learning disability nurse may be changing, people with a learning disability remain at the heart of our jobs. We will continue to be their voice and advocate their rights.

The future of LD nursing

Colleagues and I have had discussions around this and where we see the future of our specialty going. Generally, we all agree that funding, or a lack thereof, will determine how our careers change. The push to community continues and we are seeing more core and cluster placements for people needing that extra support. Assessment and treatment centres will continue to be needed for those individuals who are struggling in the community. Recent media coverage has brought difficulties in these centres to the publics attention with many people campaigning to have them shut. The care quality commission (2020) released a report which examines the treatment of people with a learning disabilty in these centres. It found that there needs to be fundamental change in the treatment of patients. Restraint and seclusion techniques were used excessively due to a lack of training of staff. The questions remains then on how to properly support the most complex individuals in our society? Sadly there isn’t an answer to this. There is a lack of appropriate placements and a lot of individuals are inappropriately placed in hospitals. Problem solvers are essential on how to overcome this barrier. There remains the need for ongoing discussions around this. Devine (2019) found that a lack of housing and support has led to hundreds of people with learning disabilities remaining in hospital unnecessarily. A further point made by my colleagues was that there is certainly now a push for integrated care. University courses now focus more on general nursing for the whole first year before branching off. Some people think learning disability services may ultimately be assimilated into mental health services. Many would advocate against this as each individual with learning disabilities has unique and complex needs, requiring specialist services. In my own experience Learning Disability Nurses play an important role in advocating for the rights of people with learning disabilities. The profession currently faces a lot of challenges in ensuring people receive the right support and get the care they need. The future is uncertain and will largely depend on the funding given to support the most complex in our society however learning disability nurses along with other professionals will continue to work together to ensure equal rights for all.

Takeaway lessons

• Learning Disability Nursing is often a misunderstood branch of nursing and more training on learning disabilities with general staff would be beneficial.
• Funding for learning disabilities is essential to ensure people receive the most appropriate care and is the main struggle staff are currently faced with.

References

Darren Devine “Waiting to leave: why hundreds of adults are languishing in hospital unnecessarily”2019. Insight. Available from: https://www.insidehousing.co.uk/insight/insight/waiting-to-leave-why-hundreds-of-adults-are-languishing-in-hospital-unnecessarily-59964

Max Read. Transforming Care: supporting people with learning disabilities, autism and mental health issues to move out of long-stay hospitals. 2020. Learning Disability Practice. Available from doi: 10.7748/ldp.2020.e2064 https://journals.rcni.com/learning-disability-practice/evidence-and-practice/transforming-care-supporting-people-with-learning-disabilities-autism-and-mental-health-issues-to-move-out-of-longstay-hospitals-ldp.2020.e2064/print/abs

Rory Sheehan, Aarti Gandesha et al. An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Available from doi: https://bmjopen.bmj.com/content/6/4/e010480

Nick Bouras, Geraldine Holt. Mental health services for adults with learning disabilities. 2004. The British Journal of Psychiatry 184 (4), 291–292. Available from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/mental-health-services-for-adults-with-learning-disabilities/2FC44AC0E8760F30C17F6B5FBF045BF9

Dave Atkinson. Learning disability nursing: how to refocus the profession. Learning Disability Practice. Available from: https://journals.rcni.com/learning-disability-practice/learning-disability-nursing-how-to-refocus-the-profession-ldp2010.02.13.1.18.c7540

Mencap. Death by indifference. 2007. Mencap. Available from:

NHS England, Transforming care for people with learning disabilities, autism or both , 2015. Care Quality Commission et al. Available from: https://improvement.nhs.uk/resources/transforming-care-for-people-with-learning-disabilities/